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What is cognitive restructuring?

Posted By Anthony Komaroff, M.D. On February 24, 2016 @ In Anxiety and Depression,Mental Health | Comments Disabled

DEAR DOCTOR K:

In your column you’ve mentioned something called cognitive restructuring. Can you explain this in more detail?

DEAR READER:

Cognitive restructuring is one part of cognitive behavioral therapy (CBT), a type of “talk therapy” that attempts to correct ingrained patterns of negative thoughts and behaviors. CBT is the leading therapy for anxiety. It is also used to treat stress, depression, eating disorders and many other problems.

Cognitive restructuring can help you change the way you think. That, in turn, can help change the way you feel. To better understand how it works, try to remember your thoughts the last time you were late for work. Perhaps your first thought was simply “The train is late.” But then that quickly transformed into “I’ll be late to work. I won’t make it to my meeting on time. My job is in jeopardy.”

This is an example of negative automatic thinking. Scenarios like this can activate the stress response almost as easily as a growling Doberman pinscher starting to run toward you.

Often our negative thoughts are riddled with irrational distortions. For example, you may have an “all or nothing” attitude. If you don’t perform flawlessly, you consider yourself a complete failure.

Another example is overgeneralization. If you do this, you take one negative event — such as rude service at a restaurant — as part of an endless pattern of dismaying circumstances and defeat. Perhaps you exaggerate potential problems or mistakes until they take on the proportions of a catastrophe. Or you jump to conclusions: an observation that your friend seems upset turns into the certainty that she is mad at you.

For a person who is distressed by distortions and negative thoughts, cognitive restructuring may involve asking yourself:

  • Is this thought or belief true?
  • Did I jump to a conclusion?
  • What evidence do I actually have?
  • What’s the worst that could happen?
  • How else can I think about this?

Here’s an example of how it might work: If you get stuck in traffic on the way to work, first take a few deep breaths to reduce physical tension and step back from the stressor before you react. Then, reflect: “It’s just a traffic jam. I can handle this. It’s not worth getting this upset.” Don’t assume you’ll be fired. Tell yourself, “I’ll just be a few minutes late. I’m doing the best I can. I can handle this.”

It may seem simplistic; it may sound too good to be true. And it doesn’t happen just like that: It’s not an instant cure. It takes work, focus, concentration and a talented therapist. And it takes time.

But the value of cognitive behavioral therapy, including cognitive restructuring, has been shown in scientific studies. It is the most important new type of talk therapy that I’ve seen in my professional career.


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