A Beginner’s Guide to Cognitive Restructuring

Do you often find yourself stuck in your own head, caught in endless spirals of negative thinking?

• Maybe it’s an overly-judgmental inner voice that constantly points out past mistakes and perceived faults.
• Or maybe it’s perpetual worry about the future and comparison to other people.

For many of us, negative thinking patterns like this cause tremendous emotional suffering and misery. In fact, they’re the key drivers of both depression and anxiety.

And while negative thinking can feel completely automatic and outside our control, with the right practice and techniques, you can learn how to re-train your mind’s habitual way of thinking and free yourself from the burden of negative self-talk. In fact, this is what I do every day with my clients in my clinical practice as a psychologist.

In this guide, I’ll walk you through exactly what Cognitive Restructuring is and what it looks like. Then we’ll go step-by-step through the process of using Cognitive Restructuring yourself to identify, modify, and ultimately free yourself from your own negative thinking patterns.

TABLE OF CONTENTS

You can use the following links to jump directly to a specific section of the guide:

1. What Is Cognitive Restructuring, Exactly?
2. How to Do Cognitive Restructuring: A Step-by-Step Plan
3. How to Use a Thought Record to Do Cognitive Restructuring
4. Case Study: How Julie used Cognitive Restructuring to lower her worry and anxiety
5. Summary & Key Points

What is Cognitive Restructuring, Exactly?

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Cognitive Restructuring is a core technique in Cognitive Behavioral Therapy, the most well-studied and effective approach to treating the most common mental health issues like anxiety and depression. And while it’s commonly used to treat clinical disorders like anxiety and depression, it can be just as useful to anyone who struggles with overly-negative thinking patterns and self-talk.

Cognitive Restructuring is based on the principle of cognitive mediation which says that how we feel emotionally is not the result of what happens to us, but instead, it’s the result of how we think about what happens to us. This means that we can change the way we feel by changing the way we think about what happens to us.

Here’s an example from a recent therapy client of mine:

I was browsing Facebook one evening before bed and notice that my best friend had posted about how much funshe had had with another one of our friends earlier that day. I immediately feel sad and a little angry because I had just spent the previous day with her and had a great time but she didn’t post anything about our day.

Before I knew it, I was thinking about all the reasons my best friend might not really be as good a friend as I thought and secretly want to ditch me as a friend. I had been perfectly happy all evening, and within 3 minutes, I was an anxious, despondent mess!

Cognitive Restructuring would help my client make sense out of this difficult experience by helping her to organize what happened and modifying her initial thoughts:

• What happened? Notice that it was the Facebook post triggered or set off the whole chain of events and bad mood.
• What were the initial thoughts? My client explained that as soon as she saw the Facebook post, two thoughts popped into her mind: Why didn’t she comment on our day yesterday? She must not have had as much fun with me.
• What were the initial emotions? She described feeling mostly angry at first, with a little sadness and fear mixed in as well.
• Can you come up with some alternative ways of thinking about what happened? Maybe she did post about our day together but I just didn’t see it because of Facebook’s algorithm. I didn’t post anything about our day together but that doesn’t mean I didn’t have a good time. Etc.
• How are you feeling now? After generating these alternative thoughts about what happened, my client explained that she was still a little upset, but definitely not as much.

Why Cognitive Restructuring Works

Using the example above as a reference, let’s take a look at how Cognitive Restructuring encourages us to do several very helpful things when we’re upset and trying to break free from negative thinking patterns:

• It helps us get organized mentally. Just like making a to-do list helps us feel more organized when we’re working on a big project, Cognitive Restructuring helps us feel better by getting our mental space better organized.
• It forces us to slow down. Every negative thought leads to a corresponding “dose” of negative emotion. If you can slow down your thinking and have fewer thoughts, you’ll end up with less emotion.
• It helps us be more aware. Thoughts and the emotional reactions they produce can happen quite automatically. Cognitive Restructuring helps us notice and become more aware of our mental habits, which is an essential step in eventually modifying them.
• It gives us a sense of agency and control. By noticing our default thinking patterns as just that, a default, and then generating new alternative thoughts, we change negative thoughts from something uncontrollable that happens to us to things we actually have a good amount of control over.
• It helps us think more clearly and rationally. By encouraging us to question and examine our initial line of thinking, Cognitive Restructuring helps us to see errors or mistakes in the way we’re thinking. As we’ll see in a later section, identifying “Cognitive Distortions” is a key ingredient in managing our negative thinking patterns and moods better.
• It helps us reflect instead of reacting. When we’re upset, it’s natural to just react: worry more, crack open another beer, distract ourselves with YouTube, etc. Aside from the negative effects that go along with some our favorite reactions to being upset (“empty” calories, wasted time, etc.), by always reacting without reflecting, we deprive ourselves of the opportunity to better understand our minds and learn how they work. Which of course is important if we want them to run more smoothly.
• It breaks bad mental habits. We can get into mental habits (like worry) just as easily as we can get into physical habits like twirling our hair or biting our lip. The key to breaking those habits is to notice when we start doing them and substitute a different behavior. Cognitive Restructuring does just that: it forces us to notice bad mental habits and replaces them with better ones.

