Cognitive restructuring

Cognitive restructuring, sometimes used synonymously with Debating^[1], is the process of learning to identify irrational or maladaptive thoughts and challenge their veracity using strategies such as logical disputation^[2].

Another more simple definition of cognitive restructuring is the procedure for modifying erroneous, self-imposed roles ^[3].

Various types of therapy utilize the process of cognitive restructuring, such as Cognitive Behavioral Therapy (CBT) and Rational Emotive Therapy (RET). CBT consists of the general technique of cognitive restructuring and a core procedure of the Socratic Method. ^[4]. A number of studies demonstrate considerable efficacy in using CR-based therapies ^{[5] [6] [7]}. A number of cognitive restructuring-based handbooks have also been published ^[8].

Cognitive restructuring involves 4 steps^[9]:

• (1) Identification of problematic cognitions known as “Automatic Thoughts” (ATs) which are dysfunctional or negative view of the self, world, or future
• (2) identification of the cognitive distortions in the ATs
• (3) rational disputation of ATs with Socratic dialogue, and
• (4) development of a rational rebuttal to the ATs.

There are 6 types of automatic thoughts: (1) self-evaluated thoughts, (2) thoughts about the evaluations of others, (3) evaluative thoughts about the other person with whom they are interacting, (4) thoughts about coping strategies and behavioral plan, (5) thoughts of avoidance, and (6) any other thoughts that were not categorized. ^[10]

By completing the process of cognitive restructuring, an individual can better:

• Gain awareness of detrimental thought habits
• Learn to challenge them
• Substitute life-enhancing thoughts and beliefs

Clinical applications

The process of cognitive restructuring has been utilized in different types of therapy, such as CBT, to help individuals experiencing a variety of psychiatric conditions. These include Depression ^[11], Anxiety disorders collectively ^[12], Bulemia ^{[13] [14]}, Social Phobia ^{[15] [16] [17]}, Borderline Personality Disorder ^[18], Attention Deficit Hyperactivity Disorder (ADHD) ^[19], and Gambling ^[20], just to name a few.

When utilizing cognitive restructuring in Rational Emotive Therapy (RET), the emphasis is on 2 central notions: (1) thoughts affect human emotion as well as behavior and (2) irrational beliefs are mainly responsible for a wide range of disorders. RET also classifies 4 types of irrational beliefs: dire necessity, feeling awful, cannot stand something, and self-condemnation. It is described as cognitive-emotional retraining. ^{[21] [22]}. The rationale used in cognitive restructuring attempts to strengthen the client's belief that 1) 'self-talk' can influence performance, and 2) in particular self-defeating thoughts or negative self-statements can cause emotional distress and interfere with performance, a process that then repeats again in a cycle.

When utilizing cognitive restructuring in Cognitive Behavioral Therapy (CBT), it is combined with psychoeducation, monitoring, in vivo experience, imaginal exposure, behavioral activation and homework assignments to achieve remission ^[23]. The Cognitive behavioral approach is said to consist of 3 core techniques. These are cognitive restructuring, training in coping skills, and problem solving ^[24].

Cognitive Defusion vs Cognitive Restructuring

Contrasting to cognitive restructuring, Cognitive Defusion (used in acceptance and commitment therapy(ACT)) attempts to change the function of negative thoughts rather than change their content (as seen in cognitive restructuring). A common technique that uses cognitive defusion is the “milk exercise” in which the person rapidly repeats a self-referential thought (such as “fat”) in hope of reducing the discomfort associated with it ^[25]. Critics of cognitive restructuring accuse the process of challenging dysfunctional thoughts like getting patients to “master” and “control” their thoughts. They feel as though cognitive restructuring aims to “teach clients to become better suppressors and avoiders of their unwanted thoughts”, leaving them vulnerable to potentially experiencing negative emotions. They feel that cognitive defusion is dominant over cognitive restructuring since CD works by changing the functions of thoughts (by helping patients adopt a new relationship to them) rather than directly changing the content of negative thoughts in CR^[26]. The positive results achieved through cognitive defusion sessions are immediate. Cognitive restructuring shows less immediate improvement since real-world practice is often required to master the skills of cognitive defusion. However, the results are similar after a week of homework ^[27].

