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.07 THE CONQUISTADOR MINDSET: Cognitive Restructuring


Last time we talked about testing your thoughts.

Did you get to try it this week?

Did you find any patterns to your thoughts about the NPTE®?

Are they generally positive?

What about negative?

Cognitive restructuring is a term often employed when treating test anxiety to describe a therapeutic process of challenging cognitive misrepresentations.3 It starts with identifying negative thoughts, irrational thoughts, and even thought distortions.

You might resonate with some of these thoughts:

“If I fail, I won’t be able to pay my rent!”

“I can’t get past my test anxiety. I can’t do this test.”

“They don’t have to worry about their confidence. I do.”

“I’m too stupid to take this test. I’m just not a good test taker.”

“I can’t get my dream job because I can’t pass this stupid test”

In therapy school, did you learn about central sensitization?

I used to get that confused with centralization. I had never heard about central sensitization until after graduation. Partly because it’s a relatively new term. Partly because we like to ignore this part of therapy. It’s really hard to treat.

Essentially, it is a condition characterized by generalized hypersensitivity due to abnormal sensory processing.1 It usually results in severe pain and disability, but without significant physical signs and symptoms.

Most patients’ stories will give you enough evidence to make the diagnosis without having to do much physical testing. This generalized hypersensitivity can manifest in a myriad of formats: hypersensitivity to bright light, to touch, to noise, and to temperature. “Central sensitization provides an evidence-based explanation for many cases of ‘unexplained’ chronic musculoskeletal pain” (Nijs et al. 2011, p.1). The diseases we often associate with central sensitization are things like chronic low back pain, fibromyalgia, and chronic fatigue syndrome.

These patients tend to consistently emit the same preconceived pain perceptions. These are the kind of notions that we dread as therapists because we don’t know how to fix them. Below, David Butler and Lorimer Moseley provide us some examples of the things you can hear from patients: 2

Butler D, Moseley L. Explain Pain. Adelaide City West, South Australia: Noigroup Publications; 2003, 2012. 

They like to call these “thought viruses”.

Trying to treat central sensitization from a pathoanatomical standpoint gets us nowhere. But not using a pathoanatomical approach goes against all the training you get in school.

The reason it gets us nowhere is because the problem in central sensitization is a processing problem. Not a muscle tightness problem. Not a joint dysfunction.

We aren’t exactly equipped for this type of issue when we graduate school.

Treating this condition is hard because you have to start by changing the patient’s preconceived “thought viruses”. If you proceed without working to change the patient’s PERSPECTIVE, you are missing the underlying root cause of his or her problem. You aren’t treating them. You’re putting a Band-Aid on.

And why does it matter to us?

Because our mindset shift is shockingly similar!

It’s the part that we don’t want to think about, per se. It’s the part that is really hard to treat. And it’s quite abstract.

Our patients may have “thought viruses” about their pain. But we have “thought viruses” about our test-taking skills and about the NPTE®.

I like to tell patients they have a “pain perception” problem. Like when our depth perception is off, we might run into things. Literally. I tell patients that they have a similar issue, except their perception about their pain is off. So we need to bring their perceptions back into focus first before we work on the rest of their symptoms and problems.

Similarly, we have a “perspective perception problem and we need to refocus those perspectives before we tackle the NPTE® content. This is essentially the idea behind cognitive restructuring.

Just as we discussed last time, the very first step is to identify which thought viruses plague you. We all have different ones.

In the next blog we will give you a practical activity that you can use to establish your personal “perspective thought viruses” about the NPTE®.


  1. Nijs J, et al. (2011, January 1). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy. doi:10.1016/j.math.2011.04.005.

  2. Butler D, Moseley L. Explain Pain. Adelaide City West, South Australia: Noigroup Publications; 2003, 2012.

  3. Therapist Aid. (2012). Cognitive Restructuring (Guide). (

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