What is cognitive restructuring for PTSD?

Post-traumatic stress disorder (PTSD) affects more than 8 million Americans.

PTSD symptoms include: intrusive memories, sleep problems, feeling jumpy, avoidance reminders of the traumatic event, problems concentrating and more.

Cognitive restructuring (CR) for PTSD, or CR for PTSD, is a 13- to 16-week, short-term treatment based on cognitive behavioral therapy (CBT).

CR for PTSD has 3 components:

1. Breathing retraining

2. PTSD education

3. Restructuring your thoughts

When we're anxious, we want to signal to our bodies that we're safe. We do this by training ourselves to breathe more slowly.

Breathing retraining has 4 steps:

1. Take a normal breath in through your nose. Pause.

2. Say the word "calm" or "relax" in your mind while you...

3. Focus on lengthening your exhale through your mouth.

4. Repeat.

Try following along with the video breathing exercise:

You don't need to have all the symptoms to be officially diagnosed with PTSD, and you don't have to have an official PTSD diagnosis for symptoms to cause problems in your life.

There are 4 main categories of PTSD symptoms.

Re-experiencing Symptoms:

• Intrusive thoughts or memories

• Physical or emotional flashbacks

Avoidance and Numbing:

• Avoiding reminders of the trauma

• Feeling emotionally numb

Hyperarousal:

• Sleep problems

• Irritability

• Jumpiness

• Aggressive or reckless behavior

Thought and Mood Changes:

• Difficulty concentrating

• Depression

• Mistrust of others

• Feeling guilt, shame, or self-blame

When you're first learning CR for PTSD, start with low-level, less traumatic situations. Then follow these 6 steps:

Step 1: Describe the Situation

Describe the situation. Be sure to keep to facts that you can observe with your 5 senses.

For example, "My friend ignored my texts all weekend."

Step 2: Identify the Feeling

How did you feel and how much distress did it cause?

For example, "I felt sad and I was 80% distressed."

Step 3: Identify the Thought(s)

What thoughts were going through your mind during the situation and how much do you believe the thought?

For example, "I must have done something to make her mad. I believe that 85%."

Step 4: Identify the Cognitive Distortions

Cognitive distortions areinaccurate patterns of thinking such as black and white thinking, overgeneralizing, mindreading, and emotional reasoning.

For example, "I must have done something to make her mad," is the cognitive distortion of mindreading, or assuming that you know what is going on in someone else's mind, which, of course, isn't true.

Step 5: Gather the Evidence For and Against Your Thought

Examine the thought, "I must have done something to make her mad."

What facts support your thought?

1. She didn't respond to my texts all weekend.

2. I can't think of any other facts that support my thought.

What facts don't support your thought?

1. I really don't know why she didn't answer my texts.

2. The thought is a cognitive distortion — mindreading.

If your thought isn't 100% true and accurate, the facts don't support your thought. Move on to Step 6.

If your thought is 100% true and accurate, is there anything you can do to change the situation?

Step 6: Think of a New, More Balanced Thought

Next time you are faced with a similar situation, replace the old thought with the new, more balanced thought.

For example, "There are lots of reasons why she didn't text me back besides being mad at me."

Photo by James Rathmell on Unsplash

Cognitive restructuring for post-traumatic stress disorder is one effective, short-term treatment to help cope with the symptoms of PTSD. But usually, PTSD also needs long-term treatment and professional support.

Do you think cognitive restructuring for PTSD might help you or someone you know? If yes, contact your healthcare provider for options.

Check out these Bytes for more resources on PTSD and mental health support: