The cognitive restructuring It is a technique used by clinical psychologists whose main objective is to modify the way of interpreting things, the type of thinking and the subjective evaluations that we make about the environment. It is one of the most used techniques in cognitive behavioral therapies today.
One of the defining characteristics of the human being is the ability he possesses to represent the world in his brain through images and mental representations. This implies that we react and shape our lives, not with respect to real events, but rather with respect to the mental representations that we form about the things that surround us..
In other words, 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.
If we imagine two people living in the same environment, interacting with the same people, doing the same job and having exactly the same hobbies, we could not affirm that these two people have the same life, since each would live their own existence through your subjective assessment.
So, what we could say is that each 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 in us, and the resulting behavior.
Well, it is in this first stage, in thought, where cognitive restructuring works:
In order for you to properly perform a cognitive restructuring, the first step is to teach the patient to identify their cognitions.
This task can be performed through Ellis's self-record that 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-record, filling in the 3 columns. However, this first task is not as simple as it seems, and requires some training since many thoughts are automatic and involuntary..
So: The patient must be taught to pay attention to all his thoughts! In this way you can be aware of those thoughts that are presented automatically.
Likewise, you have to make sure that those thoughts that the patient identifies are the ones that produce the discomfort or the problem that you want to solve.
An effective way to solve this is to ask the patient after identifying the thought, to think about whether another person who had that thought would feel the same way that he feels..
In the same way, it is important that the patient write the thought in a concrete way and do not confuse thoughts with emotions. For example:
If a person in a social situation thinks: “if I speak they will laugh at me ", In the self-registration, you should not write down "I will make a fool of myself" (which would be a not very specific thought) or "I will feel pathetic" (which would be an emotional state). The thought would: " if I speak they will laugh at me ".
Thus, normally this first phase can be long and expensive, since it is necessary to make sure very well that the patient has understood how to perform the self-registration, and avoid the errors that we have just mentioned..
The specific thoughts that people have are usually subject to more general beliefs. Rather, the beliefs or assumptions we have about ourselves, others or the world, usually produce concrete thoughts.
Therefore, when you carry out a cognitive restructuring it is convenient that you do not work only on concrete thoughts, and try to modify those more general beliefs that are related to thought.
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 their most specific thoughts.
To do this, you can use the down arrow technique. And how does this work?
Well, it consists in that before a specific thought, you ask the patient: “And if this thought really happened, what would happen?? When the patient answers, the question about that answer would be repeated, and this process is repeated until the patient is unable to provide a new answer..
Let's keep looking at it with the previous example:
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 I am stupid -> I too will think that I am stupid. The belief would: "If I say something uninteresting, others will think I'm stupid, which means I am").
It is important that the identified thoughts and beliefs are correctly defined and identified. To do this, it is useful to search for the one that is more catastrophic or radical among all the registered thoughts:
For example: "No one will ever speak to me again because as I say uninteresting things, I'm stupid".
Once the thoughts and beliefs of the patient have been identified, the next step that you must take before starting to apply the restructuring itself, is to explain how the therapy that you will perform works.
This explanation is of vital importance because before testing the patient's thoughts (which are real and important to him), he must understand the relationship between cognitions, emotions and behavior.
Likewise, the patient must understand that thoughts are constructions of his mind, and therefore they are hypotheses, not immovable facts, since another person could think differently before the same facts..
Thus, you must ensure that the patient is able to perform this exercise, and understand that when faced with the same event, one can think in different ways.
To do this, it is convenient that you use a situation not related to the patient's problem, and ask him how he would feel if he thought two totally different things.
For example:
With this exercise, it should be achieved that on the one hand the patient realizes that in the same situation two different thoughts can be had, and on the other hand that depending on the thought that has the emotional and behavioral consequences they can vary a lot.
Once the foundation of cognitive restructuring has been explained, you can now proceed to modify dysfunctional thoughts and beliefs by questioning them..
To begin the questioning, it is recommended that you carry out a verbal questioning, since it is less complex than behavioral questioning, and at the beginning of the intervention it can be more beneficial.
To do this, the most used technique is Socratic dialogue. With this technique, the therapist systematically questions the patient's maladaptive thoughts. And how do you do?
Well, to carry out this cognitive restructuring technique, a certain experience and skill of the therapist is essential, since the questioning is carried out by formulating a series of questions about the dysfunctional cognitions of the patient so that they have to reconsider them..
It must be taken into account that the ideas or thoughts that are intended to be modified through this technique are characterized by being irrational.
Thus, the therapist must ask in an agile and skillful way questions that reveal the irrationality of the patient's thinking, and gradually direct these same responses towards a rational thought that can supply the patient's maladaptive thinking..
Let's take a deeper look at how Socratic dialogue works.
1-Examine the tests of maladaptive thinking:
The extent to which maladaptive thinking is true is examined through questions. It is done through questions such as the following:
What data do you have in favor of this thought?
What is the probability that he is interpreting the situation correctly? Are there other alternative interpretations? Is there another way to approach this?
2-Examine the usefulness of maladaptive thinking:
It examines to what extent irrational thinking is effective in achieving the patient's goals, or what its negative effects are on their well-being or functionality. Questions such as:
Does this thought help you achieve your goals and solve your problem? Does this way of thinking help you feel the way you want?
What are the short-term and long-term pros and cons of this you believe?
3-Examine what would really happen and what would happen if what you think were true:
Normally this last step is not usually necessary, but if the irrational cognition persists (sometimes the probability that the irrational thinking is true may be small but real), the patient can be asked to think about what would happen if the thought were true, and then look for solutions.
4-Draw conclusions about maladaptive thinking:
After restructuring a thought, the patient must draw a conclusion, which usually involves a more adaptive way of approaching the situation.
Once the verbal questioning has been carried out, the irrational thinking is usually already more or less eliminated and replaced by a more adaptive thinking, however, this is not enough.
To achieve more persistent and lasting changes, you need to engage in behavioral questioning. With this technique, the therapist and generates specific predictions from irrational thinking and situations are generated to check whether such predictions are fulfilled or not.
As a summary, continuing with the previous example:
The situations in which this technique is performed must be closely controlled by the therapist, and it serves for the patient to personally experience a situation that demonstrates the "uncertainty" of their irrational thinking..
Once some progress has been made in questioning thoughts, you can continue the intervention by questioning the patient's more general beliefs..
Beliefs can be questioned in the same way that thoughts are questioned (verbal and behavioral questioning), however, modifying a deeply ingrained belief requires a more profound and costly change, so it is recommended to do it when the patient is already capable of questioning properly your automatic thoughts.
Modifying both a thought and above all a belief for a different one is usually an important change in the patient's life.
It is very likely that although the change has been adequate, it is not total and absolute, so it is recommended that the degree of belief that the patient has in the new thought be evaluated to avoid relapses in irrational thinking.
And you, what other cognitive restructuring technique do you know? Share it to learn other techniques! Thanks!
Yet No Comments