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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.
Keywords: cognitive therapy; cognitive restructuring; acceptance and commitment therapy; cognitive defusion
Cognitive models of psychopathology (e.g., Beck, 1976) posit that dysfunctional cognitions directly contribute to negative emotions. Accordingly, a common technique in traditional cognitive behavioral therapy (CBT) is cognitive restructuring, in which the therapist and patient collaboratively identify irrational or maladaptive thoughts and challenge their veracity using strategies such as logical disputation, Socratic questioning, and behavioral experiments (Hofmann & Asmundson, 2008). 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 (Beck, Rush, Shaw, & Emery, 1979).
CBT is a highly effective treatment for a wide range of mental disorders (Butler, Chapman, Forman, & Beck, 2006). CBT consists of various techniques, however, and the specific contribution of cognitive restructuring to the overall efficacy of CBT has recently come under scrutiny. In their review of treatment studies for anxiety and depression, Longmore and Worrell (2007) concluded that cognitive interventions do not consistently provide added value to behavioral interventions. Cognitive restructuring has also been criticized on theoretical grounds by proponents of mindfulness and acceptance-based approaches such as acceptance and commitment therapy (ACT;...