Medicine:Cognitive restructuring

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Short description: Type of psychological therapy
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Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions,[1] such as all-or-nothing thinking (splitting), magical thinking, overgeneralization, magnification,[1] and emotional reasoning, which are commonly associated with many mental health disorders.[2] CR employs many strategies, such as Socratic questioning, thought recording, and guided imagery, and is used in many types of therapies, including cognitive behavioral therapy (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.[3][4][5]

Overview

Cognitive restructuring involves four steps:[6]

  1. Identification of problematic cognitions known as "automatic thoughts" (ATs) which are dysfunctional or negative views of the self, world, or future based upon already existing beliefs about oneself, the world, or the future[1]
  2. Identification of the cognitive distortions in the ATs
  3. Rational disputation of ATs with the Socratic method
  4. Development of a rational rebuttal to the ATs

There are six types of automatic thoughts:[6]

  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 plans
  5. Thoughts of avoidance
  6. Any other thoughts that were not categorized

Clinical applications

Cognitive restructuring has been used to help individuals experiencing a variety of psychiatric conditions, including depression,[7] substance abuse disorders,[1][8] anxiety disorders collectively,[9] bulimia,[10][11] social phobia,[5][12][13] borderline personality disorder,[14] attention deficit hyperactivity disorder (ADHD),[15] and problem gambling.[16]

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.[17][18] 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.[19]

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.[20] The cognitive behavioral approach is said to consist of three core techniques: cognitive restructuring, training in coping skills, and problem solving.[18]

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."[20] 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.[21] Other criticisms include that the approach is mechanistic and impersonal and that the relationship between therapist and client is irrelevant.[citation needed] 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.[22] Others also argue that it's not necessary to challenge thoughts with cognitive restructuring.[23]

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus: Pearson Education Inc., 2009.
  2. ↑ Ryan C. Martin; Eric R. Dahlen (2005). "Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger". Personality and Individual Differences 39 (November 2005): 1249–1260. doi:10.1016/j.paid.2005.06.004. 
  3. ↑ 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 (8): 875–885. doi:10.1016/0005-7967(95)00033-t. PMID 7487847. 
  4. ↑ 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 (1): 75–83. doi:10.1016/s0005-7967(01)00004-3. PMID 11762429. 
  5. ↑ 5.0 5.1 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 Modification 21 (4): 487–511. doi:10.1177/01454455970214006. PMID 9337603. 
  6. ↑ 6.0 6.1 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. doi:10.1007/s10608-007-9147-9. https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1879&context=psychfacpub. 
  7. ↑ Chronis A.M.; Gamble S.A.; Roberts J.E.; Pelham W.E. (2006). "Cognitive-behavioural depression treatment for mothers of children with attention-deficit/ hyperactivity disorder". Behaviour Therapy 37 (2): 143–158. doi:10.1016/j.beth.2005.08.001. PMID 16942968. 
  8. ↑ Kanter J.W.; Schildcrout J.S.; Kohlenberg R.J. (2005). "In vivo processes in cognitive therapy for depression:Frequency and benefits". Psychotherapy Research 15 (4): 366–373. doi:10.1080/10503300500226316. 
  9. ↑ Pull C.B. (2007). "Combined pharmacotherapy and cognitive- behavioural therapy for anxiety disorders". Current Opinion in Psychiatry 20 (1): 30–35. doi:10.1097/yco.0b013e3280115e52. PMID 17143079. 
  10. ↑ 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.
  11. ↑ Cooper M.; Todd G.; Turner H.; Wells A. (2007). "Cognitive therapy for bulimia nervosa: an A-B replication series". Clinical Psychology and Psychotherapy 14 (5): 402–411. doi:10.1002/cpp.548. 
  12. ↑ 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. doi:10.1007/bf01173521. https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1900&context=psychfacpub. 
  13. ↑ 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 (4): 325–339. doi:10.1007/bf01177658. 
  14. ↑ Linehan, M.M. (1993). Cognitive behavioural treatment of borderline personality disorder. Nueva York: Guilford Press.
  15. ↑ Safren S. A.; Otto M. W.; Sprich S.; Winett C. L.; Wilens T. E.; Biederman J. (2005). "Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms". Behaviour Research and Therapy 43 (7): 831–842. doi:10.1016/j.brat.2004.07.001. PMID 15896281. 
  16. ↑ Jimenez-Murcia S. et al. (2007). "Cognitivebehavioral group treatment for pathological gambling: Analysis of effectiveness and predictors of therapy outcome". Psychotherapy Research 17 (5): 544–552. doi:10.1080/10503300601158822. 
  17. ↑ Ellis, A., & Grieger, R. (1977). Handbook of rational emotive therapy. New York: Springer
  18. ↑ 18.0 18.1 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 (1): 30–41. doi:10.1080/10503300802326046. PMID 18815947. 
  19. ↑ Werner-Seidler, A., Moulds, M. L. "Mood repair and processing mode in depression". Oct 24, 2011. US: American Psychological Association.
  20. ↑ 20.0 20.1 Huppert J.D. (2009). "The building blocks of treatment in cognitive-behavioral therapy". Israel Journal of Psychiatry Related Science 46: 245–250. PMID 20635770. 
  21. ↑ 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.
  22. ↑ "A component analysis of CBT for depression". https://www.actmindfully.com.au/upimages/Neil_original_CT_component_analysis.pdf. 
  23. ↑ "Do we need to challenge thoughts in CBT?". https://www.actmindfully.com.au/upimages/Do_we_need_to_challenge_thoughts_in_CBT.pdf. 

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