Cognitive Restructuring with Anxiety

Cognitive restructuring, straight thinking or logical reanalysis is based on the belief that the way we feel, behave and respond to situations is based on the way we think. This approach attempts to modify unhelpful thought patterns and beliefs. Cognitive restructuring, also known as cognitive reframing, is a technique drawn from cognitive therapy that can help people identify, challenge and alter anxiety provoking thought patterns and beliefs.

Thinking that is not straight or accurate is based on false assumptions about other people and the world in general and is often the basis of anxiety and other negative mood states. For example, a woman who suffers social anxiety may hate to stand in line in the grocery store because she is afraid that everyone is watching her.

Once a false assumption has been made, it will then often be used as a basis for prompting key behaviours that end up acting in response to the false assumption as if it were true. Irrational thoughts like this, and their accompanying behaviours, play a big part in the onset of anxiety.

For example; thoughts like; “What if I do something stupid?”, “What if something terrible happens to me or my family?”, “What if I can’t escape?”, “What if they end up hating me” or “What if I have another panic attack?”, can clearly evoke emotions of fear and anxiety through believing the thought and then reinforcing the thought through shaping behaviour in accord with it.

The first step in cognitive restructuring is to identify what the unhelpful thoughts or self talk are and when they are most likely to occur. For example, a person who notices they become anxious before meeting new people might be asked to write down their thoughts prior to such an event. They might end up recording such unhelpful thoughts and self talk like:

1. What if it all goes wrong?
2. I’m not good enough to do this.
3. What will people think if I say the wrong thing?
4. I couldn’t relax last time; I’ll be useless this time.

Once this self-talk has been identified, clients are assisted in modifying them into a more realistic assessment and belief.

For example:

1. Worrying about something going wrong won’t stop it from happening; it just makes me more anxious. I can take positive steps to prepare for possible problems and that’s all anyone can do. Anyway what really is the worst thing that can happen if it does go wrong? When I think about it – there really isn’t that much that would happen if it did go wrong. The word keeps spinning and the sun stays in the sky…
2. I do things well most of the time but like everyone, I will occasionally make a mistake. I will feel bad about this but I can handle that and take constructive steps to do better next time.
3. I don’t know what other people will think, but if I say the wrong thing I can cope. I’ve coped with this before. Anyway – What is ‘the wrong thing’ anyway? If its what I think or feel… then why should that be considered wrong? I have thoughts and feelings like anyone else. Just because they might be different from someone else doesn’t mean its wrong.
4. I experienced symptoms of anxiety last time which made things harder. I’ll use my anxiety management skills this time because the more I use them, the more relaxed I will become as I get the hang of it. Anyway, it’s not about focusing on the anxiety; it’s about focusing on what I need to do. I mean why worry about getting anxious… it happens to everyone… and anyway if I get anxious its not like my head is going to explode or my vital organs are going to get ripped out. I’ve got to keep it in perspective.

In teaching the client to make more accurate appraisals of each situation, they will begin to identify the unrealistic thinking that has been contributing to their anxiety.

When clients first begin to make reappraisals of their irrational thoughts, they will often state the new reappraised thought back accurately and they will usually see the logic and sense in the newly appraised thought. However, deep down, they may still feel emotionally connected to the irrational thought and somehow still believe the irrational thought over the newly appraised one. This is fairly typical as beliefs and perceptions are not always that easy to change.

One reason why irrational thoughts, beliefs and perceptions can stay fixed is because often the client’s behaviour will continue to reinforce the older more irrational thought rather than the newly appraised thoughts.

For example, if a client was trying to have the reappraised thought that closing the front door 30 times before going to work will not do anything by way of stopping a personal tragedy but continues to close the front door 30 times each morning, then the behaviour is continually reinforcing the irrational thought that closing the door 30 times will help stop the likelihood of a personal tragedy.

Therefore, to encourage a greater level of ownership or more deeply held belief in the newly appraised thought of; closing the door 30 times before work does not stop personal tragedies, the client will often need to be encouraged to act as if the new thought was true – even if deep down they still had their doubts and even when their emotional response was still anxiety laden in contradiction to the newly acquired thought.

In the context of the example already mentioned, the client would need to choose not to close the front door 30 times before work and behave instead as if the newly appraised belief was true. Even if they walked away feeling very anxious, worried and apprehensive over the strong likelihood of a personal tragedy occurring, by acting as if the new appraised thought was true, they reinforce the new appraised thought, thus encouraging a greater belief in it over time.