Cognitive Restructuring Part I
Goal
To be able to challenge negative and distressing thoughts
Faulty Thinking (Turk & Winter, pp. 131-132)
Most people tend to use some form of faulty thinking, especially when under stress. Negative thoughts create ruts in the brain, which can automatically lead down a path toward feeling like a helpless and hopeless captive of your pain. Here are some negative thoughts that people with chronic pain commonly have as well as more realistic thoughts:
| Negative Thoughts | Realistic Thoughts |
|---|---|
| My pain is terrible! I can’t bear it! How long must this go on? | The extreme pain is back again, but I know that it is only temporary. |
| I shouldn’t have so much pain. I don’t deserve this. | By relaxing my muscles I can make my pain more bearable. |
| I’m going to be an invalid. I can hardly do anything anymore. I’m a burden to those around me. | I can take a bit more rest today between activities. Tomorrow I’ll get back on my regular activity routine again. |
| I’m going crazy! Where will this all end? I’ll never get better. | I want to do something pleasant or telephone somebody as a distraction. |
| Why can’t they make my pain go away? I simply have to find some relief now. | I can keep my breathing as deep and even as possible and this will reduce my experience of pain. |
| This is going to get worse and worse. Maybe I’ll go crazy. I’ll never be able to enjoy life again. | Challenging days are to be expected, we all have them. I might as well enjoy what there is to enjoy. |
| No one else can ever really understand this pain. I’ll never be able to enjoy life again. | I can stay in control of the rest of my life, even when my neck hurts. |
| It’s all ______________ (my boss’s, etc., fill in the blank) fault that I’m in this mess. | Things are going slowly but in the right direction. I’m going to get better and better. |
| It’s all my fault that I’m in this mess. |
It is time to get out of the rut and be on a new path with more realistic, accurate, and truthful thoughts and beliefs. One of the ways you can do this is by challenging your existing thoughts.
Challenging Faulty Thinking Exercise (Barlow, p. 101)
Instructions: Identify a single faulty thought or belief and answer the following questions on a separate piece of paper:
What is the evidence for and against this idea?- Is your belief a habit or based on facts?
- Are your interpretations of the situation too far removed from reality to be accurate?
- Are you thinking in all-or-nothing terms?
- Are you using words or phrases that are extreme or exaggerated? (i.e., always, forever, never, need, should, must, can’t, and every time)
- Are you taking the situation out of context and only focusing on one aspect of the event?
- Is the source of information reliable?
- Are you confusing a low probability with a high probability?
- Are your judgments based on feelings rather than facts?
- Are you focused on irrelevant factors?
Example: You may believe that you cannot bear your pain. Consider the evidence for and against this belief. Yes, you may be experiencing pain, but your pain can become less severe by engaging in relaxation exercises.
Thinking Mistakes Exercise
Instructions: Read through the table on the next page of 12 common thinking mistakes. Put a check mark next to the mistakes that you frequently experience. For the checked items, write an example of when you have made the thinking mistake.
| ✓ | Thinking Mistake | Description | Example | Your Example |
|---|---|---|---|---|
| All-or-nothing thinking | You see things in only two categories when it is really on a continuum. | I’ll never be able to manage my pain. | ||
| Jumping to conclusions | You take one observation and are sure it has only one implication. | Since I am in constant pain, I’ll never be able to work again. | ||
| Negative fortune-telling | You make a negative prediction without recognizing it is not the only possible outcome. | Everyone depends on me. I’ve got to recover quickly or the family will fall apart. | ||
| Positive fortune-telling | You are overly optimistic about the most likely outcome. | Tomorrow I’m going to wake up and my pain is going to be gone. | ||
| Discounting the positive | You unreasonably discount your positive actions or qualities. | It doesn’t matter if I’ve lost a few pounds. I deserve credit only after I’ve lost all of the weight I need to lose. | ||
| Emotional reasoning | You think your thoughts must be true because they feel true, even if there is conflicting evidence. | I’m taking too long to heal. I must be doing something wrong. | ||
| Labeling | You label yourself (or someone else) in a globally negative way without really considering the whole person. | I’m bad for not taking my dog for a walk today. | ||
| Mind reading | You are sure you know what others are thinking, even in the absence of compelling data. | My family avoids talking to me about my pain. They don’t really care about me. | ||
| Self-deluding thinking | You tell yourself things that you really do not believe at other times. | I don’t deserve a speeding ticket for going 20 mph over the speed limit since I was running late for my doctor’s appointment. | ||
| Dysfunctional (unhelpful) rules | You mandate what you/others must/must not do without considering circumstances. | I can only express happy, positive feelings. | ||
| Irrelevance | You link two unrelated concepts. | It’s okay to go shopping because I’m so stressed out. | ||
| Exaggeration | You make a sweeping statement on the basis of a small set of data. | My kids are totally out of control. |
(Adapted from Beck, 2007, pp. 146-147; Turk & Winter, pp. 133-134)
Next Step
Identify additional faulty thoughts or beliefs and evaluate them using the questions from the challenging faulty thinking exercise.
Learn more about thinking mistakes by watching the following video: