This article is part of our introductory series on cognitive-behaviour therapy.
Cognitive restructuring is aimed at identifying those thoughts, attitudes and assumptions that create, exacerbate or maintain intense, unhealthy negative emotion such as severe anxiety or panic, shame, guilt, jealousy, envy, intense anger, excessive shyness, and depression.
Some of the cognitions or thinking patterns associated with emotional disturbance may be automatic and conscious and thus easily articulated; whilst others may be so well rehearsed that they do not form part of conscious awareness. Once elicited and identified, these beliefs are evaluated in a scientific manner with regards to the following general principles:
Whether they are merely subjective opinions or based on some sort of objective evidence that suggests that they are more like facts than mere opinions. In other words, are they in line with reality?
Whether they help us to achieve our emotional or practical goals or result in self-defeating emotional and behavioural reactions.
Whether they follow logical reasoning.
Thoughts that (1) do not follow logical reasoning, (2) that represent subjective opinion as oppose to being based on factual evidence and that (3) are likely to lead to excessive emotional arousal or self-destructive behaviour are considered dysfunctional, inaccurate or irrational. It is these sorts of thinking errors or dysfunctional beliefs that are identified and targeted throughout intervention. What we now know is that specific sorts of cognitive errors are associated with specific emotional states and behavioural responses. Well-trained CBT therapists would often be able to help their clients quickly identify which clinically-relevant beliefs are perpetuating their problem.
A variety of different dysfunctional beliefs have been identified and conceptualised as contributing toward various forms of psychological distress. Ellis, Beck and others have proposed somewhat different beliefs and belief systems responsible for psychological disturbance. Beck typically considers cognitive errors to be responsible for emotional distress and Cognitive Therapy tends to focus mainly on the attributions or meanings that individuals make about themselves, others or the world in response to specific situations or stressors. Ellis’ REBT model (Ellis & Harper, 1961) proposes that four specific types of beliefs, otherwise known as evaluative beliefs, underly psychological distress. These are further described below:
1. Demands, result from our tendency to take healthy preferences or desires and turn them into unrealistic, perfectionistic, rigid and absolute rules and expectations of one’s self, others or the world. Demandingness is typically reflected in language which incorporates words such as 'must, ought to, should, have to and need’. A typical demand associated with performance anxiety would be, "I absolutely must do well in that exam and at the very least end up in the top three in my class".
2. Awfulising, which reflects an exaggeration of the badness or negative consequences associated with a particular situation or event such that a bad, inconvenient or uncomfortable situation is seen as terrible, horrible or awful. For instance, "it would be terrible if I didn't do well in my exam. It will be the end of my studies and I'll never be able to achieve anything in my life".
3. Low frustration tolerance (LFT) beliefs typically stem from demands for ease and comfort, and reflect an intolerance of discomfort or frustration. For example,"I would not be able to handle failing that test; I couldn’t stand the embarrassment. That, would be intolerable".
4. Global evaluations of human worth, either of self or others, refer to a set of beliefs that imply that our value and worth can be objectively rated and that some people can be evaluated as objectively worthless (including yourself) or at least less worthy than others. Typically, individuals neglect merely judging their behaviour or performance (which is objectively possible) and end up judging their entire selves instead. For instance, "I would really be a complete failure and a worthless idiot if I were to fail this test".
Written by Bradley Drake and Jaco Rossouw, Centre for Cognitive-Behaviour Therapy, Cape Town, South-Africa. For further details visit: www.cognitive-behaviour-therapy.co.za. (September 2011)
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