What is cognitive restructuring and when is it used? - Chapter 6

How do biases arise?

Cognitive models of psychopathology assume that problems in behavior and emotion arise from biases in the interpretation or evaluation of events. Biases also perpetuate or amplify problems, as seen in depression. Cognitive biases are therefore seen as mediators in depression. The biases lead to schematic processing: the tendency to filter information through a specific lens. A schema is a concept that influences the way information is processed. For example, if someone tells you that Anne is extroverted, and you see Anne in a movie, you will find her even more extroverted and come up with additional information to confirm this image.

According to Beck's model, depression and anxiety disorders are characterized by negative automatic thoughts, which are mood-dependent. Some typical biases are: personalizing ('event was directed at me' 'it was my fault'), catastrophizing (seeing things as devastating), dichotomous thinking (black and white thinking), fortune counting (predicting the future based on little information ), discounting the positives (only looking at the negative), overgeneralizing (drawing conclusions based on one event), mind reading (attributing thoughts and feelings to others based on little information) and labeling (seeing yourself or others in terms of rigid personal characteristics or moral failure). These thoughts directly and indirectly perpetuate anxiety and depression (negative impact on behavior). Negative automatic thoughts are supported by assumptions, which consist of "should statements," "if-then statements," and other overgeneralizing guidelines. Cognitive restructuring tries to discover the automatic thoughts, the situations in which they are evoked and change the thoughts. It also tackles the assumptions.

What role do schemas play in personality disorders?

Schemas are often maintained by the confirmation bias, the tendency to select information that conforms to the schema. Schemas are also important in personality disorders. The cognitive theories of Beck, Freeman and Davis and Young's Schema-Focused Therapy look at the underlying schemas under specific personality disorders. Personal schemas are characterized by underdevelopment (in OCD, for example, spontaneity), and are often maintained by a biased perception of others (in OCD: others are careless). Young and colleagues call schemas "early maladaptive schemas", referring to the role of socialization. Schema-coping can be done by "schema maintenance" (abused as a child, and later seeking a domineering man), "schema avoidance" (later avoiding intimate relationships) or "schema overcompensation" (trying to be perfect).

Explanatory biases play a role in learned hopelessness. Learned hopelessness the tendency to attribute negative things to internal, stable causes, to generalize negatives, and to attach great importance to the particular behavior, leads to a vulnerability to depression.

What views are there about cognitive restructuring?

Cognitive restructuring is a multi-step procedure, consisting of:

• Discovering automatic negative thoughts about oneself, the world and the future.

• Formulating rational responses to the thoughts.

• Identifying and removing cognitive errors.

• Correcting false assumptions, assumptions and expectations through Socratic dialogue.

Moreover, learning coping strategies and developing positive assumptions is paramount. Cognitive restructuring is a central active part of CBT and is very succesful for depression, anxiety, PTSD and anger, among others.

The founders of CBT are Ellis and Beck, who lived during the time of psychoanalysis in which a great emphasis was on the ego. They explored a more here-and-now approach. The cognitive revolution was slow: Kelly developed "personal constructs" in 1955. The constructs he referred to are equivalent to what we now know of as schemas. Kelly indicated that psychopathology was due to differences in an individual's construction of reality. Constructs differ per person, in terms of content, openness to invalidation, and ease with which new information can be integrated. Kelly also coined the term "constructive alternativism", people differ in the ability to see alternatives or options.

In the field of developmental psychology, the idea that everything is equally associable was undermined. Chomsky pointed out that language is far too complex and universal to be learned through simple reinforcement. Chomsky argued that all humans were born with the ability to learn language, "language acquisition device (LAD)," which makes humans "language learners." In social psychology, it was found that schemas influence the way we remember things and that schemas direct attention.

Seligman introduced the idea that depression is the consequence of the perception that behaviors and outcomes are unrelated (non-contingent; no matter how hard I try, it doesn't affect the outcome). This model was adapted to a cognitive model of depression (learned hopelessness, reformulated model) under the influence of Weiner's attribution cube. According to Weiner, success on a task can be attributed to internal (skill or effort) or external factors (difficulty of the task or luck) and these factors can be stable (skill) or variable (effort). Weiner thereby integrated the idea that cognitive biases can underlie depression. According to the reformulated model, depression is a consequence of the belief that failure is due to stable internal factors, which is generalized to anything considered important. Heider's "naive psychology" in turn influenced Weiner's ideas, naive psychology was interested in how people formed psychological constructs such as intention and motivation and how people explain behavior.

According to Ellis's Rational Emotive Therapy, psychopathology comes from irrational assumptions (should statements: I need to be liked, awfulizing: it's terrible if I don't succeed, and low frustration tolerance: I can't wait). Beck tested the Freudian idea that depression came from inward frustration. Beck studied dreams of depressed people with the expectation that they would reveal a lot of anger. However, the same themes emerged as during the day: sadness, failure and emptiness. When he started to investigate these themes, he concluded that depressives have negative automatic thoughts and a negative triad: a negative image of themselves, experiences and the future. The automatic thoughts became the focus of therapy by focusing on changing and testing these thoughts.

