Cognitive restructuring

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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, over-generalization, 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]

Contents

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:

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

Related Research Articles

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Originally, it was designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety, alcohol and drug use problems, marital problems, and eating disorders. CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Anxiety disorder Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety is a worry about future events, while fear is a reaction to current events. Anxiety may cause physical and cognitive symptoms such as restlessness, irritability, easy fatigability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and many others. In casual discourse the words "anxiety" and "fear" are often used interchangeably; in clinical usage, they have distinct meanings: "anxiety" is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas "fear" is an emotional and physiological response to a recognized external threat. The umbrella term "anxiety disorder" refers to a number of specific disorders that include fears (phobias) or anxiety symptoms.

Bulimia nervosa A type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging; and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives. Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise. Most people with bulimia are at a normal weight. The forcing of vomiting may result in thickened skin on the knuckles and breakdown of the teeth. Bulimia is frequently associated with other mental disorders such as depression, anxiety, and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm.

Aaron T. Beck American psychiatrist

Aaron Temkin Beck is an American psychiatrist who is professor emeritus in the department of psychiatry at the University of Pennsylvania. He is regarded as the father of both cognitive therapy and cognitive behavioral therapy. His pioneering theories are widely used in the treatment of clinical depression and various anxiety disorders. Beck also developed self-report measures of depression and anxiety, notably the Beck Depression Inventory (BDI) which became one of the most widely used instruments for measuring depression severity. In 1994, he and his daughter, psychologist Judith S. Beck, founded the nonprofit Beck Institute for Cognitive Behavior Therapy providing CBT treatment, training, and research. Beck currently serves as President Emeritus of the organization.

A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological states, such as depression and anxiety.

Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioral problems and disturbances and to help people to lead happier and more fulfilling lives.

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on learning theory, such as respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method but it has a wide range of techniques that can be used to treat a person's psychological problems.

The Dodo bird verdict is a controversial topic in psychotherapy, referring to the claim that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes. It is named after the Dodo character in Alice in Wonderland. The conjecture was introduced by Saul Rosenzweig in 1936, drawing on imagery from Lewis Carroll's novel Alice's Adventures in Wonderland, but only came into prominence with the emergence of new research evidence in the 1970s.

Acceptance and commitment therapy is a form of psychotherapy and a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing. Steven C. Hayes developed acceptance and commitment therapy in 1982 in order to create a mixed approach which integrates both covert conditioning and behavior therapy. There are a variety of protocols for ACT, depending on the target behavior or setting. For example, in behavioral health areas a brief version of ACT is called focused acceptance and commitment therapy (FACT).

Daniel David is a Romanian academic. He is "Aaron T. Beck" professor of Clinical Psychology and Psychotherapy at the Babeș-Bolyai University, Cluj-Napoca. He was the head of the Department of Clinical Psychology and Psychotherapy of the Babeş-Bolyai University between 2007 and 2012. Daniel David is also an adjunct professor at Icahn School of Medicine at Mount Sinai and is the head of the Research Program at Albert Ellis Institute in New York.

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working collaboratively with the therapist to develop skills for testing and modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A tailored cognitive case conceptualization is developed by the cognitive therapist as a roadmap to understand the individual's internal reality, select appropriate interventions and identify areas of distress.

Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

Gerhard Andersson Swedish psychologist (born 1966)

Gerhard Andersson is a Swedish psychologist, psychotherapist and Professor of clinical psychology at Linköping University. He was previously affiliated researcher at Karolinska Institutet. He was a co-recipient of the Nordic Medical Prize in 2014.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a “time-limited and focused approach” which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

Mike Abrams (psychologist)

Mike Abrams is an American psychologist and co-author with Albert Ellis of several works on rational emotive behavior therapy (REBT) and cognitive behavioral therapy (CBT). He is best known for extending CBT to include principles of evolutionary psychology and collaborating with the founder of CBT Albert Ellis to develop many new applications to for these clinical modalities. His new clinical method which applies evolutionary psychology and behavioral genetics to CBT is called Informed Cognitive Therapy (ICT).

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

Homework in psychotherapy is sometimes assigned to patients as part of their treatment. In this context, homework assignments are introduced to practice skills taught in therapy, encourage patients to apply the skills they learned in therapy to real life situations, and to improve on specific problems encountered in treatment. For example, a patient with deficits in social skills may learn and rehearse proper social skills in one treatment session, then be asked to complete homework assignments before the next session that apply those newly learned skills.

Michelle Craske

Michelle G. Craske is a Professor of Psychology, Psychiatry, and Behavioral Sciences, Miller Endowed Chair, Director of the Anxiety and Depression Research Center, and Associate Director of the Staglin Family Music Center for Behavioral and Brain Health at the University of California, Los Angeles. She is known for her research on anxiety disorders, including phobia and panic disorder, and the use of fear extinction through exposure therapy as treatment. Other research focuses on anxiety and depression in childhood and adolescence and the use of cognitive behavioral therapy as treatment. Craske served as the past president of the Association for Behavioral and Cognitive Therapy. She was a member of the DSM-IV work group on Anxiety Disorders and the DSM-5 work group on Anxiety, Obsessive Compulsive Spectrum, Posttraumatic, and Dissociative Disorders, while chairing the sub-work group on Anxiety Disorders. She is the editor-in-chief of Behaviour Research and Therapy.

References

  1. 1 2 3 4 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.
  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: 75–83. doi:10.1016/s0005-7967(01)00004-3.
  5. 1 2 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.
  6. 1 2 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.
  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. CiteSeerX   10.1.1.560.1667 . 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.
  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.
  16. Jimenez-Murcia S.; Moya E. M.; Granero R.; Aymami M. N.; Gomez-Pena M.; Jaurrieta N.; 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. 1 2 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. doi:10.1080/10503300802326046.
  19. Werner-Seidler, A., Moulds, M. L. "Mood repair and processing mode in depression". Oct 24, 2011. US: American Psychological Association.
  20. 1 2 Huppert J.D. (2009). "The building blocks of treatment in cognitive-behavioral therapy". Israel Journal of Psychiatry Related Science. 46: 245–250.
  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" (PDF). www.actmindfully.com.au.
  23. "Do we need to challenge thoughts in CBT?" (PDF). www.actmindfully.com.au.