Topic 5: Behavioral Activation & Automatic Thoughts {by 2/24}

[Behavioral Activation] – Watch MDD-7: Behavioral Activation – Introducing Daily Activity Schedule.  Answer the following: (1) Based on what you know about this client so far (e.g., information from his assessment and his Weekly Activity Monitoring Log), what specific activities or tasks would you like to see on his first Daily Activity Schedule?  (2) How would monitoring this client’s thoughts (and believability rating) and emotions (and severity rating) be helpful for future cognitive work?

 

[Automatic Thoughts] – What are some possible reasons why it is difficult for some clients to differentiate thoughts from emotions?  Why is it important to know the difference (see Tables 7.3 & 7.4)?

 

Your original post should be posted by 2/24.  Have your two replies posted no later than 2/26.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

40 Comments (+add yours?)

  1. Tressa Novack
    Feb 21, 2022 @ 13:32:13

    Based on what we have learned about Mark there are a few activities that I would like to see on his Daily Activity Schedule. Mark has really struggled with getting going in the morning for work. I think it could be beneficial for him to schedule a time to wake up that would allow him enough time to shower and eat breakfast. I think initially this could make Mark feel more tired, because as Dr. V pointed out sleep schedules cannot be changed overnight, but I think Mark could benefit from this adjustment in the long run. Mark should also specifically write down when he expects himself to get in the shower and eat breakfast to help himself stick to a schedule. If there are any specific tasks Mark must complete at work, he can also write down the specific times he wants to start those tasks. Lastly, I think it could be great for Mark to schedule a social activity either with Melissa or a friend, and an outdoor activity, which can be social as well.

    Monitoring his thoughts and emotions can be helpful for future cognitive work, because it will allow Mark to see during which activities he experiences the most negative thoughts and emotions. This may help Mark get to the bottom of what brings out his negative thoughts and why. By focusing on what activities activate his negative automatic thoughts Mark could come to an understanding of his negative core beliefs. This would also aid Mark in better understanding himself and his thoughts patterns and be helpful in making changes to his maladaptive thoughts.

    Reply

    • Victoria Cestodio
      Feb 22, 2022 @ 11:17:21

      Hi Tressa!
      We mentioned a lot of similar things. I also agree that mornings are really crucial for Mark, and him making time in the mornings to get up earlier is something I would really want to see. Also, social activities are huge for Mark, like we both mentioned. Getting him out to do something social I also think would be beneficial. When it comes to Mark’s thoughts and emotions you hit every point! This will really lead us to what Mark’s negative automatic thoughts and his core beliefs are which will make therapy that much more powerful for Mark, and it will make him understand himself better.
      great post!!!
      Victoria

      Reply

    • Vanessa Nichols
      Feb 22, 2022 @ 13:11:34

      Hi Tressa
      Great post this week!
      I also agreed that it seems really important to Mark to get a better morning routine, so I feel like it’s essential for him to start taking those steps. Even 30 minutes could be a huge relief for Mark that would allow him time to eat breakfast, shower, and get ready without feeling an overwhelming sense of anxiety or urgency. I also can see the importance of social activities and pleasure activities. I know mark gets a lot of joy from walking his dog, and that just seems like such an easy and accessible task. I feel like adding that on would be beneficial because it would add a little joy without adding too much additional anxiety.
      I also agree that monitoring his thoughts and emotion can be helpful for future work because it allows Mark to see what events and activities produce the most negative thoughts and the most positive thoughts. I think it’s also really important to know mark’s belief in those thoughts because I believe that will help keep the counseling flowing in a beneficial direction.

      Reply

    • Tressa Novack
      Feb 22, 2022 @ 14:32:52

      I forgot to mention why it is important for clients to differentiate between thoughts and emotions and why it may be difficult to do so, so I am replying to myself here. I think it can be hard for clients to differentiate between thoughts and emotions because our thoughts and feelings influence each other as we learned when we talked about reciprocal determinism. Also, because automatic thoughts happen so quickly, and often seem subconscious until pointed out, it can be easy to mistake thoughts as emotions. It can feel as if our thoughts are our emotions because they often line up with the way we are feeling. It is important for clients to be able to differentiate between thoughts and emotions so they can understand where their emotions are coming from. If clients can identify a thought, positive or negative, they will have a better understanding of where their emotion is coming from. Furthermore, if clients can identify negative thoughts, they have an opportunity to adapt that thought before experiencing negative emotions or behaving maladaptively.

      Reply

    • Madelyn Haas
      Feb 23, 2022 @ 17:55:40

      Hi Tressa,

      I enjoyed reading your post. I am completely on the same page with Mark’s activities. Although getting up early is difficult for him, he acknowledges that he feels rushed and anxious every morning. These negatives feelings probably color how he feels the rest of his day and contribute to negative self-thoughts. I hadn’t considered how important it is for him to monitor his work activities, but I do think that that is a great point. He mentions how work often stresses him out and makes him feel unproductive, so it would be good to see what he is doing and how these activities make him feel. Scheduling them in advance could even help him feel less stressed and more productive.

      -Madelyn Haas

      Reply

    • Will Roche
      Feb 25, 2022 @ 11:22:56

      Hi Tressa,

      I agree with all of your points, and I especially wanted to add onto the importance of Mark changing his sleep schedule despite the difficulties this may cause. Creating new circadian rhythms and an alteration to one’s sleep schedule is not easy. But if Mark is able to change his sleeping habits, it may benefit him more than he thinks for a few reasons. First, I personally feel worse when I lay around and sleep late instead of getting a better start to my day, perhaps Mark might feel the same if he started waking up earlier. Secondly, by waking up later, Mark is beginning his day subjecting himself to the stress by rushing around his house before work and giving himself the anxiety of getting to work on time as soon as his day begins. Obviously this is not an optimal way to start one’s day. By giving himself more time in the morning to get ready, it will reduce the stress of getting things done quickly so that he gets to work on time. Great post!

      Reply

    • Pilar
      Feb 26, 2022 @ 23:20:04

      Hey Tressa,
      I like that you suggested Mark try to gradually build a schedule for his mornings, sticking to a routine would help him to feel less rushed in the morning and give himself more time to sit down and enjoy his breakfast. Just by making a checklist or setting a schedule for yourself you are more likely to follow it, it may not be perfect but checking things off the list gives you a sense of accomplishment which could be motivating for Mark to see that he’s getting stuff done.

      I agree differentiating your thoughts from your feelings is important and by bringing someone’s attention to the thoughts that cause the feeling can help them to monitor those thoughts and work towards have ing more positive thoughts.

      Reply

  2. Victoria Cestodio
    Feb 22, 2022 @ 11:10:15

    Some tasks I would like to see on Mark’s first daily activity schedule are for starters having him get a better start to his day, and not rushing in the mornings to work. I think mornings really set up Mark’s day, and when he rushes to work it only creates a negative effect for him. Another thing I would love to see him do on his daily activity schedule is get outside! It seems as though when Mark gets outside on a walk with his dog or Melissa he really enjoys it and I think it would be great for him to incorporate that more. Also, like Dr. V said in the videos, scheduling a date night in there, getting out and being social will be something I would really want to see Mark do in his DAS.
    Monitoring Mark’s thoughts and emotions would be very beneficial for future cognitive work because it will help Mark see what activities were making him feel positive and good compared to the activities that gave him the opposite effect and made him feel more negatively. Getting this insight as the clinician we can try and break down with Mark why he may think certain activities he felt very positive about and others he did not, and why that is. This will allow Mark and Dr. V to delve deeper into his thoughts and emotions and how they are affecting these tasks.
    Why it may be difficult for some clients to differentiate their thoughts and emotions is because their thoughts end up affecting their emotions therefore they become ‘one’. Therefore if I think “I am a failure” that will result in me feeling sad and upset, maybe angry. Thoughts and emotions are very much intertwined, but it is important to understand your thoughts and where they are coming from so you can break the pattern. It is important to know the difference because if you don’t, like mentioned previously you won’t be able to target your negative automatic thoughts, and not being able to identify them will lead them to keep recurring.

    Reply

    • Vanessa Nichols
      Feb 22, 2022 @ 13:21:48

      Hi Victoria,
      Great post again this week!
      I also agreed about the mornings being very important for Mark. But I also really liked that you included walking the dog or doing something with Melissa. I feel like change is so much work and can be so exhausting, especially at first, so it’s really important to make sure there’s a balance between difficulty and pleasurable activities. I think the addition of a date night or walking the dog would add to the pleasure and motivate Mark to continue working on these challenges.

      I agree that it’s difficult for clients to differentiate between emotions and thoughts because it happens quickly and automatically. Without being able to differentiate, we would be able to change the behavior or the emotions that result from those thoughts. Addressing those thoughts is the essential aspect of CBT therapy, so it’s important that we help clients through psychoeducation learn to distinguish between negative thoughts and the emotions that result from those thoughts.

      Reply

    • Tressa Novack
      Feb 22, 2022 @ 14:45:47

      Hi Victoria,
      I agree with everything you said to put on Mark’s Daily Activity Schedule and I think scheduling out his morning is the biggest thing for Mark to put down. If Mark can give himself more time in the morning, he may go into work with a more positive mood, which will set him up to have a better day entirely. I also talked about Mark trying to schedule a social activity or outdoor activity. It is important that he can find time to do things he genuinely enjoys, because that will help to lift his mood as well.
      I also said something very similar to you about why monitoring his mood and thoughts are important to future cognitive work. I do think that depending on which activities make him feel the worst, Mark may be able to come to an understanding of his negative core beliefs. This may allow him to see how he feels about himself and what he can do to change any negative beliefs he has about himself.
      I agree with what you say about thoughts and emotions becoming “one.” That is a good way to put it, because as our thoughts and emotions are typically aligned with one another it can be hard to separate them. However, it is important for clients to be able to do so, so that they can have more power over their thoughts.
      Great post!
      Tressa

      Reply

    • Lauren Pereira
      Feb 23, 2022 @ 13:45:19

      Victoria,

      I like how you thought to incorporate being outside and taking the dogs for a walk in Mark’s daily schedule. It is something that he has repeatedly said he enjoys which would make part of his days a lot more positive if he stuck to doing this everyday. Being social is another important task to consider because it can help get him out of his comfort zone more frequently which will help him adjust that part of his life to help improve his automatic thought processes.
      For Mark’s future cognitive work, it is definitely important to differentiate which activities make him happier and more positive and which ones do not. This process can also help the clinician as well because it gives them more information on what the clients interests are and what they should be focusing on.
      I also agree that thoughts and emotions can intertwine because they do affect one another. If a person has a single thought in their mind, this will affect their emotions and how that situation makes them feel. That is why it is so important to be able to tell those differences apart. Great post!

      Lauren

      Reply

    • Madelyn Haas
      Feb 23, 2022 @ 18:02:07

      Hi Victoria,

      Great post this week! You and I had similar thoughts about the importance of him attempting to get up in the morning. Although it is hard to get up in the morning, especially with depression, I think it would benefit him greatly. He feels stressed and even acknowledges that it negatively affects him, so it would be great to see if he is able to get up earlier and check what his automatic thoughts were. I also think that it is a good idea to see how he fairs with a more structured and planned out date night with Melissa. If it goes well, this could reinforce planning behaviors and could show him what works best for him. Finally, I think your description about the confusion between thoughts and emotions is apt. They are often intertwined and affect one another, so it is hard to tell them apart. With that being said, we need to teach clients how to so that we can use helpful interventions that target their automatic thoughts.

      -Madelyn Haas

      Reply

    • Jeremy
      Feb 27, 2022 @ 22:10:59

      HI Vicotria,
      I really liked your discussion on Marks’s behaviors. I agree it would be great to see that mark is taking more walks in the environment especially considering how consistently he finds that he enjoys it. Especially bringing his girlfriend along was a big benefit to a lot of his concerns right now.
      You discussed differentiation thoughts form emotions really well, being aware of the distinction allows clients to start engaging with automatic thoughts and directly challenge and oppose them.

