View source for Medicine:Cognitive restructuring

{{Short description|Type of psychological therapy}}
{{Psychology sidebar}}

'''Cognitive restructuring''' ('''CR''') is a [[Medicine:Psychotherapy|psychotherapeutic]] process of learning to identify and dispute irrational or maladaptive thoughts known as [[Cognitive distortion|cognitive distortion]]s,<ref name="Gladding 2009">Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus: Pearson Education Inc., 2009.</ref> such as [[Philosophy:Splitting (psychology)|all-or-nothing thinking (splitting)]], [[Philosophy:Magical thinking|magical thinking]], overgeneralization, magnification,<ref name="Gladding 2009"/> and [[Philosophy:Emotional reasoning|emotional reasoning]], which are commonly associated with many [[Medicine:Mental disorder|mental health disorders]].<ref>{{cite journal |author=Ryan C. Martin |author2=Eric R. Dahlen |title=Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger |journal=Personality and Individual Differences |issue=November 2005 |pages=1249–1260 |doi=10.1016/j.paid.2005.06.004 |volume=39|year=2005 }}</ref> CR employs many strategies, such as [[Socratic questioning]], thought recording, and [[Guided imagery|guided imagery]], and is used in many types of therapies, including [[Medicine:Cognitive behavioral therapy|cognitive behavioral therapy]] (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.<ref>{{cite journal |author1=Cooper P.J. |author2=Steere J. | year = 1995 | title = A comparison of two psychological treatments for bulimia nervosa: Implications for models of maintenance | journal = Behaviour Research and Therapy | volume = 33 | issue = 8| pages = 875–885 | doi=10.1016/0005-7967(95)00033-t|pmid=7487847 }}</ref><ref>{{cite journal |author1=Harvey L. |author2=Inglis S.J. |author3=Espie C.A. | year = 2002 | title = Insomniacs' reported use of CBT components and relationship to long-term clinical outcome | journal = Behaviour Research and Therapy | volume = 40 |issue=1 | pages = 75–83 | doi=10.1016/s0005-7967(01)00004-3|pmid=11762429 }}</ref><ref name="Taylor S., Woody S., Koch W.J., McLean P., Paterson R.J., Anderson K.W. 1997 487–511">{{cite journal |author1=Taylor S. |author2=Woody S. |author3=Koch W.J. |author4=McLean P. |author5=Paterson R.J. |author6=Anderson K.W. | year = 1997 | title = Cognitive restructuring in the treatment of social phobia | journal = Behavior Modification | volume = 21 | issue = 4| pages = 487–511 | doi=10.1177/01454455970214006|pmid=9337603 }}</ref>

==Overview==
Cognitive restructuring involves four steps:<ref name="Hope, D.A. 2010">{{cite journal |author1=Hope D.A. |author2=Burns J.A. |author3=Hyes S.A. |author4=Herbert J.D. |author5=Warner M.D. | year = 2010 | title = Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder | url = https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1879&context=psychfacpub| journal = Cognitive Therapy Research | volume = 34 | pages = 1–12 |doi=10.1007/s10608-007-9147-9 }}</ref>
# Identification of problematic [[Cognition|cognition]]s 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<ref name="Gladding 2009"/> 
# Identification of the cognitive distortions in the ATs 
# Rational disputation of ATs with the Socratic method
# Development of a rational rebuttal to the ATs

