To assess, record and improve the emotionally triggering situations.
Cognitive therapy, a system developed by Aaron Beck, stresses the importance of belief systems and thinking in determining behavior and feelings. The focus of cognitive therapy is on understanding distorted beliefs and using techniques to change maladaptive thinking while also incorporating affective and behavioral methods. In the therapeutic process, attention is paid to thoughts that individuals may be unaware of and to important belief systems.
Cognitive therapists are particularly concerned with the impact of thinking on individuals’ personalities. Although cognitive processes are not considered to be the cause of psychological disorders, they are a significant component. In particular, automatic thoughts that individuals may not be aware of can be significant in personality development. Such thoughts are an aspect of the individual’s beliefs or cognitive schemas, which are important in understanding how individuals make choices and draw inferences about their lives. Of particular interest in understanding psychological disorders are cognitive distortions, inaccurate ways of thinking that contribute to unhappiness and dissatisfaction in the lives of individuals.
The theoretical assumptions of cognitive therapy (Weishaar, 1993) are :
(1) that people’s internal communication is accessible to introspection,
(2) that clients’ beliefs have highly personal meanings, and
(3) that these meanings can be discovered by the client rather than being taught or interpreted by the therapist.
Cognitive restructuring (sometimes referred to as cognitive reappraisal) is a cognitive behavior therapy technique aimed at learning to recognize dysfunctional thought patterns and develop more rational, grounded ways of understanding challenging situations. Cognitive restructuring is not so much a technique in and of itself, but a collection of different techniques to help improve your thinking. Cognitive restructuring techniques can include tracking thoughts during difficult situations, identifying cognitive distortions, and engaging in behavioral experiments to test out whether your thoughts are true.
Graded Exposure Assignments:
Exposure is a cognitive behavior therapy technique that helps people systematically approach what they fear. Generally, fear causes people to avoid situations. Unfortunately, avoidance of feared situations is what maintains feelings of fear and anxiety. Through systematic exposure, people master feared situations one-by-one, and then tackle increasing difficult exposure assignments. Exposure is one of the most effective psychological treatments that exist, having a 90% effectiveness rate with some anxiety disorders.
Activity scheduling is a cognitive behavior therapy technique designed to help people increase behaviors they should be doing more. By identifying and scheduling helpful behaviors, such as meditating, going for a walk, or working on a project, it increases the likelihood of their getting done. This technique is especially helpful for people who do not engage in many rewarding activities due to depression, or people who have difficulty completing tasks due to procrastination.
This cognitive behavior therapy technique works for people who have difficulty completing a task, either due to lack of familiarity with the task, or because the task feels overwhelming for some reason. The technique works by helping people master an easier task that is similar to the more difficult task. It’s akin to practicing addition and subtraction before learning long division. Once you are practiced at addition and subtraction, long division isn’t as daunting. Likewise, by having rehearsed one behavior, one that is slightly more difficult feels more manageable.
Mindfulness is a cognitive behavior therapy technique borrowed from Buddhism. The goal of mindfulness is to help people disengage from ruminating or obsessing about negative things and redirect their attention to what is actually happening in the present moment. Mindfulness is the subject of a lot of new research in psychology and represents the cutting edge of psychotherapy practice. Significant research has shown mindfulness to be effective in improving concentration, pain management, and emotion regulation.
A lot of people’s problems result from not having the appropriate skills to achieve their goals. Skills training is a cognitive behavior therapy technique implemented in remedying such skills deficits. Common areas for skills training include social skills training, communication training, and assertiveness training. Usually, skills training takes place through direct instruction, modeling, and role-plays as well as through problem-solving therapy.
According to the APA, Thoughts are instantaneous, habitual, and non-conscious. Automatic thoughts affect a person’s mood and actions. Helping individuals to become aware of the presence and impact of negative automatic thoughts, and then to test their validity, is a central task of cognitive therapy. Thoughts that have been so well learned and habitually repeated that they occur without cognitive effort. Also called routinized thoughts.
Our minds are constantly flowing with thoughts. Sometimes we are intentionally thinking about something (like a task at hand, something that we have to do, or about something that we’ve recently experienced). Other thoughts appear suddenly and without any effort from ourselves. Have you ever been doing something and suddenly a thought pops in your head? These are automatic thoughts.
Automatic thoughts are often influenced by our view of ourselves, others, and the world. Moreover, there is an interactive relationship between our thoughts, feelings, and actions. When the automatic thoughts that distress the person are examined, it can be observed that there are some obvious errors during this thinking process. These errors are calledcognitive distortions in cognitive therapy.
How can Automatic thoughts be harmful:
We all experience automatic thoughts, they are a natural part of being a human. However, automatic thoughts can sometimes get out of control and impact our mood, actions, or ability to function. Our automatic thoughts pop into our minds, and we often believe them as being totally true. However, these thoughts can often be irrational, unhelpful, or just downright incorrect. When we believe our automatic thoughts without any consideration for their accuracy, they can quickly take over our mental space.
For example, we may text a friend and not receive a response right away. The automatic thoughts pop into our head saying, “She must not even like me. She’s totally ignoring me right now, I know it. She’ll never text me back. I’m such a loser, why would I even have texted her in the first place??”
If we believe these thoughts, we’ll probably end up feeling pretty bad about ourself. We will likely also end up feeling anxious, hurt, embarrassed, or frustrated at our friend for not texting us back. We will feel like they really are ignoring us or intentionally trying to hurt our feelings. These thoughts will also likely influence our behaviors as well. We may avoid running into this friend or refuse to text them again.
Many times when we’re feeling overwhelmed by negative emotions, our automatic thoughts are running rampant. We can quickly believe these thoughts, causing us to feel unworthy, unloved, unimportant, or totally isolated from everyone around us.
Types of Automatic Thought:
- Overgeneralisation: Coming to a general conclusion based on a single event
or one piece of evidence. If something bad happens once, you expect it to
happen again and again. Such thoughts often include the words “always” and “never”. E.g. I forgot to finish that project on time. I never do things right. He didn’t want to go out with me. I’ll always be lonely.
- Filtering (Selective Abstraction): Concentrating on the negatives while
ignoring the positives. Ignoring important information that contradicts your (negative) view of the situation. E.g. I know he [my boss] said most of my submission was great but he also said there were a number of mistakes that had to be corrected…he must think I’m really hopeless.
- All or Nothing Thinking (Dichotomous Reasoning): Thinking in black and white
terms (e.g., things are right or wrong, good or bad). A tendency to view things at the extremes with no middle ground. E.g. I made so many mistakes. If I can’t do it perfectly I might as well not bother. I won’t be able to get all of this done, so I may as well not start it. This job is so bad…there’s nothing good about it at all.
- Personalising: Taking responsibility for something that’s not your fault. Thinking
that what people say or do is some kind of reaction to you, or is in some way related to you. E.g. John’s in a terrible mood. It must have been something I did. It’s obvious she doesn’t like me, otherwise she would’ve said hello.
- Catastrophising: Overestimating the chances of disaster. Expecting something unbearable or intolerable to happen. E.g. I’m going to make a fool of myself and people will laugh at me. What if I haven’t turned the iron off and the house burns down. If I don’t perform well, I’ll get the sack.
- Emotional Reasoning: Mistaking feelings for facts. Negative things you feel about yourself are held to be true because they feel true. E.g. I feel like a failure, therefore I am a failure. I feel ugly, therefore I must be ugly. I feel hopeless, therefore my situation must be hopeless.
- Mind Reading: Making assumptions about other people’s thoughts, feelings and behaviours without checking the evidence. E.g. John’s talking to Molly so he must like her more than me. I could tell he thought I was stupid in the interview.
- Fortune Telling Error: Anticipating an outcome and assuming your prediction is
an established fact. These negative expectations can be self-fulfilling: predicting what we would do on the basis of past behaviour may prevent the possibility of change. E.g. I’ve always been like this; I’ll never be able to change. It’s not going to work out so there’s not much point even trying. This relationship is sure to fail.
- Should Statements: Using “should”, “ought”, or “must” statements can set up unrealistic expectations of yourself and others. It involves operating by rigid rules and not allowing for flexibility. E.g. I shouldn’t get angry. People should be nice to me all the time.
- Magnification/Minimisation: A tendency to exaggerate the importance of negative information or experiences, while trivialising or reducing the significance of positive information or experiences. E.g. He noticed I spilled something on my shirt. I know he said he will go out with me again, but I bet he doesn’t call. Supporting my friend when her mother died still doesn’t make up for that time I got angry at her last year.
How to move past Automatic Thoughts:
As humans, we all experience automatic thoughts. Simply experiencing an automatic thought isn’t inherently bad, it’s normal! However, we can run into a lot of distress when automatic thoughts go unchallenged and take over our mental space. The key is to build awareness over our automatic thoughts and then work to challenge, and subsequently change, our automatic thoughts.
- The first step is building awareness. If we are unaware of the automatic thoughts that we experience, or we view them as totally accurate, there isn’t much we can do to change them. Doing things like using a thought recorder or checking in with ourselves throughout the day to take note of our thoughts can be helpful to get started. Begin by writing these thoughts down. It may feel strange at first, but writing down our automatic thoughts can help us to see them more clearly, identify themes within our automatic thoughts, and determine how rational or irrational they are.
