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Stress Management for Health Course

Open Mind 4 Steps Cognitive Restructuring

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Cognitive Restructuring

In order for us to become aware of and change stressful thinking we need to identify and challenge our thoughts, to help do this we can use a 4-step approach.

 

Step 1. - Becoming Aware of our Automatic Negative Thoughts

 

Step 2. - Identifying Stressful Thinking Errors

 

Step 3. - Challenging Stressful Thinking Errors

 

Step 4. - Replacing Stressful Thinking Errors with Realistic Alternatives

 

We have combined this 4-step process into a Cognitive Restructuring Worksheet.

Step 1. Becoming Aware of our Automatic Negative Thoughts

The first step in reducing Stressful Thinking is to become aware of our internal self-talk and our Automatic Negative Thoughts/Beliefs.  Recording our thoughts in a thought record/diary is a useful tool for this.    When we encounter challenging events, it is useful to write down our thoughts so we can start to tune into what we are saying to ourselves in our internal self-talk.  (During Cognitive Behavioural Therapy treatment this record would be shown to the therapist.) 

As we have previously discussed in The A + B = C Model of Stress, our thoughts influence and play a powerful role in our feelings.  Everybody has negative thoughts but these increase when we are stressed.  Our thinking style is a habit and we can with patience and practice change a habit.  (Ref: http://open-mind.org/SP/Articles/9c1.htm)

 

 

 

 

Step 2. Identifying Stressful Thinking Errors

 

The next step is to examine our Automatic Negative Thoughts for Cognitive Distortions (Stressful Thinking Errors).  After writing down the thoughts we experienced during stressful events (Step 1), we than need to look at them to see which if our thoughts match any of the stressful thinking errors (see the list of Stressful Thinking Errors that follows), writing down the stressful thinking errors we have made. 

 

As we have previously discussed stressful thinking errors are not accurate and if unrealistic and rigid can not only cause stress, but also exacerbate any stress we are experiencing.  The problem with our thinking is that we tend to believe it is accurate.  We never examine our thoughts to see if they are unrealistic or inaccurate, we just accept them as being fact which they may not be; and here partly lies the core of stress.

 (Ref http://open-mind.org/SP/Articles/9c1.htm)

 

 

  

 

Identifying Stressful Thinking Errors

 

List of Stressful Thinking Errors (Cognitive Distortions).  Use this list to help identify any Stressful Thinking Errors you may be making.

 

1.     Catastrophising

 

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Step 3. Challenging Stressful Thinking Errors

 

Identifying stressful thinking errors is important but we have to then begin to challenge them for their accuracy.  If we have thoughts that we are a failure we just tend to accept this, but chances are these thoughts are inaccurate and fuel the difficulties we are having.  The problem with modern society is that it demands ever increasing excellence and when we think we have not met up to these demands we then say to ourselves that we have failed.

 

Downward Arrow Technique

 

This is a useful method for challenging stressful thinking errors.  The downward arrow technique consists of challenging statements to make about our stress and the related thinking errors: we keep repeating the questions:  If this were true, why would it be so upsetting?

 (Ref http://open-mind.org/SP/Articles/9c1.htm)

 

In another technique generic questions called Dispute Handles, originally developed by Sank and Shaffer (1984), can be used to challenge stressful thinking errors in 2 ways.  Questions about how certain we are a particular outcome will occur are referred to as Probability Dispute Handles.  Questions about the worst thing that could happen, how likely it is to happen and how bad that is are called Coping Dispute Handles.

 

Probability Dispute Handles:

 

1.     What are the other possible outcomes?

2.     What evidence do we have that _____________ will happen?

3.     Does ________________have to equal or lead to ____________?

4.     What has happened in the past?  Any exceptions?

5.     What are the chances of it happening/happening again?

 

Coping Dispute Handles:

 

1.     What is the evidence to suggest the consequences will be disastrous?

2.     Could there be any other explanation?

(Ref http://open-mind.org/SP/Articles/9c1.htm)

 

Challenging Stressful Thinking Errors (Contd.)

 

Probability Dispute Handles

 

        What are the other possible outcomes?

 

        (How likely is what we worry about likely to happen?)

 

        What evidence do we have that __________________ will happen?

 

        Does _______________ have to equal or lead to _______________?

 

        What has happened in the past?  Any exceptions?

 

        What are the chances of it happening/happening again?

         

         

         

 

Coping Dispute Handles

 

        What is the evidence to suggest the consequences will be disastrous?

 

        Could there be any other explanation?

 

        Is ______ really so important that my whole future depends on it?

 

        Does _______________s opinion reflect that of everyone else?

 

         

 

         

 

         

 

 

 

Step 4. Replacing Stressful Thinking Errors with Realistic Alternatives

 

Often the replacements for automatic thoughts become evident in the course of refuting the irrational beliefs on which they are based.  The following excerpt from a fictional case illustrates how this might happen.

 

Jim is a 25 year old male with a fear of negative evaluation and rejection from females he would like to approach for a date.  The therapeutic contract he negotiated with his therapist established the following goals:

 

1.     Increase the number of opportunities for meeting women by joining a health club, taking a course and by participating in some functions of a local singles club.

2.     Initiate conversations and engage in small talk with women he hasnt met before.

3.     Initiate follow-up conversations with women he has met previously.

4.     Ask a woman to join him in a social outing.

 

The following automatic thoughts were reported by Jim in response to anticipating a role play of initiating a conversation with a woman.  Listed below his automatic thoughts are the underlying stressful thinking errors/beliefs, the rebuttal he used to challenge these beliefs and the alternative beliefs he substituted:

 

1.     Automatic thought: I wont be able to talk.

2.     Stressful thinking error: fortune telling.

3.     Rebuttal used to challenge the thought: Im able to talk to men and women for whom I have no attraction.

4.     Alternative beliefs: I have been able to talk just fine in other situations. (Ref http://open-mind.org/SP/Articles/9c1.htm)

 

 

  

 

 

Cognitive Restructuring

 

Stressful Beliefs

  

 

Cognitive Restructuring

 

Stressful Thinking Errors

 

 Automatic Negative Thoughts

 

We all have automatic negative thoughts but these increase when we are stressed.  Automatic negative thoughts as the term says, can be automatic.  They are not based on logical reasoning, they just occur.  Automatic thoughts are habitual ways of thinking.

 

Automatic negative thoughts usually occur spontaneously.  When they dont, we can use any one of the following techniques to elicit them.

 

1.     Focus on the other components of the problem (mood, behaviour) and notice the associated thoughts.

2.     Focus on an image and notice what words come to mind.

3.     Use imagination in mentally recreating the situation, perhaps with someone else in your role.  Notice what thoughts you have.

 

(Ref http://open-mind)


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