Cognitive Behavior Modification
Cognitive Restructuring
Overview of Cognitive Restructuring
Cognitive restructuring is a psychotherapeutic intervention whose main purpose is to help an individual change erroneous thinking patterns, ideas and schemas which usually result in unwanted behavior patterns and conditions and instead teaching the identification of those thought patterns as erroneous, irrational or exaggerated, and therefore challenging, dispute them. This ultimately results in a change in behaviour ( Martin & Dahlen, 2005). By teaching the challenging of automatic thought patterns, cognitive restructuring creates a feed back system where patients are able to use new data to create new schemas about certain events, and therefore to change their behavior patterns. “Individuals learn to use knowledge to break the limit os certain belief sets while learning to Inspect their criteria for judging the rationality of norms” ( Sharoff, 2002. pp.17).
These problematic thoughts are known as Automatic thoughts( Cormier, Nurius &Osborn, 2009) . They occur as a result of cognitions that have not been examined or tested but rather accepted as fact. They may have a root causative event, or may have begun spontaneously. Left unattended these thoughts result in crippling behavior patterns that include negative views of self and others. Cognitive restructuring has been used to treat individuals experiencing maladaptive behaviour which involves cognition. Such conditions may include depression, eating disorders, anxiety disorders and social phobias ( Sharoff, 2002,pp.17).Cognitive restructuring involves identification of unwanted thought patterns and distortions, rational disputation of the same and learning to apply rational parameters to judge rationality of ideas and norms (Passer et al., 2009).
Concerns Addressed-Social Anxiety Disorder
In this cognitive restructuring case study, treatment is sought for an anxiety disorder. The disorder being dealt with is a social anxiety disorder. This is because it involves an intense fear in the face of public scrutiny or situations where there is potential for embarrassment and vulnerability in front of a crowd of people. (Connor et al., 2000). The willing participant in the study has a social phobia that is mainly characterized by the fear of public speaking. the case study was conducted on a willing participant .In this case cognitive restructuring is applied to give remedy to fear and anxiety that is triggered in the participant when she speaks to a group of people in a public formal kind of setting such as class presentations and other settings that require her to stand in front of a group of people and present verbally.
Currently, the study volunteer, X, whose identity has been kept confidential, suffers a debilitating anxiety when she is faced with situations when she has to address people publicly. Whenever she is faced with this kind of situations, X experiences both emotional and physical symptoms which include; heightened heart beat, trembling of hands and voice, shortness of breath, dryness in the mouth and sweaty palms. She is unable to organize her flow of thought when speaking. Since X is a student, she is continually faced with such situations due to the nature of her studies. She is required to give class presentations and speeches every now and then.X also desires to run for office in the student’s council but is limited by the fact that this would require her to do a lot of public speaking.
X claims that her fear of public speaking is associated with perceived negative scrutiny and judgment from her peers. She fears that her presentations, quality of language and speech are not up to par with the rest. She is afraid of sounding and looking “ foolish” in front of people. X is convinced that people “are continually laughing at her while she speaks and might stand up and leave as she speaks”. X experiences these thoughts every time she has to speak in front of people, which is at least. Once a month. After the public speaking situation is over she experiences relief, although it is usually accompanied by fatigue. Although X understands that the level of her fear and anxiety is not equivalent to the thereat posed, she still presents with the same symptoms ( 9 ).The intensity of fear and anxiety intensify as she progresses with speeches until she cannot speak any longer and has to sit.
Method of Implementation
X comes from a relatively stable background and is a academically superior to most of her peers. She does not indulge in substance abuse, neither does she have any physically or mental disabilities. These factors would be barriers to implementation of cognitive reconstruction ( Zayfert & Becker, 2008 ).X was asked to verify that she had given approval for the therapy. The process wasimplemented with a two-week period where sessions were done daily.
The first step taken was that of helping X to identify the specific situations in which she experiences fear and anxiety and to identify the exact physical and emotional symptoms experienced. These were identified to be in situations where she had to speak publicly. She was encouraged to rate the intensity of the emotions on a scale of 1-10.Fear, anxiety, self consciousness, self-doubt and intense vulnerability were among the highest rated emotions.
After this X was helped to identify the exact reasons why she felt anxious while speaking in front of a crowd. Fear of negative judgment and scrutiny as well as the fear of being perceived as ‘foolish’ were rated the highest.
X was then helped to recognize the connection between the negative thought patterns and unwanted emotions (Sharoff, 2002). She was helped to see that these thoughts most of the time occurred to her without her awareness and that she has already made erroneous conclusions before she even stood to speak in public. Thus she understood that her emotions and actions were a direct result of her thought patterns.
Each thought was then examined individually to determine how it measured up against reality (Zayfert & Becker, 2008). Its rationality as examined. This was done by gathering evidence for and against the truth of that thought. X was asked to put herself in the place o those in the audience and asked if what she was thinking was reflection of the things she thought audiences thought of her. She was asked to investigate whether she would have the same reaction as part of the audience if someone elsewhere in her situation. Mock public speaking situations were created where she presented to an imaginary audience every day.X was encouraged to convert all prior belief about how audiences see her to hypothesis and then examine the truth of each. These exercises were done daily for eleven days, with each day challenge and mostly disputing prior negative thoughts. On the thirteenth day, X was encouraged to deliver a short speech in front f ten people and fifteen people ion the fourteenth day.
X was encouraged to replace her negative thoughts about public speaking with positive ones so as to create an association of public speaking with positive things.
Levels of increasing fear with increased duration of speech were taken at the start and at the end of the cognitive restructuring and results compared.
Results
At first, it was difficult to identify the maladaptive thoughts that were eliciting the unwanted emotions but gradually it became easier. X readily realized there was a connection between her thoughts and her fear and anxiety. As she, questioned and challenged the negative thoughts she realized that they were actually irrational and greatly exaggerated. She therefore disputed them one by one. She instead replaced them with a realistic assessment of the situation and even replaced them with positive thoughts. As a result her fear and anxiety began to decrease. In her first public speech to ten people after cognitive restructuring X reported to have done much better. She felt less fear and less anxious. The next speech delivered to 15 people was even better. Some of those in the audience who had seen her speak publicly before reported that she seemed less distracted and anxious. She is optimistic that this will get even better with experience. Levels of increasing fear were seen to decrease with increasing duration of speech.
Reflection
The assignment was a success and proves that cognitive restructuring is an effective method in treating cognitive-related disorders. Although it is requires a lot of commitment to the process for the therapist and the patient, its results are overall satisfactory. Patient X significantly benefited from the intervention and will continue to do so if she keeps applying principles taught to her thought processes.
However, the time-constraint given in the case study is an impediment to exhaustive challenging of all negative automatic thoughts. Only major negative thoughts were tackled. Cognitive restructuring in my opinion would work better with more time, where the process is not rushed.
There were lessens in the assignment that cognition is greatly manipulate-able. We are able to choose how to think about issues and we do not have to be slaves to our thought patterns. We are able to train our selves to become positive thinkers and thus acquire positive behavior patterns.
References
Connor K.M., Jonathan R.T., et al. ( 2000). Psychometric properties of the Social Phobia Inventory
(SPIN): New self-rating scale. The British Journal of Psychiatry Vol. 176: 379-386
Cormier, S., Nurius, P.S., & Osborn, C.J. (2009). Interviewing and change strategies for helpers:
Fundamental skills and cognitive behavioral interventions, (6th Ed.). Belmont: engage Learning Inc.
Frojan-Parga, M.X., Calero-Elvira, A. & Montano-Fidalgo, M. (2009). Analysis of the therapist’s
verbal behavior during cognitive restructuring debates: a case study. Psychotherapy Research, Vol.19: 30-41.
Hope, D.A., Burns, J.A., Hyes, S.A., Herbert, J.D. & Warner, M.D. (2010). Automatic thoughts and
cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy Research, Vol.34: 1-12.
Huppert, J.D. (2009). The building blocks of treatment in cognitive-behavioral therapy. Israel
Journal of Psychiatry Related Science, Vol.46: 245-250.
Martin, R. C., & Dahlen, E. R. (2005). Cognitive emotion regulation and the prediction of depression,
anxiety, stress, and anger. Personality and Individual Differences, Vol.39, 1249-1260.
Passer,M., Smith,R., Holt, N., Bremner, A., Sutherland,E.,& . Vliek,M.
(2009). Psychology. London: McGrath Hill companies Inc.
Sharoff, K. (2002) Cognitive Coping Therapy.New York:Brunner Routledge.
Zayfert,C.& Becker, C.B. ( 2008).Cognitive-Behavioral Therapy for PTSD: A Case Formulation
Approach. New York : The Guilford Press.
Appendix 1.
Pre-cognitive restructuring
Post-cognitive restructuring
Increasing
Fear& anxiety response.
Increasing duration of speech
Graph shows decreasing anxiety and fear with increased duration of speech.
Appendix 2
The diagram shows the interconnection between thoughts, emotions, physiology and behaviour.