- Once you have gained awareness of your automatic thoughts, you can begin to challenge them by presenting an alternative, more rational thought. For the earlier example, one of the automatic thoughts was, “She MUST be ignoring me!” A more rational thought would be, “She has been really busy lately, she will probably text me back when she gets a chance.” This thought is much more likely to help us feel more calm and less distressed about not receiving an immediate response.
- We eventually want to adopt these more rational thoughts. This comes with time and practice of thought awareness and developing alternative thoughts. Again, this is not to prevent a negative automatic thought from ever occurring again. Rather, it is to help us to quickly recognize, challenge, and change our thoughts to gain control over our mental space and to feel less stressed, anxious, depressed, angry, or self-conscious.
Thought records are one of many skills taught in CBT. They are based on the premise that you don’t have to believe every thought you have. The CBT Thought Recordis an essential tool in cognitive behavioral therapy. Thought challenging
records help people to evaluate their negative automatic thoughts for accuracy and bias. The
principle underlying this worksheet can be summarized as “what do you believe, and why do you believe it?”
A thought record is a way of putting your thoughts to the test. It is designed to help you change your moods by finding a more balanced way of thinking about things. In short, you identify a dubious thought and “put it on trial.”
This seven-column CBT thought record can be used to:
- Identify Negative Automatic Thoughts.
- Identify the thought most strongly related to the client’s emotional reaction (the ‘hot’ thought)
- Help clients to understand the links between thoughts and emotions.
- Examine the evidence for and against a selected Negative automatic thought.
- Generate more realistic alternatives to a Negative automatic thought which take into
- account the evidence for and against.
- Examine how the new thought makes the client feel.
|Date||Time||Situation||Thought||Feelings (rate 1- 100%)||Sensation (rate 1-100)||Action|
|This situation due to which you got negative thoughts||What is the negative thought? Kinds of negative thoughts you felt.||What you felt at that time.||How did your body react?||What was the reaction to negative thoughts?|
REVIEW OF LITERATURE:
Kirschbaum & Hellhammer (1993) examined the effects of thought record completion on affective and physiological responses to a laboratory stressor. Participants underwent the Trier Social Stress Test and were randomized to a thought record condition (n = 50) or a control condition (n = 50). Affect and biological responses (i.e., cortisol, dehydroepiandrosterone, and alpha-amylase) were collected throughout the session. Participants in the thought record condition showed greater peak cortisol response following the stressor.
The study was done by McManus, Doorn, Katie & Yiend (2011) examined the relative efficacy, in comparison to a control condition, of two central techniques in CBT: thought records (TRs) and behavioral experiments (BEs). A mixed within and between participants design was used to compare the efficacy of a single session TR and a single session BE intervention with a control intervention, in a non-clinical sample. Ninety-one participants were randomly allocated to one of the three conditions. The overall pattern of results suggests that both TR and BE had a beneficial therapeutic impact in comparison to the control condition on beliefs, anxiety, behavior, and a standardized measure of symptoms.
Waltman et. al. (2019) sought to prepare a way for further understanding the differential utility and effectiveness of different iterations of thought records by creating a coding system, which is described in detail to guide future research. Thought records were gathered from seminal texts and solicited from the certified members of the Academy of Cognitive Therapy and the American Board of Behavioral and Cognitive Psychology. In total, 110 non-identical thought records were gathered and coded into 55 unique combinations. These results demonstrate that the variability of thought records used by qualified therapists extends well beyond those found in seminal CBT texts.
Materials required- thought record diary
After establishing rapport with the participant the following instructions were given to them, “Everyone has hundreds of ‘automatic thoughts’ every day. These are thoughts that just ‘pop’ into your mind. Sometimes the thoughts that we have are facts, but other times they are opinions: sometimes they are accurate and helpful, and sometimes they are inaccurate and unhelpful. A good way of catching and examining your negative automatic thoughts is to use a thought record. Would you be willing to practice one with me now?”
The subject was provided with a diary and was explained how to fill it out accordingly. They were told how to fill each column as follows:
1. Situation– Thought records are completed with respect to specific situations. The participant was instructed to complete a thought record when they notice a change in how they are feeling and record this in the first column. Enough information about the situation should be recorded so that the event can be recalled and discussed when the thought record is reviewed.
2. Automatic thought– Automatic thoughts can be described as thoughts which ‘pop’ involuntarily and effortlessly into our minds. They are often concerned with judgments about a situation, other people, or us, or they might be predictions about what will happen in the future. It is important to remember that automatic cognitions can be images or memories as well as thoughts. Prompts to help the participant to complete the third column include:
- What was going through your mind as you started to feel that way?
- What memories or images were in your mind?
