Therapist Aid. (2022). Cognitive restructuring. https://www.therapistaid.com/therapy-guide/cognitive-restructuring
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:
- “My friend is so forgetful! I bet they don’t know anyone’s birthday.”
- “Maybe something came up unexpectedly, and they’re busy.”
- “We did talk earlier in the week, so I guess it isn’t a big deal.”
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.
Step 1: Psychoeducation
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.
The CBT Model: Psychoeducation
worksheet
Cognitive Distortions
worksheet
Tip
Share a list of common cognitive distortions with your clients to start a discussion about how our thoughts impact emotions, whether or not they’re accurate. Most clients will identify with at least a few of the cognitive distortions, and easily connect them with their own experiences. In a group, ask participants to circle the cognitive distortions they’ve fallen victim to, and share stories.
Step 2: Increase Awareness of Thoughts
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.
| Example: “Alarm” Situations |
|---|
| You notice a feeling of anxiety before going out with friends. Your heart races, and you sweat. |
| You start arguments with your partner after you’ve had a meeting with your boss. The arguments always start over something minor, like chores. |
| When a big assignment is due at school, you put it off until the last minute. Small assignments are no problem. |
| You feel depressed when you have to spend an evening alone. You feel so lonely that you can’t take it. |
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.
Tip
When emotions seem to sneak up on your client, or if they have a hard time identifying their emotions, have a discussion about warning signs. How do they feel or behave differently immediately before the situation occurs? For example, someone struggling with anger might notice that their face feels hot, or their voice trembles, before they “snap”.
With the completion of step 2, your client has laid the foundation for a core tool of cognitive restructuring: thought records.
Step 3: 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.
Tip
When a client has a hard time remembering to complete their thought record, ask them to set a regular time to fill it out each day. Encourage them to set a reminder on their phone, or to complete it at a time that’s easy to remember (e.g. right before bed).
Thought Record (with example)
worksheet
| Example: Thought Record | ||||
|---|---|---|---|---|
| Situation | Thoughts | Emotions | Behaviors | Alternate Thought |
| Everyone’s busy, so I’m spending an evening alone with no plans. | No one wants to hang out with me. I’m just wasting my life, sitting here alone. | Depressed | Stayed home all night and did nothing. Just sat around having bad thoughts. | I’m alone tonight, but everyone is alone from time to time. I can do whatever I want! |
| A difficult assignment is due at school. | This is so much work. I’m horrible at this stuff. I don’t think I can do it. | Anxious | Avoided the assignment until the last minute. Had to rush my work. | This is a difficult assignment, and it’ll take a lot of work. But I know I can do it if I break it into small pieces. |
| Thought Record Instructions | ||
|---|---|---|
| Columns | Instructions | Example Entry |
| Situation | Describe the situation that led to unwanted emotions or behaviors. Record only the facts of what happened, without any interpretation. | I received negative feedback about a report I wrote at work. |
| Thoughts | Thoughts are like an inner monologue. They can be statements or questions. | I really messed this up. I don’t think I’m cut out for this job. Will they fire me? |
| Emotions | Write a single word or a description of a feeling. If your feelings changed throughout the experience, describe that process. | Felt bad about myself. Anxious. |
| Behaviors | Record what you did in response to the situation. | I procrastinated on fixing my work because it seemed so daunting. This made everything worse! |
| Alternate Thought | What’s a different thought you could’ve had? The goal isn’t to be overly positive—you just want to be fair. | I made a mistake on my work, but it isn’t that big of a deal. I’ll correct it, and no one will care in a few days. |
Tip
When generating alternate thoughts, the goal isn’t to be ultra-positive, but rather, to be fair. It’s fine to acknowledge when a bad situation exists. The exaggeration of a bad situation is what we want to avoid.
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.
Socratic Questioning
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.
Socratic Questioning
worksheet
| Example: Socratic Questions |
|---|
| Is this thought realistic? |
| Am I basing my thoughts on facts or on feelings? |
| What is the evidence for this thought? |
| Could I be misinterpreting the evidence? |
| Am I viewing this situation as black and white, when it’s really more complicated? |
| Am I having this thought out of habit, or do facts support it? |
Tip
Anyone can quickly spit out answers, just to have the exercise done. However, the value of Socratic questioning comes from the thought behind each answer. Spend at least 1-3 minutes on each question to get the most out of this exercise.
Decatastrophizing
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.
Note: Decatastrophizing is sometimes called the “what if” technique because of the style of questioning.
Putting Thoughts on Trial
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.
Putting Thoughts on Trial
worksheet
| Example: Putting Thoughts on Trial | |
|---|---|
|
The Thought My partner probably hates me. (after an argument about housework) |
|
|
The Defense argument in defense of the thought |
The Prosecution argument against the thought |
|
|
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The Verdict Arguments are sometimes upsetting, but overall, this is a healthy and loving relationship. There’s no evidence that my partner hates me. |
|
If you would like to continue learning about cognitive behavioral therapy, cognitive distortions, and cognitive restructuring, check out these additional resources:
CBT Practice Exercises
worksheet
Change How You Feel by Changing the Way You Think
book
References
- Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26(1), 17-31.
- Carey, T. A., & Mullan, R. J. (2004). What is socratic questioning? Psychotherapy: Theory, Research, Practice, Training, 41(3), 217.
- McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of behavior therapy and experimental psychiatry, 43(1), 540-547.
