Restructuring Negative Thoughts

Though it is not uncommon for individuals to have negative thoughts from time to time, if negative thought patterns become so ingrained that they begin interfering with daily life, relationships, and overall well-being, individuals may benefit from cognitive restructuring.  Cognitive restructuring is an evidenced-based tool that can help interrupt and redirect negative thought patterns by allowing individuals to notice and actively change their thinking.  There are numerous strategies for mental health practitioners to use in order to help their patients learn to this skill, including increasing awareness of cognitive distortions, putting thoughts "on trial," using Socratic questioning, life event visualization, and keeping thought records, to name a few. 

This lesson is designed to maximize patient engagement and talk time. The focus tasks, small-group sizes, collaborative objectives, and individual work assignments are included strategically to meet this purpose. The timing, number of sessions, and room makeup may be adjusted according to need.

Session Objective:

By the end of this session, participants will be able to demonstrate the ability to restructure negative self-talk by reframing negative statements to positive, productive statements with supporting evidence.

Delivery Time: 

60 Minutes

Materials: 

Notebook paper, writing materials, clipboards (if no desks/tables are available), Restructuring Deck PPTX (if screen is available)  Thought Record Sheet  PDF (1 copy per participant).

Set-up: 

1. If possible, set chairs and desks in a semicircle. If no desks are available, distribute clipboards so participants have a sturdy, portable means of taking notes and completing tasks.
2. If a whiteboard or projector is available, write the session objective.
3. Print all associated materials so they are ready for use.
4. If a Smart Board, projector, or screen is available download and open the Restructuring Negative Thoughts Deck PPTX and enter “full screen” mode so the both initial and restricted sentences are hidden.

Procedure: 

1. Session Objective – Read the session objective aloud.
2. Introduction (5 minutes) Begin by asking participants to close their eyes. Imagine you were at work or school, and a group of friends just returned from a lunch you weren't invited to attend. What are some of the thoughts that initially come to mind?

Why does no one like me? I must be pretty awful to be around if I'm always being left out.

I'm such a loser; I don't even know why I try.

What if, instead of taking it personally, you thought of other possible alternatives?

Mistakes happen. Maybe my friends simply forgot.

Maybe they sent an email or text to arrange it, and I didn't catch it.

They know I am allergic to most seafood, and maybe they went to a seafood restaurant.

We all spend time in our own heads. Dwelling on negative emotions, reliving unpleasant memories, and giving in to cognitive distortions can prevent you from enjoying the present. It also has the potential to get you stuck in a negative feedback loop resulting in lost time, feelings of anxiety or depression, and lost hope.

Think how easy it would be to go from the thought, "I'm a loser, and no one likes me." to "I want to drink or use because my life doesn't matter anyway." 

Today we are going to practice using some tools that help us to identify negative thoughts and cognitive distortions and restructure them, resulting in more positive feelings and outcomes. Does that sound like something that might be useful to you?

3. Whole Group Restructuring (10 minutes) – Using the Restructuring Negative Thoughts Deck PPTX, advance to the first sentence: “I am a liar and an addict; no one will ever trust me.” If no screen is available, write this first statement on the whiteboard.

This is a thought many of us may have had before, and it’s a claim that we can likely find a lot of evidence to support.  The issue is, this kind of statement is self-defeating and an example of black and white thinking.  Absolutes (always, never, ever) usually indicate a cognitive distortion because there are, more often than not, exceptions.  Even if you have lied before, there are probably examples you can find of times when you were honest.  Even though it may be difficult for you to rebuild trust in certain relationships, is it impossible?  No.  It may take a lot of work, and understandably so, but it is not impossible.

If we were to simply say the opposite, “I am not a liar or addict and people do/will trust me.”  Would that be enough?

Why or why not?  (Simply stating the opposite is not a good example of cognitive restructuring because simply saying something doesn’t mean we are going to believe it.  We must reframe thoughts in ways that are believable.  One way to do this is with evidence…   We want patients to come up with the reasoning on their own to help reinforce the proper way to restructure this thought, but provide support through guided elicitation to help patients reach this conclusion as necessary).

What might a better way be?  Let’s think of some examples of times we were honest; maybe the most recent time we decided to go into treatment, or a time when we put a family member or friend’s needs above our own. 

“I have made mistakes, but I have demonstrated I can be honest, like last week when I was late for work.  I told my boss it was my fault for not leaving the house early enough.  I want to be honest, so I have to work harder to rebuild trust with others.”  There are several variations that could be appropriate, and this is one example.   It is important that patients are as specific as possible with their examples because they need to believe what they are saying.

Repeat this with statement 2, giving less support if possible to help participants get a greater grasp on the skill: “I am no good at anything and I’ll never get this job.” 

Possible example of cognitive restructure: “I have a lot of strengths.  I’m punctual and am a nice person (I took care of my mom when she was sick, for example).  I need to find a job that is the right fit for me.”

4. Partner Restructure (15 minutes) – Split partners into pairs.  Reveal the next three distorted claims:

My boss is a jerk and doesn’t like me.  I shouldn’t even try.

No one is answering the phone; they must be avoiding me.

If I take on this big task, I’ll mess it up, get fined, and not be able to get hired again.

Give pairs time to work together to restructure these claims using the techniques they learned.  Provide support as necessary. 

Once complete, have pairs share their responses and check them against the answers provided on the Restructuring Negative Thoughts Deck PPTX.  There are many possible answers and evidence will vary by participants.

5. Performance Task (15 minutes) – Have all the participants stand up and form two lines facing each other.  One side of the line will be 1s and the other 2s.  The 1s will begin by stating an original negative self-talk statement to their partner across from them.  The 2s will restructure the statement using the technique taught in the session.  Give the groups 1-2 minutes to finish their interaction. Then have 1s move one spot to their left (the person on the end comes all the way to the other end). After 3 rounds, switch sides. Now the 2s will provide a statement and the 1s will restructure. 

While participants are engaged in the activity, monitor the room and write down good and bad examples to board for the next task.

6. Summary and Review (10 minutes) – Using the examples from the previous activity, have a group discussion on the positive examples and allow participants to provide feedback and advice for the ones to be improved.

7. Additional Practice (5 minutes) - Distribute the Thought Records Sheet to each group member. Read through the example together and ask participants to complete the next one before the next session.