COGNITIVE RESTRUCTURING: TECHNIQUES AND HOW THEY ARE APPLIED - ECONOMÍA - 2024

The Cognitive restructuring is a technique used by clinical psychologists whose main objective changing the way of interpreting things, the kind of thinking and subjective judgments 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 that 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:

• It allows us to be able to detect and modify our automatic thoughts.
• It is effective in changing 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 appropriate psychological state, achieve greater emotional well-being and consequently, eliminate inappropriate or harmful acts and embrace a healthy behavioral style.

The 10 Foundations of Cognitive Restructuring

Identify specific thoughts

In order for you to properly carry out a cognitive restructuring, the first step is to teach the patient to identify their cognitions.

This task can be accomplished 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 talk they will laugh at me", in the self-record it should not be noted "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 be: »if I speak they will laugh at me«.

Thus, normally this first phase can be long and expensive, since it is necessary to ensure very well that the patient has understood how to perform the self-registration, and avoid the errors that we have just discussed.

Identify beliefs

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 often produce concrete thoughts.

Therefore, when you carry out a cognitive restructuring it is convenient that you do not work only on specific 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 concrete 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 I am stupid. The belief would be : "If I say something uninteresting, others will think I am stupid, which means I am").

Translate them in their essence

It is important that the thoughts and beliefs identified are correctly defined and identified. For this, it is useful that among all the registered thoughts, the one that is more catastrophic or radical is found:

For example: "No one will ever speak to me again because as I say uninteresting things, I'm stupid."

Justify cognitive restructuring

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 vitally important 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 completely different things.

For example:

1. You hear a noise at night and you think that your house has been burglarized: How would you feel? What would you do?
2. You hear a noise at night and you think it is your cat playing with your slippers: How would you feel? What would you do?

With this exercise, it must 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.

Verbal questioning of maladaptive cognitions

Once the foundation of cognitive restructuring has been explained, you can now proceed to modify dysfunctional thoughts and beliefs through 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 is it done?

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 borne in mind 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 guide 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 a maladaptive thinking is true is examined through questions. It is done through questions such as the following:

2-Examine the usefulness of maladaptive thinking:

It examines the extent to which 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:

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.

Behavioral questioning of maladaptive cognitions

Once the verbal questioning is done, 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 generate 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:

• In verbal questioning: the therapist would ask a series of questions to reveal the irrationality of the 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. public will listen to me »
• In behavioral questioning: the therapist would invite the patient to speak in public so that they can experience first-hand what happens when they perform the action (they laugh at me vs. listen to me).

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.

Questioning beliefs and assumptions

Once you have achieved some progress 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 your automatic thoughts properly.

Degree of belief in the rational alternative

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 is having in the new thought be evaluated to avoid relapses in irrational thinking.

References

1. Bados, A., García, E. (2010). The technique of cognitive restructuring. Department of personality, evaluation and psychological treatment. Faculty of Psychology, University of Barcelona.