When we identify problematic behaviours or disproportionate emotions of a client, we face the task of exploring the WHY with the client. With the application of cognitive restructuring, there is a method that allows us to identify with the client situations that evoke thoughts that result in emotions. Behaviour follows in response to these emotions. With the application, we can work with the client to perform this analysis and find solutions to restructure thoughts and cognitions. The result is that the client is able to recognise what causes him or her to behave.
Cognitive restructuring has its base in cognitive-behavioural therapy (CBT) and it is a psychosocial intervention that is used as an evidence-based practice for improving mental health. CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviours, and emotional regulation.
The diagram depicts how emotions, thoughts, and behaviours all influence each other. The triangle in the middle represents CBT’s tenet that all humans’ core beliefs can be summed up in three categories: self, others, future.
The basic assumptions and the idea of man of CBT are, that human beings
- actively process environmental stimuli against the background of previous learning experiences
- form expectations about situations, actions and consequences
- have a controlling and planning “I”
- are capable of self-regulation and self-reflection
CBT is based on the idea that our thoughts, feelings, and behaviours are constantly interacting and influencing one another. How we interpret or think about a situation determines how we feel about it, which then determines how we will react.
The process of cognitive restructuring may can describe this way:
identifying irrational thoughts / cognitive distortions with 3 steps
- Step 1: Psychoeducation
- Step 2: Increase Awareness of Thoughts
- Step 3: Thought Records
We would like to focus 3 of a lot of cognitive restructuring techniques
- Socratic Questioning
- Putting Thoughts on Trial
In the end the process will be rounded with a review.
Before we can implement the technique of cognitive restructuring, it’s important for clients to understand what cognitive distortions are, and how powerful they are in influencing one’s mood.
Cognitive Distortions are exaggerated or irrational thought patterns that are believed to perpetuate the effects of psychopathological states, especially depression and anxiety
The coach can guide patients to assess their automatic thoughts, especially when there is a perceived emotional arousal during the session, by simply asking: “What is going through your mind?”, or any variation of this question. Cognitive distortions may be unveiled by asking, for example, “What are the evidences for your conclusion?”, “Are you omitting contradictory evidence?”, “Does your conclusion follow logically from the observations you have made?”, “Are there alternative explanations that may be more accurate in explaining this particular episode?”. When asked to reflect on alternative explanations, patients may realize that their initial explanations evolved through invalid inferences, which leads them to think of different interpretations of events, thus attaching new attributions and meanings to them.
Thoughts are an energetic substance that influence the perceptions we have about beliefs and identity, so that every behaviour we have and action we take starts with a thought. The subconscious level of our mental body has more control over our thoughts, impulses and brain activity than at the conscious mind level. This is especially true if we are totally unaware of how our mind works, as the subconscious takes over and we remain unaware of the thoughts and inner dialogue we have with ourselves and others. On the path of becoming conscious and awake, observing how our mind works and registering what our heart feels while being present to what our body experiences, are critical skills in personal and spiritual development.
Emotions are complex psychophysical processes that evoke positive or negative psychological responses (or both) and physical expressions, often involuntary. Emotions are often related to feelings, perceptions or beliefs about elements, objects or relations between them, in reality or in the imagination. They typically arise spontaneously, rather than through conscious effort. An emotion (reaction or state) is often differentiated from a feeling (sensation or impression), although the word feeling can mean emotion in some contexts.
Core beliefs are those held by persons about themselves and others as absolutely true to the point that they do not question them; to the believer, these global, rigid, and over-generalized cognitions about self are just the way things are. These beliefs typically arise early in development as children organize experiences and interactions with other people and their environment. Although, generally, these core beliefs may be inactive, they can be activated during periods of depression or anxiety. These are beliefs that people have held for much of their lives and that are activated across a wide range of situations, having a profound influence on how people feel, appraise situations, and see themselves and the world.
Cognitive Distortions are exaggerated or irrational thought patterns that are believed to perpetuate the effects of psychopathological states, especially depression and anxiety.
