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

Symptoms of Stress

“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?!

If you enjoyed – and found meaning in – this piece, there’s plenty more where it came from. Check-out some titles!

  • Leslie Ferris August 6, 2013, 11:35 am

    Bill, this is a great summary for people structured in such a way that it is easy to read and understand. It demystifies a big and kinda potentially scary phrase like ‘cognitive restructuring’. There is a lot of common sense in here!!! Thanks for sharing this.

    • chipur August 6, 2013, 1:36 pm

      Hey, Leslie – thanks for your visit and participation. Actually, I wanted it to be an easy to digest and use “go to” resource for those having a rough go (for clinicians too?). Glad it came across that way!!!

  • Patricia Miller August 6, 2013, 11:39 am

    This whole article makes me happy because it lines it out so I can “do” something to feel better. Feeling tossed to and fro on the sea of emotions is a scary thing. Your beautifully outlined guide simplifies things enough that I could take even just one piece and try it and cling to it like a life preserver for a little while until I feel like I can swim again. Thank you for providing a lovely beacon today.

    • chipur August 6, 2013, 1:38 pm

      It’s always my pleasure (and honor) being that “beacon.” I’m pleased you found the details simple, so you can grab pieces and give them a go. You know how much I appeciate your visits and contributions, Patricia!

  • Cathy | Treatment Talk August 7, 2013, 10:38 am

    This is wonderful information Bill about cognitive restructuring. You have really broken it down in an understandable form. Thank you!

    • chipur August 7, 2013, 11:10 am

      Well, thank you, Cathy. I think it’s life-applicable stuff – and wanted to make it right-now user friendly. Thanks for your visit and comment…

  • Dr. Herby Bell August 8, 2013, 8:35 pm


    I’m with Patricia’s happiness and somehow delighted because #1, there are dedicated professionals like you who deliver such effective work and #2, because it reminds me of the discipline of the practice of Buddhism and that we truly DO have it all on-board available to practice anytime, one day at a time.

    Thank you, Bill. I’ll re-read this post a few times and then–for the top drawer archives.

  • Lisa Frederiksen August 9, 2013, 12:09 am

    Excellent description of cognitive restructuring, Bill, and most importantly, how one goes about it. I spent three years working with a therapist who specializes in addiction – especially as it affects the family members of the person with addiction – in a manner as you’ve described here, “…work with it (CR) 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.” It was a TREMENDOUS help in my recovery from secondhand drinking and frankly saved the quality of my life. Thanks for explaining CR in such easy-to-follow terms – it’s sure to help others!