      Reply

  3. Vanessa Nichols
    Feb 22, 2022 @ 13:03:48

    I think it would be highly beneficial to Mark to work on his morning routine. Throughout the interviews, Mark discusses feeling rushed and anxious in the morning. I think it would be helpful for Mark to try to wake up earlier than he usually wakes up and plan a productive morning that will make him feel good. However, changing sleep schedules can be extremely difficult and takes time, so we must find the balance between pushing without pushing too hard. I really like that Dr.V said to break the morning into parts. This will help Mark maximize his time and feel accomplished with his morning routine. Even just having enough time to sit, have breakfast, and have a cup of coffee would be beneficial for Mark. I also agreed with Dr.V that social and pleasurable activities would be necessary. With the sleep schedule being so hard, maybe it would be beneficial to focus on adding pleasure activities to balance the sleep difficulties, such as walking the dog. Mark really likes that, so adding some joy may counterbalance his difficulties in changing his sleep schedule.
    Monitoring Mark’s thoughts, believability rating, emotions, and severity rating will be helpful for future cognitive work because it gives both of us (mark and the counselor) insight into which thoughts and emotions hold the most weight and how true they end up being. It’s important to know what events create the most negative emotion in Mark and how much Mark believes those thoughts or emotions. Mark’s believability in those thoughts can be more significant than the thought itself. It provides insight into what we should focus on and offers contradictory evidence for Mark in the future.
    It can be challenging for clients to differentiate between thoughts and emotions because automatic thoughts happen quickly and almost has a reflex. Due to the quick nature and connection, thoughts are not often even recognized. Usually, we only acknowledge the emotion that results from those thoughts. It’s essential to recognize the difference between thoughts and emotions because they often result in emotional and behavioral responses. To change your behavior and negative emotions, we must address the thoughts and core beliefs that caused them in the first place.

    Reply

    • Tressa Novack
      Feb 22, 2022 @ 14:53:01

      Hi Vanessa,
      Great post! I said many similar things, especially about the sleep schedule. Sleep schedules can he hard to change, but I think it will help Mark to get up earlier. By having a well planned morning Mark will be set up to have a much better day. I also like how you talked about how important it is to see which events create the most negative emotions in Mark. It can allow us insight into Mark’s beliefs about himself and how his beliefs affects his thoughts. I like how you point out that the recognition of thoughts results in emotional and behavioral responses, and to change these responses we need to recognize the spots. I could not agree more. Again, great post!
      Tressa

      Reply

    • Monika
      Feb 23, 2022 @ 12:27:41

      Hi Vanessa,
      I agree with you that it would be beneficial for mark to work on his morning routine and have some extra time to himself so he doesn’t start his day anxious. And of course to get up early in the morning he needs to make sure he is going to bed on time. Adding pleasurable activities is a great way to keep him motivated and I think if he decides to walk his dog in the morning, it can be something he looks forward to every morning and that can probably motivate him to go to bed early. I really liked how you explained automatic thoughts happen so quickly and result in an emotion that it can be difficult for clients to even notice the negative thoughts. This point really helped me have a better understanding of the quick nature and connection of thoughts to emotions. Great post as usual.
      Monika

      Reply

    • Lauren Pereira
      Feb 23, 2022 @ 13:50:37

      Vanessa,

      I agree that Mark’s morning schedule should be adjusted so he gives himself enough time to get everything done in the morning. In order to have a good day, you would want to start off on the right foot. In this case, I like that you mentioned that Mark needs to find a balance between pushing himself and pushing too hard. It is true that changing his sleep schedule is going to be an adjustment, but he will eventually get used to it and it will benefit him in the future.
      It is also important to consider his thoughts and emotions in different ways because they both weigh so much on his day. It is important to find the events that create the most stress and negative emotions he has so that way these things can be the priority of focus in order to benefit his days.
      You did a nice job mentioning thoughts and emotions and how these aspects will result in certain responses. In order to change a negative emotion, you must first start at the cause of the feeling which would be ones thoughts. This is why it is so important to differentiate the two in order to move forward. Great post!

