Cognitive Restructuring for Symptoms of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, and Major Depressive Disorder by Dr. Rebecca Wang-Harris

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Cognitive restructuring is an effective therapeutic technique, which can be used alone or in conjunction with medication therapy, to help a client with identifying, understanding, and gaining control over ruminating and self-defeating thought patterns.  This technique can be applied to the cognitive symptoms which are common among those who have Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, and Major Depressive Disorder.  During the cognitive restructuring process, the therapist teaches the client how to navigate through anxiety-provoking or emotionally painful memories and thoughts to move forward with increased self-awareness and self-acceptance.  By learning and implementing cognitive restructuring techniques, a client can gain a sense of freedom from one’s ruminating thoughts and the debilitating emotions caused by these thoughts.  Yes, this process does require motivation and effort on the client’s part but can be a valuable skill which provides resilience when confronted with any life challenge.

Post-Traumatic Stress Disorder (PTSD)

Some cognitive symptoms of Post-Traumatic Stress Disorder (PTSD) which can be alleviated by cognitive restructuring include difficulty creating a motivating attitude toward daily tasks, repetitive fearful thoughts about abandonment or loss within intimate relationships, difficulty with remembering even simple daily experiences, frequent negative thoughts about oneself or about the world in general, distorted or irrational thoughts about the traumatic experience or experiences which may transfer to current experiences, and difficulty controlling or understanding the specific thoughts which fuel persistent negative emotions, such as fear, anger, guilt, and shame.

Generalized Anxiety Disorder (GAD)

Some cognitive symptoms of Generalized Anxiety Disorder (GAD) which can be alleviated by cognitive restructuring include persistent worrisome thoughts about a variety of life events which are disproportionate to the realistic probability of these events occurring or to the ability to predict such events, difficulty making decisions, and difficulty maintaining concentration on daily tasks.

Major Depressive Disorder (MDD)

Some cognitive symptoms of Major Depressive Disorder which can be alleviated by cognitive restructuring include difficulty concentrating on necessary daily tasks, recurring negative thoughts about oneself which create guilt, insecurity, and shame, and perceived helplessness and hopelessness when thinking about one’s present and future life.  Cognitive restructuring techniques can help a client to clarify self-defeating thoughts and to replace these thoughts with more realistic and productive thoughts, which can empower the client to function more effectively in work, academic, and social environments.

Two Significant Theories which have Emphasized the Role of Cognitive Processes in Overall Mental Health

According to Albert Bandura’s social cognitive theory, created during the 1960’s, individuals develop their thought patterns through various life experiences. Bandura proposed that an individual’s sense of self-efficacy is a key aspect of one’s overall mental health and is represented by one’s perceived ability to succeed in particular situations.  Bandura’s theory emphasized the important role of an individual’s thoughts about painful and challenging situations in managing one’s emotional and behavioral responses to these situations.

Carl Rogers was another prominent theorist who, during the 1940’s, created the person-centered therapeutic approach. This approach focused on the importance of one’s perceived self-esteem or self-worth, which he proposed to be largely gained through experiences which create positive regard from others.  According to Rogers’ theory, without positive self-statements, a person can become hopeless toward reaching one’s potential, which can then lead to depression, anxiety, and other negative mental health outcomes. Rogers also developed the concepts of the real self, which is represented by one’s current reality, and the ideal self, which is represented by one’s desired reality, in terms of thoughts, emotions, daily life satisfaction, occupation, and significant relationships. Rogers proposed that mental and emotional struggles often result from a gap between one’s real self and ideal self and that a person’s mental health lies in the ability to bridge this gap.             

My Approach:  Client Empowerment through 4 Stages of Cognitive Restructuring Strategies

While I use an eclectic approach to counseling my clients, I have found cognitive restructuring exercises to be extremely effective in teaching clients how to identify and to “catch” disturbing, irrational, or, otherwise, unhealthy thoughts.  This is the first crucial step toward gaining control over such thought patterns which generate anxiety and depressive symptoms.  This approach guides the client toward increased awareness about how the perception of life events can control one’s emotions, in either positive or negative ways.  Through 4 stages, the client will learn how to change or manage one’s emotions about what happens or has happened by changing one’s thoughts about any given experience in life, no matter how painful it realistically is.  Learning how to identify and “own” self-doubting, irrational, fear-perpetuating, and, otherwise, unproductive thoughts is the first crucial step toward gaining control over such thought patterns.

Negative thoughts and emotions have historically been construed as parts of our personality to avoid, deny, hide, or escape.  Thoughts which focus on shame, self-blame, guilt, inadequacy, disappointment, anger, frustration, and fear can be transformed into more rational, empowering, and managed thoughts through a process of acknowledging them as both real and valid but also as often counterproductive to completing daily tasks, wasteful of one’s daily mental energy, and damaging to one’s interpersonal relationships.

I use a 4-stage cognitive restructuring process which focuses on empowering the client through the identification of specific “I” statements which influence one’s emotions.  Stage 1 of the cognitive restructuring process consists of an exercise during which I ask the client to rate on a scale of 1 to 10 how often one experiences 10 different cognitive distortions.  This process can take a few sessions or longer, depending upon the client’s motivation.  Stage 2 consists of prompting the client to verbalize at least 3 specific and frequent “I” statements which relate to EACH of the cognitive distortions with the higher ratings on the 1 to 10 scale, as identified during the first stage.  Stage 2 focuses on helping the client to track the accuracy and validity of each of these cognitive distortions.   Stage 3 consists of prompting the client to verbalize at least 3 memories or experiences which create each of the cognitive distortions with the higher ratings.  Stage 4 consists of assisting the client in creating a structured and proactive plan for acknowledging disturbing and unproductive thoughts, using thought-stopping strategies when these thoughts create too much emotional pain, using thought-replacement strategies to refocus on the present moment, committing to writing these disturbing thoughts in a daily journal, and continuing to process one’s thoughts during therapy sessions.  An ongoing focus of cognitive restructuring is the client’s movement toward more accurate, balanced thoughts and beliefs in relation to external events. Having these balanced thoughts and beliefs to replace the distorted thoughts in turn leads to a decrease in the intensity of the emotions the person experiences when they think about the traumatic events.    

A final point about cognitive restructuring is that “We are what we think.”

 

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