John R. Cook, Ph.D.
Registered Psychologist

A cognitive restructuring approach to managing our anxiety works by helping us to recognize and then challenge thinking errors that cause us to feel tense or on edge. In the Recognizing Our Anxious Thoughts article, we learned to recognize two main types of thinking errors: probability over-estimation, and catastrophizing. In this article we will be learning how to challenge these thinking errors by asking questions called dispute handles.

The first step in challenging our thinking errors is to verify that our anxiety stems from distorted thinking rather than from real danger. For example, consider two patients in a hospital awaiting surgery. Both have concerns about surviving the procedure. Patient A is having triple bypass heart surgery and has been given a 50% chance of survival. Patient B is having cataract eye surgery and has been told that there is no chance of a fatality, and that the success rate for the procedure is well over 95%. The evidence therefore suggests patient A has cause for concern, whereas patient B seems to be overestimating the probability of something going wrong.

In the case of patient A, where the danger is real, cognitive restructuring alone does not meet the demands of the situation. Real danger calls for real problem solving. In other words, patient A ought to be working on improving his chances of survival such as finding the best possible heart surgeon, or trying to remain calm by using relaxation techniques. Once he has done everything in his power to survive, even though worry may still be justified, there is simply no point.

In the case of patient B, there is no real danger. His anxiety is therefore excessive, or at least misplaced. The next step for him is to tease out the type of thinking error by asking two questions called dispute handles. The first question is, "What evidence do we have to support our belief, based on available information?". It pulls for over-estimation thinking errors. The second question is, "So what?", or "What's so bad about that?", or if you're really desperate, "Is it really so important that the rest of my life depends on it?". This second type of question pulls for catastrophizing thinking errors.

By now patient B is probably starting to feel a little silly for scaring himself with his thinking. This is because, within minutes of using the dispute handles, his mind is already working on more realistic, positive outcomes. This more realistic, positive thinking can be prompted by using sentence stems, such as "Other, much more probable outcomes are ...", or "My realistic ability to cope with that situation is ...". The bottom line is, regardless of how distressing his anxiety becomes, he knows that the worst-case scenario is either improbable or manageable or both. Even if the surgery seems unmanageable, he knows that it won't go on forever and, like patient A, once he has done his best to prepare, it does him absolutely no good to worry further.

A final point to be understood about correcting our thinking errors is that the success of this entire process turns on the strength of our evidence. The goal is to replace our faulty thoughts with ones that are healthier and better supported, rather than to simply have happy thoughts. This is not about the power of positive thinking. In fact, having unsupported happy thoughts can be as harmful to your mental health as having unsupported negative ones.