Cognitive restructuring

Clinical applications

Cognitive restructuring has been used to help individuals experiencing a variety of psychiatric conditions, including depression, substance abuse disorders, anxiety disorders collectively, post-traumatic stress disorder, bulimia, social phobia, borderline personality disorder, attention deficit hyperactivity disorder (ADHD), and problem gambling.

When utilizing cognitive restructuring in rational emotive therapy (RET), the emphasis is on two 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 four types of irrational beliefs: dire necessity, feeling awful, cannot stand something, and self-condemnation. It is described as cognitive-emotional retraining. 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. Mood repair strategies are implemented in cognitive restructuring in hopes of contributing to a cessation of the negative 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. The cognitive behavioral approach is said to consist of three core techniques: cognitive restructuring, training in coping skills, and problem solving.

Applications within therapy

There are many methods used in cognitive restructuring, which usually involve identifying and labelling distorted thoughts, such as "all or none thinking, disqualifying the positive, mental filtering, jumping to conclusions, catastrophizing, emotional reasoning, should statements, and personalization." The following lists methods commonly used in cognitive restructuring:

• Socratic questioning
• Thought recording
• Identifying cognitive errors
• Examining the evidence (pro-con analysis or cost-benefits analysis)
• Understanding idiosyncratic meaning/semantic techniques
• Labeling distortions
• Decatastrophizing
• Reattribution
• Cognitive rehearsal
• Guided imagery
• Listing rational alternatives
• Rational emotive behavior therapy (REBT) includes awfulizing, when a person causes themselves disturbance by labelling an upcoming situation as 'awful', rather than envisaging how the situation may actually unfold, and Must-ing, when a person places a false demand on themselves that something 'must' happen (e.g. 'I must get an A in this exam'.)

Criticism

Critics of cognitive restructuring claim that the process of challenging dysfunctional thoughts will "teach clients to become better suppressors and avoiders of their unwanted thoughts" and that cognitive restructuring shows less immediate improvement because real-world practice is often required. Other criticisms include that the approach is mechanistic and impersonal and that the relationship between therapist and client is irrelevant. Neil Jacobson's component analysis of cognitive behavioural therapy (CBT), claims that the cognitive restructuring component is unnecessary, at least with depression. He argues that it is the behavioural activation components of CBT that are effective in giving therapy, not cognitive restructuring, as delivered by cognitive behavioural therapy. Others also argue that it's not necessary to challenge thoughts with cognitive restructuring.