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The past few months have found the first author immersed in reading chapters for the forthcoming revised International Society for Traumatic Stress Studies’ Prevention and Treatment Guidelines book (Forbes, Bisson, Monson, & Berliner, in press) and training clinicians in PTSD treatments grounded in cognitive models of trauma processing (i.e., Cognitive Processing Therapy (CPT; Resick, Monson & Chard, 2016), and Cognitive-Behavioral Conjoint Therapy for PTSD). This work led to our Innovating Methods to Manage, Prevent, Assess, and Care for Trauma (IMPACT) Lab at Ryerson University in Toronto immersing ourselves in cognitive theory and considering advances in neuroscience relevant to our practice of cognitive interventions for PTSD. We routinely refer to “cognitive restructuring” when describing what we do when we directly help clients change their minds, but is that what we are really doing?

If you trace the history of the cognitive revolution applied to clinical problems, you will find early references to “thought replacement” by Ellis (1957). This conceptualization suggests that thoughts are “plug and play” —simply replace a maladaptive thought with a healthier thought to ameliorate a given clinical problem. Beck (1979) first introduced the notion of “restructuring” thoughts, which was originally applied to depression and later a range of clinical disorders. Inherent to the notion of “re” -structuring thoughts is that the original thought is modified to be more realistic or adaptive. The original thought no longer exists, but has been changed into something new.

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