Cognitive restructuring includes methods and techniques to change the content or credibility of thoughts (including "evaluating the evidence"). It differs from positive psychology, for example, in that it examines or tests beliefs, which can lead to the conclusion that the thought is correct. A therapist will explain the cognitive model to the client and identify the difference between thoughts and feelings. Bibliotherapy is also often used in psycho-education (giving flyers / books). Techniques in cognitive restructuring are:

• Identifying, monitoring and categorizing automatic thoughts: This often uses self-monitoring (such as thought records) of situations, thoughts, feelings and thinking errors. Clients often start to see patterns in the cognitive errors. By adding belief in a thought, it can be evaluated whether the cognitive restructuring works.
• Examining the advantages and disadvantages of the thoughts: There are often thoughts about thoughts (metacognitions), such as thinking that the thoughts also have advantages. By examining this you can discover conditional rules or assumptions, which can also be investigated.
• Defining the terms: someone can say he is a loser, when you ask what a loser is and what the opposite is, there is often a dichotomous answer: loser-winner. The advantages and disadvantages of this dichotomous view can be considered and the continuum technique can be applied. It is examined whether the client can also cite examples along a continuum of 0-100 of the construct (loser-winner). This leads to re-evaluation of the dichotomous, catastrophic thinking and seeing more proportions.
• Examining the evidence for and against the thought: CBT is about the power of realistic thinking and behavior. Essential for dealing with reality is to perceive reality accurately. Negative thoughts can be submitted to reality checks by examining the evidence for and against and weighing it against each other. The goal is not to change the thought, but to create doubt about the negative thought. A possible technique is the defense attorney, in which the client is asked if the judge would be convinced of the evidence for the negative thought.Vertical descent: The first negative thought is usually not the most annoying, requiring the therapist to dig deeper. One technique for this is vertical descent, constantly asking “if that is true, what would that mean for you?” “What would happen?” “Are there any alternatives?” “How likely is that to happen? '. The information that comes out often leads the client to realize that the thought is absurd.
• Rational role-play against the belief: discovering underlying negative defenses of automatic thoughts through role-playing. The client can take the position of the positive, negative or alternative response and argue against or in favor of this response. This often brings up other defenses or assumptions, which can also be examined for advantages and disadvantages, prove that it works and then investigate alternatives.
• Double-standard technique: people are reasonable when they judge others, but harsh and critical when they judge themselves. The double-standard technique examines the nature and reasons for holding a particular standard for oneself and a much looser standard for others. Again, role plays can be used (what if you were someone else?) And the thoughts or assumptions that emerge can be re-examined.
• Behavioral experiments to test belief: This is part of collecting and examining evidence of negative thoughts. An advantage of behavioral experiments is that it directly challenges the thought and can provide disproving evidence. It is also a way of behavioral activation. Specific expectations are set which can be investigated. Various forms of behavioral experiments are exposure (how long do you think anxiety will last at 95%), ability to get work done (how much do you think you can do?), Predicting pleasure (how enjoyable will it be?) Or predicting discomfort (how unpleasant will it be?).
• Develop adaptive thoughts and strategies: When a client has discovered, explored, and challenged negative thoughts, more adaptive thoughts and behaviors become the focus of attention. Things that can help with this are "coping cards" (for example negative thoughts on the one hand, more rational, helpful thoughts on the other), specific plans or a "bill of rights", which says "more acceptance of self". More adaptive schemas can also be identified.

Thoughts do not occur in isolation, but are related to behavior, emotions and environment. Therefore, cognitive restructuring is used in conjunction with principles that address the other modalities and with the understanding that there is a bidirectional influence between the modalities (change in one domain also affects the other domain). Behavioral activation, for example, also leads to changes in thoughts by breaking the negative circle. It also helps to discover and set goals and apply (behavioral) strategies to reduce worry, which is all cognitive. This makes it difficult to say whether the addition of cognitive restructuring is necessary, because changes in cognitions take place even without this element and therapy is effective. It is also questioned whether it is necessary to "change" thoughts. Acceptance and Commitment Therapy (ACT) states that emotional problems do not come from the content of thoughts, but the context of thoughts (how the person sees the thought). ACT therefore tries to distance people from negative thoughts (mindfulness, acceptance) and not actively challenge them, just as in Dialectical Behavior Therapy (DBT), which uses acceptance-oriented strategies.

Cognitive models of psychopathology assume that problems in behavior and emotion arise from biases in the interpretation or evaluation of events. Biases also perpetuate or amplify problems, as seen in depression. Cognitive biases are therefore seen as mediators in depression. The biases lead to schematic processing: the tendency to filter information through a specific lens. A scheme is a concept that influences the way information is processed. For example, if someone tells you that Anne is extroverted, and you see Anne in a movie, you will find her even more extroverted and come up with additional information to confirm this image.