DESCRIPTION OF THE STRATEGY

Cognitive restructuring is a broad term encompassing a variety of procedures designed to

eliminate maladaptive thinking patterns and increase the frequency of constructive thoughts
and beliefs. The roots of cognitive restructuring may be traced to cognitive psychology.
Cognitive theorists proposed that most learning in humans is cognitively mediated (i.e.,
thoughts influence perceptions and behavior). A major tenet of cognitive therapy is that
through the modification of clients' thought processes, their belief systems will be altered, and
this ultimately will result in changes in overt behavior and emotional processing.
The work of Albert Ellis was quite influential with respect to the development and
proliferation of cognitive and cognitive-behavioral therapies. Ellis termed his approach
rational emotive therapy (RET). According to Ellis, psychological disorders are the product
of irrational thinking patterns. For Ellis, irrational thoughts are those that could be considered
self-defeating in that they reduce opportunities for fulfillment and adaptive functioning.
Categories of irrational thoughts include thinking that one must receive approval from
everyoneall the time, one must succeed in every task, that it is catastrophic when something
does not go one's way; and that things will always be the same, nothing will ever get better.
Treatment involves the therapist challenging these faulty beliefs and assisting the client in
substituting more rational thoughts.
Other theorists whose work was highly influential in setting the stage for the development of
cognitive restructuring procedures included Aaron Beck and Donald Meichenbaum. Each
emphasized the importance of cognitive processes to socioemotional functioning and the need
to address maladaptive cognitions in an effort to reduce symptoms of psychological disorders.
In 1974, Goldfried and colleagues detailed a more structured form of RET, which they
referred to as systematic rational restructuring (SRR). Essentially, SRR was a set of specific
operational procedures for obtaining the type of cognitive change noted as essential within
RET. Subsequently, in their text on therapeutic strategies, Cormier and Cormier classified
strategies designed to effect cognitive change under the umbrella term cognitive
restructuring. The term has been used since that time to refer to various techniques intended
to enhance more adaptive thinking on the part of clients.
A typical cognitive restructuring procedure includes the following elements: the therapist
provides the client with the theoretical rationale underlying the procedure and outlines how
the therapy will take place; through formal assessment and discussion, the therapist identifies
the client's maladaptive thoughts, perceptions, and beliefs; the therapist models more adaptive
coping thoughts; the client practices adaptive coping thoughts when faced with the occurrence
of irrational thoughts; and ultimately the client is taught to go beyond coping, to the induction
of more pervasive positive self-talk intended to enhance self-concept. Imagery and role play
may be used to facilitate cognitive rehearsal. Homework assignments typically are a routine
part of cognitive restructuring therapy in an effort to increase generalization and maintenance.
Self-monitoring logs or diaries assist the client in identifying irrational thoughts as well as
antecedents and consequences. Two complementary goals of cognitive restructuring are (a) to
help clients learn to cope more effectively when in stressful situations and (b) to alter clients'
belief systems so that situations that once would have been perceived as stressful will no
longer be seen as such, should they arise in the future. It is the second goal that would be
indicative of successful restructuring per se.

RESEARCH BASIS
Numerous research studies have been conducted on the efficacy of cognitive restructuring
procedures. In general, cognitive restructuring strategies have demonstrated success in the
treatment of a diverse array of psychological symptom states, including depression, test
anxiety, speech anxiety, social anxiety, panic, assertiveness problems, and posttraumatic
stress. However, it should be noted that within most treatment outcome studies, cognitive
restructuring was used as a component in a treatment package rather than the sole therapeutic
strategy. A limited number of studies have attempted to compare the effectiveness of cognitive
restructuring versus exposure-based strategies in isolation. With respect to the treatment of
anxiety disorders, cognitive restructuring techniques have tended to yield similar results in
terms of symptom reduction as have exposure-based strategies. Mixed results have been
found regarding potential enhanced benefit of using exposure and cognitive restructuring in
combination. Furthermore, the positive benefits of cognitive restructuring tend to be more
pronounced for self-report data than for measures of behavioral change (e.g., direct
observation, behavioral performance tasks).

