Cognitive Restructuring: Two of The Five Steps to Follow

“Automatic thoughts; cognitive distortions; what do we do next?” Vladimir, my friend and colleague who has been asking me to tell him more about cognitive distortions, is now asking, “Then, now what?”

As I mentioned in previous articles, cognitive restructuring is the process of learning to identify, evaluate, and correct our cognitive distortions.  Just like Vladimir, you must now be ready to start putting into practice all the concepts I outlined in the previous related six articles.  Here are two of the five steps to follow, as you embark on the process of cognitive restructuring with your patients and clients, with your friends, your loved ones, or with yourself.

1. Identify the automatic thought:

Automatic thoughts are just that, “automatic.”  Our brain is often on autopilot, and we just think without “thinking” or without knowing or paying attention to what we are thinking.

And as I said before, attempting to keep track of all the thoughts going through our mind, as we go about our day is rather unwise, unhealthy, and humanly impossible.  However, as I have also said, there are those thoughts that get us into trouble, distress us, and overwhelm us with unbearable feelings.  These are thoughts that create tensions in our relationships, at work, and prevent us from making use of our best potential or from living life to its fullest.  These thoughts are not just worth identifying, but also worth addressing.  The question is how do we identify our automatic thoughts.

The answer to this is through the following steps: (1) Listen to the feeling; (2) Identify the feeling; (3) Listen to the thought; (4) Identify the thought; (5) Look for the trigger; and (6) Compare the trigger to the automatic thought.  Elaborating on these steps is beyond the scope of this article, but I hope this serves as a roadmap for you, as you embark on helping your patients and clients identify their automatic thoughts.

2. Discern the cognitive distortion:

In four previous articles, I described and illustrated twelve types of cognitive distortions.  Cognitive distortions underlie the types of automatic thoughts that we have.  You can consider each one of them as a theme, and under each theme are a number of associated automatic thoughts.  It, therefore, makes sense to discern the type of cognitive distortion once you have identified the automatic thought.  For you to do that, a bit of work will be required, following these simple steps: (1) Take the list of the most common cognitive distortions; (2) As much as possible, identify as many types of cognitive distortions that the automatic thought is most likely related to; and (3) Plot the identified automatic thought to the one cognitive distortion to which it is most likely related.  For your convenience, here are the 12 most common types of cognitive distortions, as I described in previous articles.  Consider putting them in a worksheet for you and your patients and clients to continue exploring.

• Should Statements

• Emotional Reasoning

• Global Labeling

• Magnifying

• Minimizing

• Always Being Right

• Filtering

• Polarized Thinking

• Overgeneralization

• Jumping to Conclusions

• Catastrophizing

• Personalization

“Automatic thoughts; cognitive distortions; what do we do next?” Vladimir, my friend and colleague who has been asking me to tell him more about cognitive distortions, is now asking, “Then, now what?” I responded to him by speaking about the steps to follow for an effective process of cognitive restructuring.

 Two of the five steps have been outlined, and you can start using them to work with your patients and clients on living a healthier and happier life.

Dr. Sidor is quadruple board certified in psychiatry, with vast clinical, teaching, supervision, mentorship, and management experience. He also has extensive experience in public speaking, leadership, business, and research, in addition to a passion for program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), where he continues to see patients and consult on challenging cases. He speaks and writes fluently in six (6) languages—French, English, Spanish, Portuguese, Creole and Italian.

References:

1. Taylor S.; Woody S.; Koch W.J.; McLean P.; Paterson R.J.; Anderson K.W. (1997). “Cognitive restructuring in the treatment of social phobia”. Behavior Modification. 21: 487–511.

2. Hope D.A.; Burns J.A.; Hyes S.A.; Herbert J.D.; Warner M.D. (2010). “Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder”. Cognitive Therapy Research. 34: 1–12.

3. Frojan-Parga M.X.; Calero-Elvira A.; Montano-Fidalgo M. (2009). “Analysis of the therapist’s verbal behavior during cognitive restructuring debates: a case study”. Psychotherapy Research. 19: 30–41.

4. Huppert J.D. (2009). “The building blocks of treatment in cognitive-behavioral therapy”. Israel Journal of Psychiatry Related Science. 46: 245–250.