These are just some of the mental skills that Cognitive Restructuring helps us to build.

Now that we have a better idea of what Cognitive Restructuring is, what it looks like, and why it works, let’s move on to how to actually do it.

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#How to Do Cognitive Restructuring: A Step-by-Step Plan

Now that we’ve talked a little bit about what Cognitive Restructuring is, what it looks like, and what some of the benefits are, it’s time to dive into the nuts and bolts of actually doing it.

A quick note before we jump in: Like running on the treadmill or practicing scales on the piano, the power of Cognitive Restructuring comes from doing it consistently over time. Simply understanding it and doing it occasionally is not enough. For Cognitive Restructuring to have a meaningful effect on your life, it must be done consistently and become a habit.

With that in mind, here are the 6 basic steps to follow in order to do Cognitive Restructuring.

STEP 1: Hit the pause button.

Cognitive Restructuring can be useful in many situations. But the best time to use it is when you notice that you’re feeling a strong negative emotional reaction to something, especially if your response seems out of proportion to what happened.

Our typical way of responding to a sudden wave on negative feeling is to act on instinct:

• Feel angry → lash out
• Feel anxious → hide
• Feel sad → have a beer

An alternative is to use sudden, strong emotion as a cue or reminder to “hit the pause button” instead. Then, once you’ve briefly paused, ask yourself: What’s going on here?

When we can inhibit our instinctive response to negative feeling and approach it with an attitude of curiosity, our chances of managing the situation intelligently go way up.

STEP 2: Identify the trigger.

Once you’ve used sudden, strong emotion as a cue to pause, the next step is to identify what event triggered your response in the first place.

A triggering event is often something that happens in our external environment: A coworker makes a sarcastic comment, our spouse gives us “the look,” a car cuts us off on the freeway, etc.

But events in our internal environment — that is, in our minds — can also act as triggers: A thought pops into mind that we forgot to mention a critical idea during the meeting, a memory of a recently deceased friend comes to mind, etc.

To help identify the triggering event in a given situation, use who, what, when, where:

• Who is or was present with me at the time I got upset? Because we’re social animals by nature, people often play either a direct or indirect role in our emotional reactions.
• What happened? Literally, what sorts of things happened to me leading up to feeling upset. Remember that no detail or fact is too small to be influential. The trigger doesn’t have to be something big and obvious — in fact, often it’s something quite small and subtle.
• When did I first start feeling upset? What happened immediately before this? This question is particularly important if you’re doing Cognitive Restructuring hours or days after the fact.
• Where did it all occur? Often the initial triggers for becoming upset are a part of or connected to our physical environment.

STEP 3: Notice your automatic thoughts.

Automatic Thoughts are our default, initial interpretations of what happens to us. They’re almost always spontaneous (I.e. we didn’t initiate them) and typically take the form of verbal speech in our mind or sometimes images and memories.

For example, if someone cuts you off while driving, your automatic thought might be “What a jerk!” Or, if you see an email from your boss late at night, your automatic thought might be “Oh no! What’s wrong?! I must have forgotten something earlier.” Or perhaps seeing a billboard advertisement for a funeral home triggers a memory of your father’s funeral — what it looked like, how you felt, etc.

We all have automatic thoughts all the time. And most of the time we either don’t notice them at all or we’re only vaguely aware of them. When not comes to Cognitive Restructuring, it’s important to build the habit of becoming more aware of our automatic thoughts and really examining them closely.

STEP 4: Identify your emotional reaction and note how intense it is.

Emotions are generated from our mental interpretations of things that happen. And the type and intensity of the emotions we experience depend almost entirely on the type of thinking we engage in.

For example, using the example from above of being cut off while driving: If your thought is “What a Jerk,” you’re likely to feel angry. If your thought is “That son of a B*tch! What the hell is he thinking?!” you’re likely to feel an even stronger form of anger, perhaps bordering on rage.

On the other hand, if your automatic thought was “Oh my God, he almost hit me! I’m going 70 miles an hour — I would have died!” You’re much more likely to experience something like fear or anxiety.

Finally, your emotional response can contain more than just one emotion. If your automatic thought had been, “What a jerk! He almost hit me?!” You’d probably experience some mixture of anger and anxiety. In this case, it’s good to note both but typically there will be one that’s stronger or more dominant.

STEP 5: Generate alternative thoughts.

This is the crucial element in the whole process. Once you’ve identified a trigger, noticed your automatic thoughts about that trigger, and taken note of your emotional reaction, the next step is to come up with alternative thoughts for each of your initial, automatic thoughts.

For example, sticking with the car example from above, instead of “Oh my God, he almost hit me! I’m going 70 miles an hour — I would have died!” You might construct an alternative thought like “Wow that was scary! He got pretty close to hitting me but I’m a pretty good driver and probably could have handled it.”

Or, instead of “What a jerk! He almost hit me?!” You might say something like “Maybe his wife is going into labor in the backseat and he’s on his way to the hospital?!”

In any case, the important thing is to simply be flexible and come up with more interpretations than your first automatic one. This practice creates mental flexibility, a key component in the ability to disengage from negative thinking patterns and overwhelming emotion.

Also, in addition to simply generating more alternative interpretations or explanations of what happened, it can be useful to notice any obvious errors in your initial thoughts and develop alternative thoughts that are more realistic.

For example, if you’re automatic thought was “Oh my God, he almost hit me! I would have died!” you might point out to yourself that “I would have died” is far from certain, even if he had hit you and substituted a thought that contains something about how you’re a good driver and it’s very possible that you could have acted soon enough to prevent an accident.

If possible, generate at least two or three alternative thoughts for each overly-negative automatic thought.

STEP 6: Re-rate the intensity of your emotional response.

After generating multiple (hopefully more realistic) alternative thoughts, return to your emotion(s) you identified in Step 4 and reassess their intensity. Almost always, they will have gone at least modestly as a function of questioning your automatic thoughts and generating alternative and more realistic ones.

This final step is crucial because noticing and feeling the relief of your negative emotion decreasing is an important reinforcer of the new habit of Cognitive Restructuring. In other words, you’re much more likely to stick with it as a habit and benefit in the long-term if you get the reward of even slightly lower negative feeling as a result.

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How to Use a Thought Record to Do Cognitive Restructuring

The 6 steps mentioned above are a good overview of the elements of Cognitive Restructuring and how to do it in a general way. But when we’re first starting out, it’s helpful to have a specific template for guiding us through the steps. And that’s exactly what a Thought Record is for.

A Thought Record simply a guide for walking you through the specific elements and steps of Cognitive Restructuring. Often it takes the form of a paper worksheet like this:

But you can also do a Thought Record digitally in a notes file on your phone, perhaps something like this:

Finally, if you really want to see how a Thought Record looks, here’s a video of me doing an example:

A few more thoughts about getting started with a Thought Record

If you’re just getting started with Cognitive Restructuring and Thought Records, I actually recommend the paper and pencil approach, at least in the beginning.

Research shows that taking notes with Pen and paper leads to better encoding and memory for the subject matter, which is essential early on when you’re trying to learn the overall technique.

However, the digital version on your phone is often more discreet, which can be nice if you want to quickly do some Cognitive Restructuring in a public place, for example.

You can use a Thought Record any time you want to do Cognitive Restructuring. In the beginning, it’s usually best to always do your Cognitive Restructuring in the form of a Thought Record so that you can learn the process. Eventually, once you’ve had enough practice, you’ll be able to walk through the entire six steps in your head.

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Case Study: How Julie used Cognitive Restructuring to lower her worry and anxiety

As a way to tie this article together, I wanted to offer a practical, real-world example of how Cognitive Restructuring actually looks.

The following example came from my own work with one of my former clients.

Julie the chronic worrier

Julie was a client of mine who struggled with chronic and severe anxiety.

I remember the day I met her Julie described how she felt like her mind was her own worst enemy, constantly attacking her with negative, worst-case-scenario thoughts about herself and her future.

When I asked Julie to tell me some of her worries, she listed a few recent examples of the kind of negative thoughts and self-talk that were common for her:

• What if Abbey (her daughter) gets in a wreck on the way to school? I might never see her again.
• Why can’t I get my mind to stop all these negative thoughts? What’s wrong with me? What if it gets so bad that I lose touch with reality and just go crazy?
• She thinks I’m anxious. I bet that’s why she didn’t smile when I walked in. I always screw up interviews. This is going to be a disaster. I’ll never get the job.

Needless to say, with a near-constant stream of negative thinking like this going on in her mind, Julie was extremely anxious.

Julie’s mother-in-law anxiety

After describing what Cognitive Restructuring was and what it looked like, I asked Julie where she thought it would be most useful in her life. After thinking briefly, she explained that she had the most severe worry and anxiety whenever she had to interact with her mother-in-law who she found to be a very negative, judgmental, and difficult person to get along with.

This was an especially big problem for Julie because her in-laws lived in the same neighborhood and she was constantly seeing them. For Julie, the worst part was the hour or so before she had to interact with her mother-in-law.

