Cognitive Restructuring: How It Works, Tips, & Effectiveness

What Is Cognitive Restructuring?

Cognitive restructuring (CR), also called cognitive reframing, is a way to address and challenge people’s thoughts, especially if they engage in negative self talk and patterns of thinking. CBT suggests that people experience beliefs or feelings related to an occurrence in an objective situation; after experiencing negative thoughts or feelings, they may act or react in an unhealthy, negative, and potentially harmful or damaging way to themselves or others.¹

Cognitive restructuring skills are used as a tool in connecting and challenging these negative perspectives. Ideally, the goal is to help people reduce negative thinking patterns, explore unhealthy belief systems,  and be able to engage in healthier and more flexible thought patterns.³

CR is used in other therapies, mostly cognitive theories, but has become well-known in the application and as a basic piece of CBT. Although each therapy theory has different sources and backgrounds, this technique is based on a background of research supporting the power of thought in the way people perceive and interact with the world and themselves.^2,3

Cognitive restructuring skills are defined as structured, goal-directed, and collaborative in their intent and use.³ CR can open the door for complex and even harmful emotions, thoughts, and situations if not processed and explored with a qualified mental health professional. CR can be helpful in the right application.

Issues Cognitive Reframing Can Help With

Cognitive restructuring can help with mental health concerns like depressive disorders, anxiety, dependence, and psychosis.

Here are six issues CR can help with:^1,2,3,4,5

1. Depressive disorders
2. Anxiety and phobia disorders
3. Post-traumatic stress disorder (PTSD)
4. Dependency treatment
5. Psychosis
6. Life stressors or changes

Cognitive Restructuring Techniques

Cognitive restructuring differs in application, depending on the counseling theory. There is a basic format that most therapies use, following a certain set of steps. These are important as each step plays a role in identifying, processing, and challenging the thought and belief system of the person.

Here are techniques for reframing thoughts:

1. Identify Automatic Thoughts

You may notice a thought that continually occurs after difficult situations, even if you try to ignore it, such as repeatedly thinking, “I’m a failure and an idiot.” It can be more complex than this, especially if the thought is not so easy to identify or shows as a feeling like disappointment or anger. <

In that case, you can explore this event and repetitive thoughts or feelings in a session with your therapist. Your therapist could then help you explore said thoughts and feelings to figure out the deeper message and, ultimately, be able to identify the persistent automatic negative thought or belief.^1,5,7

2. Identify Cognitive Distortions

Once you’ve identified the automatic thought, you then identify the cognitive distortions or thinking errors (phrases also used for negative or unhealthy thoughts and beliefs). These can include distortions such as negative labeling (“I’m an idiot so all my thoughts are stupid.”) or mind-reading (“She’s looking at me because she thinks I’m ugly.”).

Because identifying these can be difficult, your therapist can help you walk through and label your thoughts to identify patterns.^5,7

3. Dispute Thoughts

This can be one of the harder parts of this process, especially if you and your therapist have not reviewed how to do this effectively. In experiencing these negative thoughts, you’ll want to look for objective facts, situations, or statements that dispute the belief and distortion.

Consider all factors; for example, looking behind you to see if the person looking at you is looking or waving at someone else, or observing that people take your opinions seriously regardless of your perspective on them. Your therapist can help you find ways to do this in addition to finding contradictions, such as helping you consider a rational or objective perspective to your thought pattern.^1,5,7

4. Replace Thoughts

At this point, you have begun to challenge negative thoughts with contradictions to your prior perceptions. It’s important to find a way to apply the rational or objective perspective to keep yourself from spiraling back into negative thoughts.

This can look like when you immediately start to think, “They all think I don’t know what I’m doing,” stop yourself, and replace it with “I don’t know what they’re thinking; however, I can see they took my perspective seriously and are discussing it, which indicates that they feel comfortable with my work and I’m competent.”

This method of reframing thoughts can be difficult; however, the replacement helps stop the pattern and continuous cycle of automatic negative thoughts and beliefs on how you feel and behave. As mentioned, if you regularly struggle to replace these thoughts, your therapist can work with you to practice reframing negative thoughts with more objective ones.^1,5,7

Negative thoughts and beliefs, distortions, and thinking errors can impact you in several ways, especially in how you perceive, approach, and interact with yourself and the world. These types of thoughts have been identified as major indicators of depressive emotions and thoughts; they can be seen in feelings of hopelessness and suicidal ideation. Cognitive restructuring is a helpful technique, yet you must be in a healthy place to be able to cope with the adverse effects of this intervention.

It is highly suggested that you work with a qualified mental health professional while working on CR to be able to access support and guidance for adverse effects and potential fallout in the process.

Beginner Tips For Getting the Most Out of Cognitive Restructuring

Although it’s suggested to work with a qualified mental health professional when starting the journey of cognitive restructuring, this doesn’t mean you can’t try different approaches to challenging your negative thoughts. They can be less intense while also still allowing you the opportunity to feel better.

If you want to try cognitive restructuring, here are six tips to get started:

1. Practice daily gratitude: while you can absolutely allow for time to vent, limit yourself to 5 or 10 minutes daily⁶
2. Remind yourself that feelings and situations are temporary: while they can feel permanent, think about your situation/feelings as an obstacle vs. a mountain⁶
3. Consider different perspectives in regards to your thoughts and situations: regularly challenge your thought process⁶
4. Remind yourself that blame isn’t always necessary, but that it’s important to take responsibility if there’s a mistake: this does not require offering yourself up for sacrifice, but considering your control and ability in a situation⁶
5. If possible, brainstorm several solutions to create a habit of exploration: this keeps you open-minded and allows space for your brain to consider options vs. fixating⁶
6. Remember you are not alone: cognitive restructuring was created because many people throughout time have struggled with negative thought patterns and beliefs⁶

Is Cognitive Restructuring Effective?

Several studies show how CR can be effective in certain situations.

Here are examples of the effectiveness of CR:

• Deacon, Fawzy, Lickel, and Wokitzy-Taylor (2011) noted that both cognitive restructuring and cognitive defusion were observed to influence significant improvement in individuals with negative self-talk⁸
• Bryant and co-authors (2008) reported that a sample of individuals being treated with exposure therapy and cognitive restructuring for PTSD were noted to have less PTSD and depressive symptoms within 6 months of treatment⁹

• Leahy and Rego (2012) wrote that cognitive restructuring has been observed to be an effective treatment, especially with depression, anxiety disorders, anger issues, and relationship treatment, among others²

Are There Any Drawbacks to CR?

Although there’s more research, it’s important for us to discuss the drawbacks of cognitive restructuring.

Here examples of potential drawbacks to CR:

• Suttenberg (2015) noted that for individuals with significant trauma history—their population specifically including long-term trauma from the Holocaust—cognitive restructuring can address certain thought patterns but not address how it may be a coping technique for the deeper trauma and present dangerously if not considered in an individual’s treatment¹⁰
• Metzner (2021) also notes trauma history and how it may not be considered in the perspective of an individual’s thought and belief system; he noted it may be deemed as irrational and this is not helpful in trauma treatment
• In addition, Metzner notes that cognitive treatment can be time-consuming due to the homework expectations, especially in regards to cognitive restructuring, which can frequently be seen as a daily expectation and monitoring by an individual’s therapist¹¹

Cognitive Restructuring Examples

Cognitive restructuring has been observed to be effective in treating several disorders and life stressors, even severe grief.^2,12

Here several cognitive restructuring examples:

1. Reframing Generalized Anxiety

Abigail is a 23-year-old woman began experiencing anxiety symptoms two years ago. She has frequent difficulty focusing, is restless and tired, can get irritable, and has fluctuating sleep patterns. It has begun to affect her schoolwork and her friendships as she’s often frustrated, overwhelmed, and feels that she’s annoying.

She recently began working with a therapist on campus who suggested she try cognitive restructuring to cope with anxious thoughts.

• Automatic thought: Abigail, as she works with her therapist, notes that whenever she leaves a conversation, whether it be friends, family, or colleagues, she automatically thinks: “They think that I am rude because I left and they hate me.”
• Cognitive distortions: Abigail’s automatic thoughts aren’t healthy; she presents with mind-reading and self-blaming cognitive distortions
• Dispute thoughts: Abigail’s therapist challenges her to dispute this thought process. Abigail notes that most of the individuals she talks with smile and wave at her when she leaves, even if she turns back around to wave farther away. She identifies that no one reports any issues with her interactions and that people are kind to her. She has difficulty with this as she feels like they’re being kind and not saying anything, but was able to ask a close friend who disagreed with this, confirming that a number of their mutual friends care for Abigail.
• Replace thoughts: Abigail works with her therapist on trying to challenge this thought pattern as it has impacted her self-esteem and anxiety levels, making her think her friendships aren’t real. They agree that when she catches herself doing this, she will stop and think, “That appeared to be a fair conversation with no concerns expressed. I am (whatever she is feeling at that time) that we talked.” Soon enough, Abigail can regularly engage in this without too much prompting; some difficulties are to be expected and Abigail and her therapist agreed on a few individuals whom she could ask for a verbal prompt if it appeared her anxiety was increasing.

