Cognitive restructuring refers to the process in cognitive behavioral training of identifying and changing inaccurate negative thoughts that contribute to the development of depression. This is done collaboratively between the patient and therapist, often in the form of a dialogue. For instance, a college student may have failed a math quiz and responded by saying, "That just proves I'm stupid."

The therapist might ask if that's really what the test means. In order to help the student recognize the inaccuracy of the response, the therapist could ask what the student's overall grade is in math. If the student answers, "It's a B," the therapist can then point out that his answer shows he's not stupid because he couldn't be stupid and get a B. Then together they can explore ways to reframe what the performance on the quiz actually says.

The "I'm stupid" response is an example of an automatic thought. Patients with depression may have automatic thoughts in response to certain situations. They're automatic in that they're spontaneous, negatively evaluative, and don't come out of deliberate thinking or logic. These are often underpinned by a negative or dysfunctional assumption that is guiding the way patients view themselves, the situation, or the world around them.

Other examples of automatic thinking include:

• Always thinking the worst is going to happen. For instance, a person may convince himself he is about to lose his job because the boss didn't talk to him that morning or he heard an unsubstantiated rumor that his department was going to cut back.
• Always putting the blame on oneself even when there is no involvement in something bad that happened. For example, if someone did not return your call, you might blame it on the fact that you are somehow a very unlikeable person.
• Exaggerating the negative aspects of something rather than the positive. Think of someone who exercises a stock option from a bonus a week before the stock rises another 10%. Instead of enjoying the bonus money he just got, he tells himself he never gets the breaks or that he's too afraid to take risks that he should take. If he weren't, he would have known to wait.

The idea in CBT is to learn to recognize those negative thoughts and find a healthier way to view the situation. The ultimate goal is to discover the underlying assumptions out of which those thoughts arise and evaluate them. Once the inaccuracy of the assumption becomes evident, the patient can replace that perspective with a more accurate one.

Between sessions, the patient may be asked to monitor and write down the negative thoughts in a journal and to evaluate the situation that called them up. The real goal is for the patient to learn how to do this on his or her own.

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