When I asked her what kind of thoughts she experienced during this hour leading up to a visit, she mentioned things like:

• What if she asks me about my job again? I’ll probably stick my foot in my mouth as usual and come across as an even bigger airhead.
• I don’t know what to wear? She’s always dressed so well and I never look put together. I’m sure she thinks I’m a complete mess.
• What if I get so anxious that I start getting stomach issues? I don’t want her to see me going to the bathroom dozens of times. What if I can’t wait and I lose control…?

The first thing I encouraged Julie to do was make a plan for remembering to do her Cognitive Restructuring during these high anxiety times before a visit with the mother-in-law. Because her husband was usually with her on visits like this, she asked him to help remind her to do it if she seemed anxious.

Next, we reviewed her plan for using a Thought Record. She preferred the pen and paper version, and I suggested she make a bunch of copies and keep them in her house and car so that she’d always have some available and close by.

Julie’s success with Cognitive Restructuring

When Julie came back to see me one session after a visit with her mother-in-law we talked about how it went doing Cognitive Restructuring. She explained that at first, it was hard to even get started because she was so anxious. She even found herself worrying that she wasn’t doing it right and that it wouldn’t work.

I reassured her that that was a completely normal response — literally everybody worries that they’re not doing it right the first few times!

Next, she described how she had remembered to pause and check in with herself (Step 1) before leaving for her in-laws. For her, the feeling of anxiety was a good cue and reminder to begin Cognitive Restructuring.

After that, she walked through how she tried but struggled to identify the trigger for her worry (Step 2). After working our way backward from a point when she knew for sure that she was anxious, we discovered that her worry first started after her husband asked what color shirt she liked better for their dinner at his parent’s house.

The next step of identifying her negative automatic thoughts (Step 3) was even more difficult she explained, mostly because they were going so fast and she was also thinking about all the things she still needed to do to get ready. But, she explained that once she started writing down a few thoughts, she felt her thinking noticeably slow down, which was a relief.

She went on to explain that the thought that kept coming up was: It’s going to be miserable. She even explained that she was able to identify the cognitive distortion of Fortune Telling — predicting the future without any substantial evidence.

Next, she identified anxiety as her dominant emotion and rated it as a 7 out of 10 (Step 4).

Julie then told me how the next step in the process was the hardest part — generating alternative thoughts (Step 5). For a while, her mind just felt blank. But as she sat with it, she realized that her initial though — It’s going to be miserable — was an overgeneralization in addition to fortune telling. She was assuming that every aspect of the visit was going to be miserable. But in reality, she realized, there were parts of it that were not and that she even enjoyed (he father-in-law was very funny and good-natured, and the food was always excellent at her in-laws).

This realization helped her get started with some alternative thinking:

• Having to interact with Sharon (the mother-in-law) will probably be rough, but it’s always fun chatting with Bruce (the father-in-law).
• Tim (her husband) mentioned that we were having ravioli for dinner, which I love.
• I’m usually more anxious anticipating the visit than the visit itself.

Finally, Julie thought about her anxiety. And while it was still there, it was a little bit lower (5.5 out of 10). And even though she still felt anxious, she remembered feeling encouraged by the fact that it had worked, even a little.

A few key takeaways from Julie’s story

A few key points from this case-study:

• One of the most important points about getting started with Cognitive Restructuring is that you start small. Julie didn’t just try to do Cognitive Restructuring everywhere, all the time. Instead, she picked a particular area in which she struggled and worked on it there first.
• Julie was experimental. When she first tried her Cognitive Restructuring, there were multiple moments of doubt and confusion. The important thing was that she stuck with it and just did something.
• Even though she didn’t need it, she had a plan for remembering to do her Cognitive Restructuring in the first place.
• Julie discovered that she didn’t have to have all her anxiety go away to find the exercise helpful. The confidence that came from learning that she could start to make a positive difference in her self-talk and negative thinking was huge for her, even if her anxiety reduction was fairly modest.

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Summary and Key Points

Cognitive Restructuring is a powerful technique for reducing negative thinking patterns and whatever stress, anxiety, or other negative emotions and moods they create.

By learning to practice identifying and restructuring these habitual ways of thinking, we can not only start to feel better in the moment, but in the long-run, we can train our minds to think about the world in a more realistic and balanced way.

Here are the 6 basic steps in Cognitive Restructuring:

1. Hit the pause button.
2. Identify the trigger.
3. Notice your automatic thoughts.
4. Identify your emotional reaction and how intense it is.
5. Generate alternative thoughts.
6. Re-rate the intensity of your emotions.

Finally, remember that the power and benefit of Cognitive Restructuring come from the consistent practice of doing it.

Understanding is never enough; practice leads to change.

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Originally published at nickwignall.com on April 8, 2019.