Some Examples are:
MAGNIFICATION AND MINIMIZATION: Giving proportionally greater weight to a perceived failure, weakness or threat, or lesser weight to a perceived success, strength or opportunity, so the weight differs from that assigned to the event or thing by others. This is common enough in the normal population to popularize idioms such as “make a mountain out of a molehill”. In depressed clients, often the positive characteristics of other people are exaggerated, and negative characteristics are understated.
CATASTROPHIZING: Giving greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable. Example: A teenager is too afraid to start driver’s training because he believes he would get himself into an accident.
OVERGENERALIZATION:Making hasty generalizations from insufficient experiences and evidence. Making a very broad conclusion based on a single incident or a single piece of evidence. If something bad happens only once, it is expected to happen over and over again.
Example: A person is lonely and often spends most of her time at home. Her friends sometimes ask her to come out for dinner and meet new people. She feels it is useless to try to meet people. No one really could like her
MAGICAL THINKING:The belief that actions will influence unrelated situations. “I am a good person—Bad things shouldn’t happen to me.”
PERSONALIZATION: Attributing personal responsibility, including the resulting praise or blame, for events over which a person has no control.
Example: A mother whose child is struggling in school blames herself entirely for being a bad mother, because she believes that her deficient parenting is responsible. In fact, the real cause may be something else entirely
JUMPING TO CONCLUSIONS:Reaching preliminary conclusions (usually negative) from little (if any) evidence.
MIND READING: Inferring a person’s possible or probable (usually negative) thoughts from their behaviour and nonverbal communication; taking precautions against the worst reasonably suspected case or some other preliminary conclusion, without asking the person.
FORTUNE TELLING: predicting outcomes (usually negative) of events. Example: Being convinced of failure before a test, when the student is in fact prepared
EMOTIONAL REASONING:Presuming that negative feelings expose the true nature of things and experiencing reality as a reflection of emotionally linked thoughts. Thinking something is true, solely based on a feeling.
Example: “I feel (i.e. think that I am) stupid or boring, therefore I must be.” Or, feeling that fear of flying in planes means planes are a very dangerous way to travel. Or, concluding that it’s hopeless to clean one’s house due to being overwhelmed by the prospect of cleaning.
DISQUALIFYING THE POSITIVE:Discounting positive events. Example: Upon receiving a congratulation, a person dismisses it out-of-hand, believing it to be undeserved, and automatically interpreting the compliment (at least inwardly) as an attempt at flattery or perhaps as arising out of naïveté
“SHOULD” STATEMENTS:Doing, or expecting others to do, what they morally should or ought to do irrespective of the particular case the person is faced with. This involves conforming strenuously to ethical categorical imperatives which, by definition, “always apply”, or to hypothetical imperatives which apply in that general type of case. Albert Ellis termed this “musturbation”. Psychotherapist Michael C. Graham describes this as “expecting the world to be different than it is”.
Example: After a performance, a concert pianist believes he or she should not have made so many mistakes. David Burns’ Feeling Good: The New Mood Therapy clearly distinguishes between pathological “should statements”, moral imperatives, and social norms.
Increase the awareness of thoughts
If the client understands the cognitive model, it’s about recognizing CDs. That means asking what thoughts lead me to this CD. This leads to an increased attention to thoughts. Thus, special thoughts can be identified, which influence the mood and ultimately trigger a certain behaviour.
Another important aspect in this context is to associate emotions with behaviour. This makes it easier to deduce the underlying idea.
Examples are critical situations such as
- After a busy day, I always start arguing with my partner.
- Even large orders I do only at the last minute.
Identifying and reflecting these warning signals helps the client to classify his own behaviour. A certain method to do is thought recording.
Thought recordings are usually tabular records in which the table columns symbolize the individual aspects of the cognitive model. Situation-thought-emotion-behaviour. Each line represents a situation to be described. Sometimes it is recommended to add another column to the alternative idea. This immediately gives the client the opportunity to question the original thought.
Finding of alternative thoughts should happen under the premise “fair” instead of “over-positive”.