RELEVANT TARGET POPULATION

Theoretically, cognitive restructuring procedures would seem to be most appropriate for
psychological disorders in which cognition plays a substantial part. The negative thinking
patterns characteristic of individuals suffering from depression and anxiety perhaps would
suggest that these populations would be among those who would benefit most from cognitive
restructuring procedures. Persons experiencing phase-of-life and adjustment reactions also
may benefit from promotion of more rational-based modes of thought.

COMPLICATIONS
Implicit in the successful conduct of cognitive therapy is that clients have the capacity for
sufficient metacognition (thinking about thinking). Clients must be able to identify (and report
to the therapist) how they think, feel, and behave. Clients must possess sufficient logical
reasoning skills to engage in formal problem solving. Memory must not be impaired to any
significant degree. Clients must be oriented to reality and not actively psychotic. Furthermore,
the therapeutic process requires that clients be motivated to change (limited success will be
effected for clients ordered to therapy under duress, as in the case of criminal offenders or
parents referred for issues of abuse and neglect).
It should be apparent that cognitive restructuring should be used with young children only
under limited and highly structured situationsif at all. Young children do not possess
sufficient metacognitive ability to be active participants in the cognitive restructuring process.
More efficient behavioral strategies should be considered when working with preadolescent
children.

CASE ILLUSTRATION
Alex was a 16-year-old boy who was referred by his school counselor for treatment of
social anxiety. He reported (and his parents confirmed) that he has felt shy most of his life.
Over the past 2 years, however, his social anxiety had become much more pronounced. Alex

did not want to attend school on days he was expected to participate in public speaking tasks.
He would have liked to obtain a part-time job after school but was unable to make phone calls
to inquire about positions and was terrified of undergoing a job interview. Most of his friends
had begun dating. Alex very much liked to date and participate in social activities, but the
very thought of asking a girl out made his stomach churn, his head spin, and his palms sweat.
Alex was convinced that his peers thought he was a dork, and he felt utterly incompetent.
Comprehensive assessment was conducted following intake. Alex obtained extreme
elevations on self-report measures of social anxiety. Parent reports and teacher reports
corroborated Alex's self-reportsand all measures indicated social anxiety as the primary
concern. Structured diagnostic interview confirmed that Alex met criteria for social anxiety
disorder. While Alex did not meet full criteria for any other disorders, he was experiencing
symptoms of mild depression that seemed to be a consequence of his increasing social
isolation. Behavioral performance tasks indicated that Alex possessed the basic social skills
required to be a functional teenager but was inhibited in engaging in certain social behaviors
in the natural context due to severe anxiety.
Treatment involved targeting and disputing Alex's irrational beliefs regarding his level of
social competence and how others perceived him. Alex experienced intense fear of negative
evaluation. The therapist helped him see that all individuals make a social faux pas from time
to time, that these mishaps are rarely catastrophic, and that what is important is that he learn
to roll with these situations when they occur and not retreat socially. Since not all teenagers
are as gracious with their peers as we would like them to be, Alex and the therapist roleplayed situations in which he was made fun of by others. This allowed Alex to practice
positive coping statements, which later helped him to handle real-world stressorswhich
were never as bad as he had expected them to be. Over the course of 14 weekly sessions (and
accompanying homework assignments), Alex learned to hold more realistic expectations and
to see himself in the way that others saw him: a bright, funny young man with a positive
future. His scores on social anxiety measures fell within normal limits, and the symptoms of
depression had all but abated. While therapy was considered a success, Alex and his parents
were informed that symptoms of social anxiety might reoccur with certain developmental
transitions (e.g., going away to college), and if that were to happen, it should not be looked
upon as a failure; instead, it should serve as an impetus for a brief booster course of therapy.
Once clients gain skill in disputing irrational thinking, they tend to progress through
subsequent courses of therapy with even greater ease.
Tracy L. Morris
Further Reading

Entry Citation:
Morris, Tracy L. "Cognitive Restructuring." Encyclopedia of Behavior Modification and
Cognitive Behavior Therapy. 2007. SAGE Publications. 15 Apr. 2008. <http://sageereference.com/cbt/Article_n2029.html>.