there are some significant problems with cognitive restructuring that result in it being a strategy with limited utility.

basic emotional responses are modular. i'll give you an analogy. have you ever seen the muller lyer? which of the following two lines is longer?

http://facweb.furman.edu/~einstein/g...ndpdemo/75.jpg

most people say that the top line looks longer. and indeed, it DOES look longer. now take a ruler and measure the lines. they are of equal length. does RATIONALLY KNOWING that the lines are of equal length help with their APPEARING to look different? No, it does not.

what is happening with the illusion is that our visual system is being fooled. there are basic visual processes that result in the lines appearing to be of different length. Those basic visual processes are impervious to our background knowledge (that what we are experiencing is illusory).

Basic emotional responses can similarly be modular (impervious to what you rationally know). Part of it is because low level emotional responses are triggered by the amygdala whereas our 'rational knowledge' is localised in higher cortical areas. There are many more projections from amygdala to higher cortical areas than there are from higher cortical areas to amygdala. What that means... Is that quite often we can find ourselves experiencing an emotional response that we know full well is inappropriate to the situation but our rational knowledge is simply not in a position to change how we feel.

So we can feel like we are disgusting and dirty even while rationally knowing that we aren't. That rational knowledge doesn't change how we feel, however. Saying 'I am a worthwhile human being' 100 times a day is of limited utility because the message doesn't get to the amygdala...

It isn't you... It is a fact about brains... Different people have slightly different wiring... Trauma... Tends to mean that people have even less projections from higher cortical areas back to the amygdala and it also means that their amygdala responses are more intense than usual and more easily triggered.

I personally found cognitive restructuring to increase my sense of shame (I felt ashamed that I had 'irrational' thoughts and feelings). In other words, I found it to harm more than help. It encouraged me to deny what I was feeling and thinking on because the implicit message that I took was that it was not okay for me to be thinking or feeling the way I was (it was considered 'irrational' and therapist was focused on changing it).

So... The therapist can switch strategies to acceptance (if the therapist has acceptance in their tool kit).