Cognitive restructuring techniques
When we talk about restructuring cognitions, we have several techniques to support. Of course, it’s easy to identify and judge CDs from others, and to give advice. If we are forced to clean up our own CDs, difficulties often arise. The techniques, of which we will explain here 3 examples, provide very good tools for the coach and the client to dissolve cognitive distortions and restructure it.
Socratic questioning (or Socratic maieutics) was named after Socrates, who was a philosopher in c. 470 BCE–c. 399 BCE. Socrates utilized an educational method that focused on discovering answers by asking questions from his students. Socrates believed that “the disciplined practice of thoughtful questioning enables the scholar/student to examine ideas and be able to determine the validity of those ideas.
The purpose is to help uncover the assumptions and evidence that underpin people’s thoughts in respect of problems. A set of Socratic questions in cognitive therapy aim to deal with automatic thoughts that distress the client:
- Revealing the issue: ‘What evidence supports this idea? And what evidence is against its being true?’
- Conceiving reasonable alternatives: ‘What might be another explanation or viewpoint of the situation? Why else did it happen?’
- Examining various potential consequences: ‘What are worst, best, bearable and most realistic outcomes?’
- Evaluate those consequences: ‘What’s the effect of thinking or believing this? What could be the effect of thinking differently and no longer holding onto this belief?’
- Distancing: ‘Imagine a specific friend/family member in the same situation or if they viewed the situation this way, what would I tell them?’
Careful use of Socratic questioning enables a therapist to challenge recurring or isolated instances of a person’s illogical thinking while maintaining an open position that respects the internal logic to even the most seemingly illogical thoughts.
In cognitive therapy, decatastrophizing or decatastrophization is a cognitive restructuring technique to treat cognitive distortions, such as magnification and catastrophizing, commonly seen in psychological disorders like anxiety and psychosis.
The technique consists of confronting the worst-case scenario of a feared event or object, using mental imagery to examine whether the effects of the event or object have been overestimated (magnified or exaggerated) and where the patient’s coping skills have been underestimated. The term was coined by Albert Ellis, and various versions of the technique have been developed, most notably by Aaron T. Beck.
Decatastrophizing is also called the “what if” technique because the worst-case scenario is confronted by asking: “What if the feared event or object happened, what would occur then?”
The following is an example:
“I could make an absolute fool of myself if I say the wrong thing.”
“What if you say the wrong thing, what would happen then?”
“He might think I’m weird.” …
Thoughts on trail
The client goes into a role play. He will successively be defence lawyer, prosecutor and judge of his thoughts. As a first step, he prepares the defence by defending the negative thought argumentatively. Then he will deal with the role of the prosecutor and build the counter-argumentation. Finally, as a judge, he will juxtapose both arguments and issue a judgment.
The thought is: My wife actually hates me. She is always screaming at me.
The defence says:
We often argue about trifles. Yes, she screams at every argument. She is always so angry. I behave as always.
The prosecutor says against the thought:
You always find a way to end the dispute. You have been living together for a very long time. My wife is sometimes mad at others too. My wife told me that she loves me.
In the end, the client takes on the role of the judge and weighs the verdict. The verdict: Quarrels are often annoying, but they are a part of togetherness. After weighing the arguments, especially the aspect that, according to your statement, a solution is always found, there is no proof that supports the initial thought.
More techniques are
Understanding idiosyncratic meaning, which is more of a skill, aims to solve the client’s problem when using a vague language.
Reattributiona technique in which the client is encouraged to consider possible alternate causes for events
Cognitive rehearsal is an imagery technique devised to help patients experience their feared situations by imagining that it is occurring right at that moment. At the office or as a between-session assignment, patients are asked to “live through” the feared situation in imagery and build up the best coping strategies to overcome it successfully.
Guided imagery which means the coach helps the client to evoke and generate mental images that simulate or re-create
Sources: Paulo Knapp, Aaron T Beck on http://www.scielo.br/scielo.php?pid=S1516-44462008000600002&script=sci_arttext&tlng=en
Irismar Reis de Oliveira on http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462008000100003
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