Learning & cognitive restructuring

Some researchers suggest that operant conditioning and classical conditioning are involved at the core of making changes in cognition observed in cognitive restructuring and the Socratic Method ^{[28] [29]}.

Applications within therapy

The following short excerpt from Huppert, J.D. (2009), concerning a therapists view on how cognitive restructuring is incorporated into some common issues encountered within CBT.

“In some forms of CBT, cognitive restructuring is the most essential and theoretically the main mechanism of change. The general principle behind cognitive restructuring is examining a specific incident and the thoughts that occurred during that incident (sometimes elicited by the thought record). The patient is asked to recall in detail the context of the situation that led to an intensification of his or her emotional experience (e.g., “I felt depressed and anxious when I went to school”). This is to facilitate elicitation of “hot” cognitions: thoughts that are emotionally laden. Then, the patient is asked to describe what thoughts came to mind within that context (e.g., “I thought I will never pass the exam”). The thoughts are then evaluated for their basis in logic and reality, with the goal of helping the patient reevaluate distorted thoughts in a way that is more accurate, and likely to decrease the negative emotional reaction that they had within the situation (e.g., “How many times have you failed before? What is the worst thing that would happen if you failed?” leading to answers like “Well, I got an 80 once when I was sick,” with the therapist then asking, “So what is the likelihood that you will get a 60?” and the patient saying, “Yeah, I guess I exaggerate a lot when I feel bad. I really will do ok on the exam”). There are a number of variations of how cognitive restructuring is done. The most traditional method with Beckian CBT is via the thought record (also used for monitoring described above, but with a greater emphasis on the thoughts and evaluations of the thoughts). In some forms of CBT, part of the evaluation process is labeling the type of cognitive distortion that characterizes the specific thought such as all or none thinking, dis¬qualifying the positive, mental filtering, jumping to conclusions, catastrophizing, emotional reasoning, should statements, and personalization. ^[30]”

Sources

• A free Thinking Matters Facilitator Manual
• National Institute of Corrections
• An Overview of Cognitive-behavioral Group Therapy for Social Phobia
• Cognitive Restructuring - ACCI's list of erroneous beliefs of the criminal mind.
• Cognitive Restructuring Techniques - as pioneered by Albert Ellis, Aaron Beck, and others.
• Cognitive restructuring worksheets - Tools that therapists use to help guide cognitive restructuring

