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]



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:


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

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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.

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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.

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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.

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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.


  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 . 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).
  23. "Do we need to challenge thoughts in CBT?" (PDF).