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Cognitive Restructuring

At the core of the cognitive model is the assumption that a patient’s appraisals of an event determine their feelings and reactions to it. Cognitive restructuring is an umbrella term that refers to any methods that help people to think differently about an event (which might include any stimulus, thought, memory, or belief). In a broad sense the term ‘cognitive restructuring’ could apply to anything done in (or outside of) a therapy session that promotes cognitive change. In a narrower sense, therapists deliberately use a range of therapeutic approaches designed to promote cognitive restructuring. Leahy and Rego (2012) give a narrow definition of cognitive restructuring as:

“a multistep process that involves: (1) eliciting problematic cognitions known as automatic thoughts or negative automatic thoughts of the self, world, or future, (2) formulating rational responses to these negative automatic thoughts by (3) identifying and removing cognitive distortions found in the automatic thoughts and (4) correcting false beliefs, assumptions, predictions and so on, using a Socratic dialogue.”

Behavioral experiments (including hypothesis testing and surveys) have been a fundamental CBT technique since the publication of the first treatment manual: “a powerful method with which to investigate the validity of a specific assumption consists of designing an experiment or task to test the assumption empirically” (Beck et al., 1979). Bennett-Levy et al. (2004) define behavioral experiments as:

“planned experiential activities, based on experimentation or observation, which are undertaken by patients in or between cognitive therapy sessions … their primary purpose is to obtain new information which may help to: test the validity of the patients’ existing beliefs …; construct and/or test new, more adaptive beliefs; contribute to the development and verification of the cognitive formulation.”

Examining and reality-testing automatic thoughts and images, popularly known as ‘thought challenging’ or ‘disputing thoughts’ is a technique by which patients are encouraged to examine the accuracy of and validity of their negative automatic thoughts and images.
Psychoeducation in therapy refers to information-giving. Many patients experience psychological distress because they lack critical information. Information can be given directly in the form of handouts or reading, or indirectly in the form of information-gathering exercises.
Socratic dialogue is “a method of guided discovery in which the therapist asks a series of carefully sequenced questions to help define problems, assist in the identification of thoughts and beliefs, examine the meaning of events, or assess the ramifications of particular thoughts or behaviors” (Beck & Dozois, 2011). The Socratic method can help patients to reflect upon how they think and the assumptions they make, and can promote cognitive change.

References

Beck, A. T., & Dozois, D. J. (2011). Cognitive therapy: Current status and future directions. Annual Review of Medicine, 62, 397–409.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (2004). Oxford guide to behaviouralexperiments in cognitive therapy. New York: Oxford University Press.

Leahy, R. L., & Rego, S. A. (2012). Cognitive restructuring. In W. T. O’Donohue & J. E. Fisher (Eds.), Cognitive behavior therapy: Core principles for practice(pp. 113–158). Hoboken, NJ: Wiley.

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Case formulation – Case conceptualization can promote cognitive restructuring by helping clients to think about their difficulties from a different perspective. For example, some clients find the process of formulation can instill hope by making potential solutions apparent
Psychoeducation – Learning more about a condition, disorder, or process almost by definition promotes cognitive restructuring. For example, learning about typical automatic reactions in trauma (e.g.freezing, soiling) can reduce a sense of self-blame and associated shame
Traditional CBT thought records – Thought records help clients to identify Negative Automatic Thoughts, then to identify any unhelpful thinking styles, then to generate alternative (cognitively restructured) ways of thinking
Behavioral experiments – Behavioral experiements can help clients to experimentally test the validity of beliefs which may or may not be unhelpful. They can promote cognitive restructuring by helping clients to uncover evidence which contradicts previously held beliefs
Socratic questioning – Guided discovery is used to explore a client’s beliefs. This can promote cognitive restructuring by making explicit belief structures, rules, and assumptions of which a client may have been unaware
Diaries – Diaries or other forms of evidence gathering can generate concrete evidence. This can promote cognitive restructuring by undermine unhelpful assumptions

Intervention

Definition of cognitive restructuring download
Schema change processes in cognitive therapy download archived copy
Modification of core beliefs in cognitive therapy (book chapter) download archived copy
Identifying and challenging thinking errors download archived copy
Identifying and modifying negative automatic thoughts download archived copy
Identifying and working with dysfunctional assumptions download archived copy

Cognitive Restructuring

Techniques for Cognitive Restructuring

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