3. Emotion or feeling– The cue for completing a thought record is often a sudden change in emotion. In the second column record, the emotion felt and its subjective intensity. The participant was asked to record how strongly they felt the emotion and their emotional reaction was rated along side in the form.
- How did you feel in that moment?
- What did you feel in your body?
4. Action– The participant was asked to record the way they reacted after the negative thought, and after the emotions, they felt, how the whole situation turned out. After the completion of two weeks, the diary was taken back and studied for relevant information. The participant was asked to submit their experience in a form of reflection.
Participant’s reflection– “It was a very great experience writing down my thoughts I didn’t expect it would be different from writing daily dairy, I really start focusing on what I was really thinking the whole day and it was very self-realizing and was a fresh experience. I realized
some new things about myself like I am always very strict on myself and my self-esteem decrease quite easily. I realized that I spent too much time worrying instead of doing something about the problems. I will try not to worry too much from now on, and think about solutions.”
The subject filled the Thought Record Form for a period of 15 days, starting from the 6th of April 2021 to the 20th of April 2021. as perform, most situations that elicited negative automatic thoughts made the subject think critically of themselves. Thoughts such as “I’m always wasting my time”, “this always happens with me”, and “why are all my ideas so bad” cropped up automatically. These thoughts also caused intense negative feelings and sensations as rated by the subject. The subject was also told to consciously try to think of alternate thoughts and practical solutions to take when such thoughts occurred to her. As reported by the subject, in the beginning, it was challenging to think of ways to combat these intense negative automatic thoughts. However, with much effort, actions like planning the day when feeling like there wasn’t much progress being made with respect to work or trying to put more effort by going about tasks systematically were made by the subject.
Slowly and steadily the way the subject felt about these thoughts and the resulting negative sensations decreased in intensity. And because of forming a habit to quickly replace the negative automatic thoughts with positive and practical ones, she felt a lot more at ease to naturally combat the negative automatic thoughts. And by the end of the task of filling the Thought Record Form, she realized that she was automatically able to reason with herself and feel more in control of her own thoughts.
THOUGHT RECORD DIARY
|Date||Time||Situation||Negative Automatic Thought||Feeling||Sensation||Action||Alternate Thought|
|1||6/4/21||6 pm||Thinking about my work.||Will I be able to meet my targets?||80% anxious||60%||Started making a plan of action.||If I set proper goals, I will be able to meet my targets.|
|2||7/4/21||11:30 pm||I binged watched youtube||I am always wasting my precious time.||80% guilty||60%||Made a timetable.||I will compensate by working hard tomorrow.|
|3||8/4/21||7:30 am||My favorite color pen broke||This always happens with me.||90% angry||50%||Changed into something else.||I will buy the exact same new one.|
|4||9/4/21||2 pm||My project idea got rejected.||Why are all my ideas so bad?||90% fury||70%||Started looking for well-researched topics.||I will find at least 5 topics to choose from.|
|5||10/4/21||4:45 pm||I wasn’t feeling productive.||I am always so useless||70% shame||40%||Set a timetable for the rest of the day.||I can chill at times.|
|6||11/4/21||3:30 pm||Missed my bus.||This always happens with me.||100% anger||80%||Took the cab home.||I should be on time.|
|7||12/4/21||9 pm||Was feeling sad and irritated||I don’t know when the college will end there is too much work to complete||50% low||50%||I will just study.||It is only a matter of a few more months.|
|8||13/4/21||8 pm||Had a stomach ache.||It must be food poisoning.||40% scared||40%||I should try a home remedy.||It is nothing major.|
|9||14/4/21||8 am||Late for college||I am so careless||50%||50%||I will stay in and complete assignments.||We are bound to make mistakes sometimes.|
|10||15/4/21||7:30 pm||My friend didn’t help me.||Why do people never help me?||40% disappointed||40%||I tried to solve my problem.||Sometimes people are busy.|
|11||16/4/21||9 pm||Ordered online and received a damaged product.||All the wrong happen with me only.||40% furious||30%||I applied for a refund||It’s okay, I will reorder the same one.|
|12||17/4/21||11 am||Had to travel long-distance alone||How will I take care of myself||30% scared||30%||Tried to prepare me||I have to grow up and be independent.|
|13||18/4/21||4 pm||The exam got delayed.||I can’t believe how unprofessional this is.||30% angry||20%||I tried to listen to music.||Things go south sometimes.|
|14||19/4/21||8 pm||Was feeling homesick||When will I go back home?||50% sad||50%||Made a plan to explore the city.||These 4 days, I will have fun here.|
|15||20/4/21||4:30 pm||Overslept.||Oh god, so much time got wasted.||40% guilty||40%||Planned the rest of the day.||It’s worth it if I had a nice nap.|