2. Reframing Depression

Sterling is a 32-year old man who began experiencing depressive emotions including worthlessness, and sadness), lowered motivation and energy, decreased appetite, difficulty focusing, anxiety, and poor sleep in the last year.

He has a history of major depression in his teens, but reports no episodes in the last 5 years. He expresses frustration with the sudden reduction in his performance at work, lack of working out (which used to be an important hobby), and difficulty feeling motivated to interact with friends.

His manager referred him to the employee assistance program (EAP), as she had known Sterling for several years and felt he might need to re-engage in treatment. Sterling’s therapist challenged him to engage in several homework activities, one of which was cognitive restructuring to help with his thought patterns, increase his coping ability, and reduce the chances of depressive relapse.

• Automatic thought: Sterling will often isolate, even when invited out verbally or physically, and not engage in his regular tasks. When he is prompted about it, he reports that the minute he is invited, he thinks, “They shouldn’t have to deal with me like this. I am an awful person.”
• Cognitive distortions: Sterling presents with a classic presentation of labeling and “should,” statements that are seen in individuals with depression. These can be difficult, especially if the individual has experienced these thoughts for a substantial amount of their life. Sterling’s therapist educates him about what cognitive distortions look like as well as assesses his safety due to his depressive thoughts.
• Dispute thoughts: Sterling’s therapist challenges him to ask or talk to his support system—or observe them if this is difficult for Sterling—about how they feel when he is depressed and isolating. Sterling notes that his family and close friends often validate how he is feeling and make attempts to include him so he feels welcome when he is ready to engage. He also noted that he asked an acquaintance about their interactions and the individual noted Sterling’s kind, flexible, and humorous nature, which is why they invite Sterling out and are disappointed when he chooses not to join.
• Replace thoughts: After Sterling and his therapist discussed what he observed, they agreed that he would attempt more rational thinking, like, “They enjoy my company and, if I feel up to it, I can allow myself the opportunity to interact.” Although this was difficult at first for Sterling, he got into the practice of it (in addition to other homework that helped stabilize him) and has had better social interactions more recently. He agreed to continue working with his therapist on his past and is considering medication to manage his depression levels.

3. Reframing Relationship Issues

Nick and Brittany, a male-female couple in their mid-twenties, have been dating for 2.5 years after meeting at work; they’ve been living together for a year. They presented to counseling after having multiple verbal blow-ups within the space of the last 6 months.

Brittany reports that the fights are due to her demanding criminal justice job; Nick reports they are due to a lack of connection and communication, as well as his demanding healthcare job. A therapist assigned regular sessions, required time together, and, among other things, communication work via cognitive restructuring practice.

• Automatic thoughts: Nick reports that when Brittany does not respond to him (physically or over the phone) over an extensive amount of time, he thinks, “She doesn’t appreciate my time and, while she might be busy, she doesn’t care about me.” When Nick doesn’t listen or empathize with Brittany’s demanding schedule, she thinks, “He cares more about his own needs than mine. He doesn’t care if I make a change because he believes I am an awful significant other.” When they fight, they both deteriorate into yelling and negatively labeling.
• Cognitive distortions: While Nick and Brittany’s relationship appeared stable when they worked together, their therapist notes that they both jump to conclusions, engage in all-or-nothing thinking, mind-reading behavior, and labeling. She further observed that they don’t communicate these thoughts; she noted their automatic thoughts are a basis of similar concerns. She asked Nick and Brittany to identify these while in session.
• Dispute thoughts: Although it took time, Nick and Brittany were able to log their thoughts and identify the distortions they both used. However, they were both challenged to dispute what these looked like. Brittany noted that Nick did call and check in with her, accepting that she was not great at communicating, and was able to acknowledge that this is an objective sign of caring. Nick noted that while Brittany’s communication skills were poor, she did call and talk at length when she could and tried to get things done to make sure that they could spend time together. They both acknowledged the stressors of their job and were both able to identify the noted qualities. Both could objectively say their communication was minimal during the day and, by the time they got home, they were both so tired they didn’t interact.
• Replace thoughts: As an agreement, Nick and Brittany would express their concerns to each other if an issue arose. They would practice challenging the mind-reading and conclusion-jumping that occurred by saying, “He/she is busy and they show behaviors that indicate they care about my wellbeing.” By the time their sessions ended, Nick and Brittany’s communication styles were much healthier and they appeared to be on a regular wavelength regarding their expectations for each other and themselves. They both agreed to individual therapy due to the nature of some of their automatic thoughts.

Final Thoughts On Cognitive Restructuring

Negative thoughts and beliefs can be difficult and even dangerous. Remember, there are others experiencing this and help is out there. Reaching out to a qualified mental health professional can help you learn how to cope with these thoughts.