Cognitive Restructuring
Harry Mills, Ph.D., Natalie Reiss, Ph.D. and Mark Dombeck, Ph.D.

Unhelpful thinking in the form of dysfunctional beliefs and/or cognitive distortions is just like any other automatically occurring bad habit; with practice and effort, people can become more aware of what is happening in their minds and change how they are thinking for the better. Cognitive restructuring, also known as cognitive reframing, is a technique drawn from cognitive therapy that can help people identify, challenge and alter stress-inducing thought patterns and beliefs. The end goal of cognitive restructuring is to enable people to replace stress-inducing thought habits with more accurate and less rigid (and therefore less stress-inducing) thinking habits.

Cognitive restructuring was first developed as a part of Cognitive Behavioral Therapy for depression (in Dr. Beck's version) and as a part of Rational Emotive Behavioral Therapy (in Dr. Ellis' version). It is a very powerful therapy technique which has been adapted to help people cope with all manner of stressful events and conditions. One drawback of this technique is that it is somewhat difficult for people to learn it in a self-help mode (without the assistance of a therapist). It is easy for people to think they are doing it right when they are not and falsely conclude that the technique is of little use. If you really want to learn how to do cognitive restructuring, we recommend that you work with an experienced cognitive behavioral therapist over the course of 10 to 15 weekly sessions.

Cognitive restructuring teaches us to stop trusting in our automatic tendency to accept the contents of our thoughts as being an accurate assessment of reality. Instead, the goal is to start testing each thought we have for accuracy. We do this by going back to the A+B=C stress equation we have previously discussed where A stands for an activating event, B for a belief, and C for the consequences of our appraisal for our mood. To this equation, we add a fourth letter "D," which stands for Disputing or Debating thoughts, and a fifth letter "E," which stands for Effective replacement thoughts.

In cognitive restructuring, we write down our thoughts (B), the context of the thoughts (A) and the emotional consequence of that chain of events (C). Then, we think carefully about whether our thoughts may have been wrong, or whether we may have unconsciously experienced a cognitive distortion and write down the findings of this analysis (D). When we are clear on what we got wrong, we rephrase or restate our thought in a more accurate, less distorted format as (E).

The first step of cognitive restructuring is to monitor and record A, B, and C events on a thought record or chart containing columns or fields where each component can be recorded separately. It is important to write things down in order to put a handle on them. Thoughts are much easier to manipulate and examine when you've pinned them down on paper.

The next step in restructuring is to look for characteristic pattens of cognitive distortions or dysfunctional beliefs. Do certain types of situations always tend to trigger certain negative or pressurizing thought patterns? Are you a black and white thinker when it comes to certain topics? Do you typically experience anger or sadness in response to stress? Think carefully about what sorts of thinking mistakes you might be making and write these findings down in your thought record under the Disputing column or field.

When disputing thoughts, it helps to ask yourself the following questions:

• Are my thoughts on the event accurate?
• What objective evidence/facts are there to support my view?
• What alternative views are there of the event?
• Am I underestimating my ability to cope with the event?
• What is the worst that can happen if my view of the event is correct?
• What actions can I take to influence the event?
• What is the worst thing that could happen to me or my family and how does this event compare to that?

After thinking things through for a while, your final task is to restate your original beliefs so that they are more accurate and less distorted. You can do this by literally rewriting your original thought in the Effective Thought column or field of your thought record. Write down new ways of thinking or more helpful beliefs that lead to a new approach to dealing with the activating event. With practice, you will be able to start changing the stress-inducing thoughts that are not helpful, and you will find yourself feeling less pressured and therefore happier.

Cognitive restructuring is not an easy skill to learn. It is difficult to identify and put into words what your thoughts actually are. It is hard to recognize what thought errors you are making. Most people have trouble figuring out a way to restate their thoughts in a manner that doesn't contain additional thinking errors. Most people really benefit from having a third party available (a therapist) who can critique their efforts and coach them towards success.

It is useful to think of cognitive restructuring as a form of mental weight lifting. By practicing this technique, you are developing mental muscles that formerly were not used. At first the practice will be difficult, effortful, and time consuming. Over time and with repeated practice, it will become much easier. When people get good at it, they find that they develop the ability to catch themselves in the act of dysfunctional thinking and to correct themselves on the fly in real-time so that they don't get as stressed out.