Cognitive Restructuring

Description of the Strategy

Cognitive restructuring is an approach to therapy based on learning theories that emphasize the role of cognitions, or thoughts. These theories share much in common with more behaviorally based approaches that focus on the role of environmental stimuli and consequences in the learning process. For example, both behavioral and cognitive theories highlight the role of learning in the development of psychological symptoms and disorders. They also both emphasize an empirical approach, relying on research findings to make conclusions about how psychological problems develop and how best to treat them. However, cognitive theories suggest that learning is mediated by thoughts: People learn to behave in certain ways and to experience particular feelings based on what they think is happening in the environment or on their expectations about consequences that will occur, rather than on cues and outcomes that actually exist. For example, if an individual believes that “stepping on a crack” will cause some untoward outcome, he or she may be anxious about doing so and try hard to step over cracks in the sidewalk, even though no real connection can be made between this type of behavior and a negative consequence.

Thus, cognitive theories suggest that the primary determinants of behaviors and feelings are thoughts. Accordingly, cognitive therapy (or cognitive restructuring) emphasizes the importance of modifying thoughts to change unhealthy behaviors and feelings. Despite a major emphasis on the role of cognitions, however, cognitive theories also acknowledge the reciprocal impact that behaviors and feelings can have on thoughts. As a result, most variations of cognitive therapy incorporate some attention to direct behavioral change.

Specific versions of cognitive therapy have been developed to address a variety of psychological problems (e.g., depression, anxiety, eating disorders, substance abuse), and each of these varies slightly with regard to the types of approaches used and thoughts targeted (e.g., thoughts about body size and shape in eating disorders, thoughts about pending danger in anxiety). However, all cognitive interventions share a common focus on the identification and change of maladaptive thoughts and the process of thinking. In addition, all cognitive therapy is goal oriented, with a focus on helping patients cope with ongoing problems, rather than on understanding historical events in their lives. The cognitive therapist assumes an active and directive role, working collaboratively with patients to identify and practice new coping strategies. Patients typically are asked to complete homework, usually focused first on increasing their awareness of and ability to identify thoughts that lead to psychological difficulties. Practice exercises in later phases of therapy emphasize the use of coping skills aimed at changing problematic thoughts in situations that produce unhealthy feelings or behaviors. It is important to note that cognitive therapy does not just teach patients to “think positively.” Instead, patients are asked to identify irrational or unrealistic thoughts associated with negative feelings or unhealthy behaviors (e.g., “I can't do anything right”) and to modify these so that they are more realistic (e.g., “I do some things well and other things not as well”). In addition, cognitive therapy does not typically include attention only to changing thoughts; rather, patients often are asked to try out new behaviors while they practice new ways of thinking.

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