Imagine it’s your birthday. You’re expecting a phone call from a close friend, but it never comes. You called them on their birthday, so why didn’t they call you? Do they not care enough to remember your birthday? You feel hurt.
Where did this feeling of hurt come from? It wasn’t the lack of a phone call that caused the hurt. It was the thoughts about the lack of a phone call that hurt. What if, instead of taking the missing phone call personally, you had thought:
Thoughts play a powerful role in determining how people feel and how they act. If someone thinks positively about something, they’ll probably feel positively about it. Conversely, if they think negatively about something—whether or not that thought is supported by evidence—they will feel negatively.
Cognitive restructuring is the therapeutic process of identifying and challenging negative and irrational thoughts, such as those described in the birthday example. These sort of thoughts are called cognitive distortions . Although everyone has some cognitive distortions, having too many is closely linked to mental illnesses such as depression and anxiety.
Cognitive behavioral therapy (CBT), and several other approaches to psychotherapy, make heavy use of cognitive restructuring. Each of these therapies leverages the powerful link between thoughts, feelings, and behaviors to treat mental illness.
The thought-feeling-behavior link is a big topic in itself, and beyond the scope of this guide. If you want to learn more, check out our CBT Psychoeducation guide and worksheet.
Remember, cognitive restructuring refers to the process of challenging thoughts—it isn’t a single technique. There are many techniques that fall under the umbrella of cognitive restructuring, which we will describe (alongside several therapy tools) throughout this guide.
Cognitive restructuring starts with the identification of irrational negative thoughts (cognitive distortions). This is trickier than it sounds. Cognitive distortions can happen so quickly that they come and go before we’ve noticed them. They’re more like a reflex than an intentional behavior. Below, we’ll discuss how to help your clients identify their cognitive distortions.
Before jumping into the “doing” part of cognitive restructuring, it’s important for clients to understand what cognitive distortions are, and how powerful they are in influencing one’s mood. Start with psychoeducation about the cognitive model and cognitive distortions, using plenty of examples.
After building a general understanding of the cognitive model, your clients will learn to identify their own cognitive distortions. This takes practice. It’s not natural, during a fit of rage, to stop and wonder: “What thoughts led me to this moment?”
To hone in on the most important cognitive distortions, start by looking for negative emotions. When are symptoms of depression, anger, or anxiety at their worst? If your client has difficulty identifying their emotions, focus on behaviors. What behaviors do they want to change? What triggers those behaviors? Think of these situations like alarms, alerting you that cognitive distortions are nearby.
This discussion is intended to improve your client’s awareness of situations where cognitive distortions are impacting their mood and behavior. The more specific triggers or situations they can identify, the easier it will be to recognize them in the moment.
With the completion of step 2, your client has laid the foundation for a core tool of cognitive restructuring: thought records.
A thought record (also called a thought log) is a tool for recording experiences, along with the thoughts, feelings, and behaviors that accompany them. This exercise will help your clients become aware of cognitive distortions that previously went unnoticed, and unquestioned. With practice, they will learn to identify cognitive distortions in the moment, and immediately challenge them.
Each row of a thought record represents a unique situation. The headings for each column will differ slightly between thought records, but generally they include “situation”, “thoughts”, “feelings”, “consequences”, and sometimes, “alternate thought”. Ideally, each row is filled in shortly after a situation ends.
Sometimes, the mere awareness of a cognitive distortion will be enough to eliminate it. Other cognitive distortions are more deeply ingrained, and require extra work. This is where cognitive restructuring techniques, which make up the rest of this guide, will come in handy.
When looking at other people’s cognitive distortions, they seem easy to dispute. No matter how much your friend believes that they’re the “worst person ever”, you know that to be untrue. But when it comes to a person’s own cognitive distortions, they can be much more difficult to overcome. That’s why they persist. We believe in our own cognitive distortions, no matter how inaccurate they may be.
For these difficult cognitive distortions, we have several techniques to help tear them down. These techniques should be used again and again, whenever cognitive distortions are identified. With enough repetition, the cognitive distortions will be extinguished and replaced with new, balanced thoughts. Here are the techniques.
Socrates was a Greek philosopher who emphasized the importance of questioning as a way to explore complex ideas and uncover assumptions. This philosophy has been adopted as a way to challenge cognitive distortions.
Once a cognitive distortion has been identified, this technique is simple. The cognitive distortion will be assessed by asking a series of questions. Therapists can set an example by asking these questions of their clients, but ultimately, the client should learn to question their own thoughts.
Oftentimes, cognitive distortions are just an exaggerated view of reality. Before a first date, a person might find themselves overwhelmed with anxiety, thinking of all the things that might go wrong. Maybe their date won’t like how they look, or maybe they’ll make a fool of themselves.
With the decatastrophizing technique, we ask very simple questions: “What if?” or “What’s the worst that could happen?”
Client: I always worry that my date won’t like how I look, or I’ll make a fool of myself. This leads to me getting so nervous that I do make a fool of myself.
Therapist: So, what if those things come true? What if your date doesn’t like how you look, or you make a fool of yourself?
Client: Well, we probably won’t have a second date…
Therapist: What if you don’t have a second date? What happens then?
Client: I guess nothing. I just won’t see them again.
This sequence of questioning helps to reduce the irrational level of anxiety associated with cognitive distortions. It highlights the fact that even the worst-case scenario is manageable.
In this exercise, your client will act as a defense attorney, a prosecutor, and a judge.
First, your client will act as a defense attorney by defending their negative thought. Ask them to make an argument for why the thought is true. Remember to stick to verifiable facts. Interpretation, guesses, and opinions aren’t allowed!
Next, ask your client to act as the prosecutor. Now they will present evidence against the negative thought. Just like in the previous step, require that they stick to facts, while excluding opinions.
Finally, ask your client to act as the judge. They will review the evidence, and deliver a verdict. The verdict should come in the form of a rational thought.
If you would like to continue learning about cognitive behavioral therapy, cognitive distortions, and cognitive restructuring, check out these additional resources: