Cognitive Defusion Versus Cognitive Restructuring in the Treatment of Negative Self-Referential Thoughts: An Investigation of Process and Outcome

Abstract

Within traditional cognitive therapy, cognitive restructuring is often used to challenge the veracity of dysfunctional thoughts. In contrast, acceptance and commitment therapy (ACT) uses "cognitive defusion" techniques to change the function of negative thoughts rather than modify their content. Previous research has shown that a cognitive defusion technique known as the "milk exercise" (rapidly repeating a self-referential, one-word thought such as "fat") reduces the discomfort and believability associated with negative thoughts. This study sought to replicate and extend these findings by comparing the impact of cognitive defusion with that of cognitive restructuring in a sample of participants distressed by negative thoughts about their body shape. Participants received a detailed rationale and training followed by instructions to practice the assigned technique as homework for 1 week. Results indicated that both cognitive techniques produced substantial improvements that generalized well beyond the specific thoughts targeted for treatment. Clear differences in treatment process and the course of improvement were evident. Findings are discussed in the context of theoretical and practical similarities and differences between these two approaches.

The relationship between negative and positive cognition and psychopathological states in adults aged 18 to 20

“…CBT is a highly effective treatment for a wide range of mental [12,49]. Cognitive-behavioral researchers have also recognized that the assessment of positive and negative cognitions may contribute to a better understanding of psychopathology and the development of more effective treatments [43,50].…”

“…Accordingly, a common technique in traditional cognitive-behavioral therapy (CBT) is cognitive restructuring [10]. The goal of this process is to encourage patients to think in more accurate and adaptive ways, which facilitate effective problem solving and living a more satisfying life [11,12].…”

Treating Adolescents with Family-Based Mindfulness

“…As such, the cognitive defusion condition reduced the emotional discomfort and believability of negative self-referential thoughts (Masuda et al, 2010 ). There are various techniques in psychotherapy such as deliteralization and physicalizing that creates space between thoughts and emotions, by disidentifying and disengaging from them (Deacon, Fawzy, Lickel, & Wolitzky-Taylor, 2011 ). Although a distinction is made between cognitive defusion and cognitive realignment/restructuring in terms of intention to change the contents of thoughts versus their function, MDT incorporates both in a systematic way depending on the nature and context of problematic thoughts.…”

“…However, cognitive restructuring may only encourage attempts to suppress and avoid undesirable thoughts, while cognitive defusion practices awareness and acceptance, which defuses the power of thoughts without changing their contents. Deacon et al ( 2011 ) concluded that both cognitive defusion and cognitive restructuring produce reductions in negative self-referential thoughts, but that defusion has a more immediate effect while not always relating effectively in the longer term to real-life contexts, which seemed to relate to the believability of the negative thoughts. The notion of MDT is that thoughts that are defused, and therefore have no deep attachment or value, are easier to realign by way of healthier alternative beliefs.…”

Cognitive-Behavioral Therapy: Next Generation of Treatments

“…Rather than challenging the validity of the thoughts as is done in CBT, ACT changes the function of the thought, making it less emotionally salient. This can be done through cognitive defusion techniques such as decreasing the thought to one word (e.g., "I am fat" to "fat") and repeating the word out loud multiple times until the word loses its literal meaning (46). The goal is to have the patient realize that thoughts are not literal but rather just thoughts that have nothing to do with the quality of the person who is experiencing them (47).…”