There are six types of automatic thoughts:<ref name="Hope, D.A. 2010"/>
# Self-evaluated thoughts
# Thoughts about the evaluations of others
# Evaluative thoughts about the other person with whom they are interacting
# Thoughts about [[Social:Coping (psychology)|coping strategies]] and behavioral plans
# Thoughts of avoidance
# 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,<ref>{{cite journal |author1=Chronis A.M. |author2=Gamble S.A. |author3=Roberts J.E. |author4=Pelham W.E. | year = 2006 | title = Cognitive-behavioural depression treatment for mothers of children with attention-deficit/ hyperactivity disorder | journal = Behaviour Therapy | volume = 37 | issue = 2| pages = 143–158 | doi=10.1016/j.beth.2005.08.001|pmid=16942968 }}</ref> [[Medicine:Substance use disorder|substance abuse disorders]],<ref name="Gladding 2009"/><ref>{{cite journal |author1=Kanter J.W. |author2=Schildcrout J.S. |author3=Kohlenberg R.J. | year = 2005 | title = ''In vivo'' processes in cognitive therapy for depression:Frequency and benefits | journal = Psychotherapy Research | volume = 15 | issue = 4| pages = 366–373 | doi=10.1080/10503300500226316|citeseerx=10.1.1.560.1667 }}</ref> [[Medicine:Anxiety disorder|anxiety disorder]]s collectively,<ref>{{cite journal | author = Pull C.B. | year = 2007 | title = Combined pharmacotherapy and cognitive- behavioural therapy for anxiety disorders | journal = Current Opinion in Psychiatry | volume = 20 | issue = 1| pages = 30–35 | doi=10.1097/yco.0b013e3280115e52 | pmid=17143079}}</ref> bulimia,<ref>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.</ref><ref>{{cite journal |author1=Cooper M. |author2=Todd G. |author3=Turner H. |author4=Wells A. | year = 2007 | title = Cognitive therapy for bulimia nervosa: an A-B replication series | journal = Clinical Psychology and Psychotherapy | volume = 14 | issue = 5| pages = 402–411 | doi=10.1002/cpp.548}}</ref> [[Medicine:Social anxiety disorder|social phobia]],<ref name="Taylor S., Woody S., Koch W.J., McLean P., Paterson R.J., Anderson K.W. 1997 487–511"/><ref>{{cite journal |author1=Heimberg R. G. |author2=Dodge C. S. |author3=Hope D. A. |author4=Kennedy C. R. |author5=Zollo L. |author6=Becker R. E. | year = 1990 | title = Cognitive-behavioral group treatment for social phobia: Comparison to a credible placebo control | url =https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1900&context=psychfacpub | journal = Cognitive Therapy and Research | volume = 14 | pages = 1–23 | doi=10.1007/bf01173521}}</ref><ref>{{cite journal |author1=Heimberg R. G. |author2=Salzman D. G. |author3=Holt C. S. |author4=Blendell K. A. | year = 1993 | title = Cognitive behavioral group treatment for social phobia: Effectiveness at five-year follow-up | journal = Cognitive Therapy and Research | volume = 17 | issue = 4| pages = 325–339 | doi=10.1007/bf01177658}}</ref> [[Medicine:Borderline personality disorder|borderline personality disorder]],<ref>Linehan, M.M. (1993). Cognitive behavioural treatment of borderline personality disorder. Nueva York: Guilford Press.</ref> [[Medicine:Attention deficit hyperactivity disorder|attention deficit hyperactivity disorder]] (ADHD),<ref>{{cite journal |author1=Safren S. A. |author2=Otto M. W. |author3= Sprich S. |author4=Winett C. L. |author5=Wilens T. E. |author6=Biederman J. | year = 2005 | title = Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms | journal = Behaviour Research and Therapy | volume = 43 | issue = 7 | pages = 831–842 | doi=10.1016/j.brat.2004.07.001|pmid=15896281 }}</ref> and [[Medicine:Problem gambling|problem gambling]].<ref>{{cite journal |author1=Jimenez-Murcia S. |author2=Moya E. M. |author3=Granero R. |author4=Aymami M. N. |author5=Gomez-Pena M. |author6=Jaurrieta N. | year = 2007 | title = Cognitivebehavioral group treatment for pathological gambling: Analysis of effectiveness and predictors of therapy outcome | journal = Psychotherapy Research | volume = 17 | issue = 5| pages = 544–552 | doi=10.1080/10503300601158822|display-authors=0}}</ref>

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.<ref>Ellis, A., & Grieger, R. (1977). Handbook of rational emotive therapy. New York: Springer</ref><ref name="Frojan-Parga, M.X. 2009">{{cite journal |author1=Frojan-Parga M.X. |author2=Calero-Elvira A. |author3=Montano-Fidalgo M. | year = 2009 | title = Analysis of the therapist's verbal behavior during cognitive restructuring debates: a case study | journal = Psychotherapy Research | volume = 19 |issue=1 | pages = 30–41 | doi=10.1080/10503300802326046|pmid=18815947 }}</ref> 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. [[Medicine:Mood repair strategies|Mood repair strategies]] are implemented in cognitive restructuring in hopes of contributing to a cessation of the negative cycle.<ref name="Werner">Werner-Seidler, A., Moulds, M. L. "Mood repair and processing mode in depression". Oct 24, 2011. US: American Psychological Association.</ref>

When utilizing cognitive restructuring in cognitive behavioral therapy (CBT), it is combined with psychoeducation, monitoring, ''in vivo'' experience, imaginal exposure, behavioral activation, and [[Medicine:Homework in psychotherapy|homework assignments]] to achieve remission.<ref name="Huppert, J.D. 2009">{{cite journal | author = Huppert J.D. | year = 2009 | title = The building blocks of treatment in cognitive-behavioral therapy | journal = Israel Journal of Psychiatry Related Science | volume = 46 | pages = 245–250 | pmid = 20635770 }}</ref> The cognitive behavioral approach is said to consist of three core techniques: cognitive restructuring, training in coping skills, and problem solving.<ref name="Frojan-Parga, M.X. 2009"/>

==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, [[Philosophy:Jumping to conclusions|jumping to conclusions]], catastrophizing, emotional reasoning, should statements, and personalization."<ref name="Huppert, J.D. 2009"/> 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
*[[Medicine:Decatastrophizing|Decatastrophizing]]
*Reattribution
*Cognitive rehearsal
*Guided imagery
*Listing rational alternatives
*[[Social:Rational emotive behavior therapy|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<!--This section is linked from other articles: do not rename without including an anchor to previous name (MOS:HEAD)-->==
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.<ref>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.</ref> Other criticisms include that the approach is mechanistic and impersonal and that the relationship between therapist and client is irrelevant.{{citation needed|date=March 2015}} 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.<ref>{{Cite web|url=https://www.actmindfully.com.au/upimages/Neil_original_CT_component_analysis.pdf|title=A component analysis of CBT for depression|website=www.actmindfully.com.au}}</ref> Others also argue that it's not necessary to challenge thoughts with cognitive restructuring.<ref>{{Cite web|url=https://www.actmindfully.com.au/upimages/Do_we_need_to_challenge_thoughts_in_CBT.pdf|title=Do we need to challenge thoughts in CBT?|website=www.actmindfully.com.au}}</ref>

==See also==
* [[Cognitive science]]
* [[Philosophy:Cognitive psychology|Cognitive psychology]]

==References==
{{Reflist|2}}

== External links ==
* [http://www.thinkingmatters.us A free Thinking Matters Facilitator Manual]
* [https://web.archive.org/web/20100531193524/http://www.nicic.org/ National Institute of Corrections]
* [http://www.cognitivetherapynyc.com/pdf/heimberg2.pdf An Overview of Cognitive-behavioral Group Therapy for Social Phobia] {{Webarchive|url=https://web.archive.org/web/20210107183846/http://www.cognitivetherapynyc.com/pdf/heimberg2.pdf |date=2021-01-07 }}
* [https://web.archive.org/web/20061004113816/http://www.accilifeskills.com/cognitiverestructuring.php Cognitive Restructuring] - ACCI's list of erroneous beliefs of the criminal mind.
* [https://web.archive.org/web/20070428025734/http://www.psyskills.com/cogther01.htm Cognitive Restructuring Techniques] - as pioneered by Albert Ellis, Aaron Beck, and others.
* [http://www.psychologytools.org/download-therapy-worksheets.html Cognitive restructuring worksheets] - Tools that therapists use to help guide cognitive restructuring

{{Psychology}}
{{Psychotherapy}}
{{Cognitive behavioral therapy}}

[[Category:Cognitive therapy]]

{{Sourceattribution|Cognitive restructuring}}