Symptoms of Stress, Anxiety and Panic? Depressed? Let’s Chat Cognitive Restructuring

“I‘m depressed, and I have big-time symptoms of stress, anxiety and panic. You tell me, ‘wise counselor,’ I need to change how I think. And just how might I do that?!”

As a counselor, I believe in the power of cognitive work – with or without the behavioral piece. Very boiled down, it’s all about the role our thoughts play in how we feel and behave. To effect change, it’s crucial to acknowledge our irrational/maladaptive automatic thoughts and cognitive distortions. However, doing that – and nothing else – will get us no where fast.

And that leads me to what I believe is the “Holy Grail” of cognitive work. So great, we’ve acknowledged the automatic thoughts and cognitive distortions doing us the disservice. Now what? Oh, it’s easy for a counselor to suggest a client change how s/he thinks. Uh, but how does one actually do that?

Cognitive Restructuring

In therapy, cognitive restructuring (CR) is the process of identifying and disputing our automatic thoughts, cognitive distortions, and assorted thought barriers. To get us started, let’s take a look at CR’s four steps…

1. Identification of irrational/dysfunctional automatic thoughts
2. Identification of the cognitive distortions contained in those automatic thoughts
3. Disputing automatic thoughts
4. Development of rational rebuttal to automatic thoughts

Now, then, automatic thoughts come in assorted flavors within these categories…

1. Self-evaluated thoughts
2. Thoughts about the evaluations of others
3. Evaluative thoughts about the person with whom one is interacting
4. Thoughts about coping strategies and behavioral plans
5. Thoughts of avoidance
6. Other thoughts that aren’t categorized

CR can be used within the context of several therapeutic models. We’re going to work with it within the cognitive behavioral therapy (CBT) realm. There, CR is often combined with psychoeducation, monitoring, one’s specific life experiences, exposure through imagery, behavioral activation, and homework assignments.

Sure makes sense that CR has its own methodology. Some of the more common strategies and techniques…

• Socratic questioning: A method of questioning and discussion between individuals (e.g. client/counselor) based upon asking and answering questions in an effort to stimulate critical thinking and illuminate ideas. Often, the defense of a point of view is questioned (“I’m a failure!”), which may lead the individual to somehow contradict her/himself. This, of course, strengthens the point of the inquirer. You know, I’d submit we can have Socratic questioning exchanges with ourselves.
• Thought recording: Maintaining a record of one’s thoughts, including details such as where one was when the thought occurred, the emotion/feeling generated, the negative automatic thought, evidence that supports the thought, evidence that doesn’t, an alternative thought, and the emotion/feeling generated.
• Examining the evidence using, say, a pros and cons analysis.
• Reattribution: Challenging one’s tendency to relate external events to self, encouraging the individual to correctly attribute the “blame,” as opposed to taking it on.
• Guided imagery: A program of directed thoughts and suggestions that guide the imagination toward a relaxed, focused state. An instructor, recordings, and/or scripts can be used to facilitate the process.
• Decatastrophizing: Often called the “What if?” technique, it consists of confronting the worst-case scenario of a feared event or object, using mental imagery to examine where and how the effects of the event or object have been overestimated (magnified or exaggerated) – and where one’s coping skills have been underestimated. The essential question here is “What if the event or object happened – then what?”
• Cognitive Rehearsal: One imagines a difficult situation and is guided through the step-by-step process of facing and successfully dealing with it. Then it’s on to mental practice/rehearsal.
• Listing rational alternatives.

Okay, so enough of the psychobabble. How ’bout some real-world applications? Check-out this article from psychologist Alice Boyes, PhD from Psychology Today: “Six Ways to Do Cognitive Restructuring.”

If you’re depressed, or enduring symptoms of stress, anxiety and panic – cognitive restructuring can bring you tons of relief. Sure, your therapist can facilitate; however, you can absolutely do the work yourself.

So get after it, okay?!

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