The Cognitive restructuring Is one of the techniques most used in Cognitive behavioral therapies nowadays.
This technique has as main objective to modify the way of interpreting things, the Kind of thinking And subjective assessments we make About the environment.
In this article we will review 8 fundamental steps of this technique, and the keys for effective cognitive restructuring.
What is Cognitive Restructuring?
One of the characteristics that define the human being is the ability of the human being to represent the world in his brain through images and Mental representations.
This implies that we react and form our lives, not with respect to real facts, but rather with respect to the mental representations that we form About the things that surround us.
Put another way: our life is not defined by what we have around us, but by how we interpret it. Our lives are not objective, But are subject to our subjective assessment.
And if we imagine two people living in the same environment, they will relate to the same people, perform the same work and Had exactly the same hobbies, we could not say that these two people have the same life, since each would live its own existence a Through their subjective assessment.
So, what we could say is that each one of us creates our lives, our well-being and our way of relating to the World through the thoughts we have in our brain, the emotions that these thoughts produce, and the resulting behavior.
Well, it is in this first stage, in the thought, where the cognitive restructuring works:
It allows us to be able to detect and modify our Automatic thoughts.
It is effective to change Maladaptive beliefs About any aspect of our life
It encourages the identification and management of emotions such as anger, anxiety or despair.
It allows us to adopt an adequate psychological state, achieve a greater emotional well-being and consequently, Eliminate inappropriate or harmful acts and embrace a healthy behavioral style.
The 10 Foundations of Cognitive Restructuring
1. Identify concrete thoughts
In order for you to properly perform cognitive restructuring, the first step is to teach the patient to identify their cognitions.
This task can be done through the Ellis self-register which includes 3 columns: situation, cognitions and consequences of cognition (both Emotional and behavioral).
The patient must detect the thought and immediately write it down in the self-register, filling in the 3 columns.
However, this first task is not as simple as it seems, and requires some training because many thoughts are automatic and Involuntary
So: The patient must be taught to pay attention to all his thoughts! This way you can be aware of those thoughts that are Automatically.
Likewise, you have to make sure that those thoughts that identify the patient are the ones that produce the discomfort or the problem that is wanted solve.
An effective way to resolve this is to ask the patient to identify the thought after thinking that another person who has that Thought would feel the same way he feels.
Likewise, it is important for the patient to write the thought in a concrete way and not confuse thoughts with emotions. For example:
If a person in a social situation thinks:" If I speak, they will laugh at me." In self-registration should not be noted"I will make the ridiculous"(that would be a Thinking little concrete) nor"I will feel pathetic"(that would be an emotional state). He thought would:" If I speak, they will laugh at me."
Thus, this first phase can usually be long and costly, since one has to make sure that the patient has understood how to perform the Self-register, and avoid the mistakes we just made.
2. Identify beliefs
The specific thoughts people have are often subject to more general beliefs. Rather, the beliefs or assumptions we have about Of us, the others or the world, usually produce concrete thoughts.
So when you make a cognitive restructuring, you should not only work on specific thoughts, and try to change those More general beliefs that are related to thinking.
However, identifying beliefs and assumptions is usually a more expensive task, so I recommend that you do it once the patient is able to Effectively identify your most concrete thoughts.
To do so, you can use the down arrow technique.
And how does this work?
For it is that before a concrete thought, ask the patient: "What if this thought really happened, what would happen? When the Patient to respond, the question about that response would be repeated, and this process is repeated until the patient is unable to provide a New answer.
Let's continue with the example above:
If I speak in public I will say something uninteresting -> people will notice -> they will laugh at me -> They will not take me seriously -> They will think That I'm silly -> I will also think that I am stupid. The Belief would "If I say something uninteresting, others will think I'm a fool, which means I am" ).
3. Translate them in their essence
It is important that the identified thoughts and beliefs are correctly defined and identified.
To do this, it is useful that among all the thoughts registered look for that which is more catastrophic or radical:
For example: "No one will ever speak to me again because I say stupid things because I say things that are not very interesting."
4. Justify cognitive restructuring
Once the patient's thoughts and beliefs are identified, the next step you must take before you begin to apply the restructuring in Itself, is to explain to you how the therapy you will perform works.
This explanation is vital because before testing the patient's thoughts (which for him are real and important), he must Understand the relationship between cognitions, emotions and behavior.
Likewise, the patient must understand that thoughts are constructions of his mind, and therefore are hypotheses, not immovable facts, since another Person might think differently about the same facts.
So, you must get the patient to be able to perform this exercise, and understand that before the same fact can be thought of different ways.
To do so, you should use a situation unrelated to the patient's problem, and ask him how he would feel if he thought two things Totally different.
For example:
You hear a noise at night and believe that they have come to steal at home: How would you feel? What would you do?
You hear a noise at night and you think it's your cat playing with your sneakers: How would you feel? What would you do?
With this exercise, it must be possible on the one hand that the patient realizes that in the same situation can have two different thoughts, and On the other hand that according to the thought that has the emotional and behavioral consequences can vary a lot.
5. Verbal questioning of maladaptive cognitions
Having explained the foundation of cognitive restructuring, you can proceed to modify dysfunctional thoughts and beliefs through Of the questioning of these.
To begin the questioning it is advisable that you make a verbal questioning, since it is less complex than the behavioral questioning, and to the Principle of intervention may be more beneficial.
To do this, the most commonly used technique is Socratic dialogue .
With this technique, the therapist systematically questions the patient's maladaptive thoughts.
And how is it done?
To realize this technique of cognitive restructuring, a certain experience and skill of the therapist is essential, since the Questioning is done by asking a series of questions about the dysfunctional cognitions of the patient so that he has to reconsider them.
It is necessary to take into account that the ideas or thoughts that are intended to modify through this technique are characterized by being irrational.
Thus, the therapist must ask in an agile and skillful way questions that show the irrationality of the patient's thinking, and Go routing these same answers to a rational thought that can supply the maladaptive thinking of the patient.
Let us go deeper into the Socratic dialogue.
Examining the evidence of maladaptive thinking:
It is examined through questions to what extent is a maladaptive thinking. It is done through questions such as the following:
What data do you have in favor of this thought?
What is the probability that you are correctly interpreting the situation? Are there other alternative interpretations? Is there any other way to approach this?
Examine the usefulness of maladaptive thinking:
It examines the extent to which irrational thinking is effective in achieving the patient's goals, or what their negative effects are on their well-being Or functionality. You can ask questions like:
Does this thinking help you to achieve your goals and solve your problem? Does this way of thinking help you feel the way you want?
What are the pros and cons, in the short and long term, of what you believe?
Examine what would really happen and what would happen if what you think was true:
Usually this last step is not usually necessary, but in case irrational cognition persists (sometimes the probability that thought Irrational is true may be scant but real), the patient may be asked to think what would happen if the thought were true, and later Look for solutions.
Draw conclusions about maladaptive thinking:
After the restructuring of a thought, the patient must draw a conclusion, which usually involves a more adaptive situation.
6. Behavioral questioning of maladaptive cognitions
Once the verbal questioning is done, irrational thinking is usually more or less eliminated and replaced by a more Adaptive, however, this is not enough.
To achieve more persistent and lasting changes, you need to conduct behavioral questioning.
With this technique, therapist and generate specific predictions from irrational thinking and situations are generated to check if such Predictions are met or not.
By way of summary, following the example above:
In verbal questioning : The therapist would ask a series of questions to highlight the irrationality of thought" If I speak in public they will laugh at me" , Until the patient is able to substitute irrational thinking for a more adaptive one" If I speak in public they will listen to me"
In the behavioral questioning: The therapist would invite the patient to speak in public so that he lives at first what happens when he performs the action They laugh at me, they listen to me.
The situations in which this technique is performed must be controlled very closely by the therapist, and it serves for the patient to experience Personally a situation that demonstrates the"non-certainty"of his irrational thinking.
7. Questioning beliefs and assumptions
Once you have made some progress in questioning thoughts, you can continue the intervention by questioning the more general beliefs of the patient.
Beliefs can be questioned in the same way that thoughts are questioned (verbal and behavioral questioning), however, Deep-rooted belief requires a more profound and costly change, so it is recommended to do so when the patient is already capable of Adequately question their automatic thoughts.
8. Degree of belief in the rational alternative
Modifying both a thought and above all a belief by a different one is usually a major change in the patient's life.
It is very likely that even if the change was adequate, this is not total and absolute, so it is recommended that you evaluate the degree of belief Which is taking the patient into new thinking to avoid relapses into irrational thinking.
And do you know another technique of cognitive restructuring? Check it for other techniques! Thanks!
References
- Bados, A., García, E. (2010). The technique of cognitive restructuring. Department of personality, evaluation and psychological treatment. faculty of Psychology, University of Barcelona.
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