References

1. ^ Frojan-Parga, M.X., Calero-Elvira, A. & Montano-Fidalgo, M. (2009). Analysis of the therapist’s verbal behavior during cognitive restructuring debates: a case study. Psychotherapy Research, 19: 30-41.
2. ^ Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28(1), 1–16.
3. ^ Martin, G., & Pear, J. (2007). Behavior modification: What it is and how to do it. Hillsdale, NJ: Prentice Hall.
4. ^ Frojan-Parga, M.X., Calero-Elvira, A. & Montano-Fidalgo, M. (2011). Study of the socratic method during cognitive restructuring. Clinical psychology and psychotherapy, 18: 110-123.
5. ^ Cooper, P.J., & Steere, J. (1995). A comparison of two psychological treatments for bulimia nervosa: Implications for models of maintenance. Behaviour Research and Therapy, 33, 875–885.
6. ^ Harvey, L., Inglis, S.J., & Espie, C.A. (2002). Insomniacs’ reported use of CBT components and relationship to long-term clinical outcome. Behaviour Research and Therapy, 40, 75–83.
7. ^ Taylor, S., Woody, S., Koch, W.J., McLean, P., Paterson, R.J., & Anderson, K.W. (1997). Cognitive restructuring in the treatment of social phobia. Behavior Modifi cation, 21, 487–511.
8. ^ Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979).Cognitive therapy of depression: A treatment manual. New York: Guilford Press.
9. ^ Hope, D.A., Burns, J.A., Hyes, S.A., Herbert, J.D. & Warner, M.D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy Research, 34: 1-12.
10. ^ Hope, D.A., Burns, J.A., Hyes, S.A., Herbert, J.D. & Warner, M.D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy Research, 34: 1-12.
11. ^ Kanter, J.W., Schildcrout, J.S., & Kohlenberg, R.J. (2005). In vivo processes in cognitive therapy for depression:Frequency and benefi ts. Psychotherapy Research, 15, 366–373.
12. ^ Pull, C.B. (2007). Combined pharmacotherapy and cognitive- behavioural therapy for anxiety disorders. Current Opinion in Psychiatry, 20, 30–35.
13. ^ Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment (pp. 361–404). New York: Guilford Press.
14. ^ Cooper, M., Todd, G., Turner, H., & Wells, A. (2007). Cognitive therapy for bulimia nervosa: an A-B replication series. Clinical Psychology and Psychotherapy, 14, 402–411.
15. ^ Taylor, S., Woody, S., Koch, W.J., McLean, P., Paterson, R.J., & Anderson, K.W. (1997). Cognitive restructuring in the treatment of social phobia. Behavior Modifi cation, 21, 487–511.
16. ^ Heimberg, R. G., Dodge, C. S., Hope, D. A., Kennedy, C. R., Zollo, L., & Becker, R. E. (1990). Cognitive-behavioral group treatment for social phobia: Comparison to a credible placebo control. Cognitive Therapy and Research, 14, 1–23.
17. ^ Heimberg, R. G., Salzman, D. G., Holt, C. S., Blendell, K. A. (1993). Cognitive behavioral group treatment for social phobia: Effectiveness at five-year follow-up. Cognitive Therapy and Research, 17, 325–339.
18. ^ Linehan, M.M. (1993). Cognitive behavioural treatment of borderline personality disorder. Nueva York: Guilford Press.
19. ^ Chronis, A.M., Gamble, S.A., Roberts, J.E., & Pelham, W.E. (2006). Cognitive-behavioural depression treatment for mothers of children with attention-defi cit/ hyperactivity disorder. Behaviour Therapy, 37, 143–158.
20. ^ Jime´nez-Murcia, S., .A´ lvarez-Moya, E. M., Granero, R., Aymami, M. N., Go´mez-Pen˜ a, M., Jaurrieta, N., et al. (2007). Cognitivebehavioral group treatment for pathological gambling: Analysis of effectiveness and predictors of therapy outcome. Psychotherapy Research, 17, 544_552.
21. ^ Ellis, A., & Grieger, R. (1977). Handbook of rational emotive therapy. New York: Springer
22. ^ Frojan-Parga, M.X., Calero-Elvira, A. & Montano-Fidalgo, M. (2009). Analysis of the therapist’s verbal behavior during cognitive restructuring debates: a case study. Psychotherapy Research, 19: 30-41.
23. ^ Huppert, J.D. (2009). The building blocks of treatment in cognitive-behavioral therapy. Isreal Journal of Psychiatry Related Science, 46: 245-250.
24. ^ Frojan-Parga, M.X., Calero-Elvira, A. & Montano-Fidalgo, M. (2009). Analysis of the therapist’s verbal behavior during cognitive restructuring debates: a case study. Psychotherapy Research, 19: 30-41.
25. ^ Deacon, B.J., Fawzy, T.I., Lickel, J.J. & Wolitzky-Taylor, K.B. (2011). Cognitive defusion versus cognitive restructuring in the treatment of negative self-referential thoughts: an investigation of process and outcome. Journal of cognitive psychotherapy: an international quarterly, 25: 218-228.
26. ^ Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger.
27. ^ Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger.
28. ^ Staats, A. W. (1967). Learning, language and cognition. New York: Holt, Rinehart & Winston.
29. ^ Skinner, B. F. (1957). Verbal behavior. New York: Appleton- Century-Crofts.
30. ^ Huppert, J.D. (2009). The building blocks of treatment in cognitive-behavioral therapy. Isreal Journal of Psychiatry Related Science, 46: 245-250.

See also

• Cognition
• Cognitive science
• Cognitive psychology
• Philosophy of mind
• Thought