      Lauren

      Reply

  4. Monika
    Feb 22, 2022 @ 17:20:53

    From what we have learned about Mark so far, the first activity that I would like to see on his Daily Activity Schedule is making an effort to get up early to have enough time to get ready for work, have breakfast or just take his dog out for a quick walk, which he did before. He described having a tough time getting out of bed in the morning so having a morning routine can really help him get some sense of accomplishment in the morning which can set the tone for the rest of his day. Also, he felt a sense of accomplishment even doing house chores like laundry and dishes so that’s something I would like to see on his daily activity schedule. He likes spending time with his girlfriend, watching football, TV and playing video games so I would to see these activities included as well.
    In the initial phase of therapy focusing on negative core beliefs or negative patterns of thinking can be unpleasant for some clients and even intimidating to start working on this immediately. So instead starting with just monitoring the thoughts can subtly prepare clients for working on their thoughts and emotions further down the road. Also, we need to assess the client’s current baseline so that we know which behaviour patterns we need to focus on. Monitoring thoughts can help us identify negative patterns of thinking or negative thoughts which is crucial since we can focus on adapting and modifying them in upcoming sessions. Clients are not aware of how our negative automatic thoughts affect our behaviours and they may not be aware they are getting these automatic thoughts so asking them to monitor can help the therapist identify these patterns. Emotions make us want to act, and different emotions guide us towards different kinds of actions, so in case of Mark, focusing on the positive emotions from the pleasurable activities can help him feel motivated to do more. And by monitoring his negative thoughts, we know he has a tendency to self-blame, we can modify those negative thoughts into positive ones in further therapy sessions.

    It’s important that clients identify their negative thoughts and emotions so that the therapist and client can work together on modifying them. Instead of telling the client not to experience negative emotions, we want to ask them to minimize negative emotions. One reason clients can confuse thoughts and emotions is that they use feelings to describe emotions, feelings are the physiological arousal we feel while experiencing an emotion. Another reason can be, they confuse thoughts for emotions like I feel like I am not good enough. People are also used to talking about thoughts and feelings as being part of the same experience and so it can be difficult for them to separate them and remember that feelings are not thoughts.
    In cognitive-behavioural therapy, distinguishing between thoughts and feelings (emotions and body sensations) is critical. Thoughts are frequently views or assumptions that can be interpreted and changed. Also, we don’t work on modifying emotions because we can’t change how a person feels about something in the moment but rather we work on their thoughts, which ultimately would lead to emotion. So for example if a client is feeling anxious before a big presentation, they might be thinking I will not be able to present my ideas clearly, people will judge the way I am speaking or I am not good enough. So in this case knowing that these negative thoughts are actually making the client anxious can help us change these thought patterns and in turn the emotion itself.

    Reply

    • Lexi
      Feb 23, 2022 @ 18:58:12

      Hello Monika

      I like your suggestion for Mark that I hadn’t thought of like laundry, dishes, incorporating his girlfriend Melissa and the dog into the morning routine. I like too what you say about how focusing on altering negative thoughts and core beliefs can be intimidating for clients – so starting with just monitoring can be helpful. I don’t know that I had thought this through until now but Its true that awareness after a week or two of monitoring may result in the client having the awareness and insight which are ingredients for planning and motivation.

      Reply

  5. Lauren Pereira
    Feb 23, 2022 @ 13:39:42

    For Mark, I think it would be beneficial to include a stricter morning routine on his daily activity schedule. Having a good start on your day is important, as these morning tasks can usually make or break how your day goes. First, I think he should schedule in a time where he should wake up and give himself a few minutes to lay in bed before having to start getting ready for work. Next, he should schedule specific times to shower and eat breakfast so that he gets those tasks done. It will be easier to complete if he adds time in on his schedule and makes it more of a priority throughout his morning routines. This will be an adjustment for Mark, but it will get easier as time passes and it will make his mornings more calm and accomplished. If he get more used to this type of schedule, I think it would also be a good idea to set some time to be around the dogs or take them for a quick walk outside because this is something he continuously enjoys. Creating a more strict and accomplished schedule will help Mark be more on time of his time management and he will likely set more time aside for these significant tasks each morning.
    Having to monitor his thoughts and emotions will help to identify which activities bring more joy to Mark. This will help establish a more positive outcome with hobbies and tasks he enjoys doing. This not only allows Mark to become more aware of his positive actions throughout the day, but he will also be able to identify which tasks bring Mark to feel more negative thoughts and emotions. Being able to distinguish between the two types of emotional and behavioral groups he expresses, it will help him stick to the more positive activities which lead to more positive thoughts and emotions for him to experience each day. Mark will be more familiar with positive and adaptive patterns rather than maladaptive thinking that he sometimes encounters.
    A person’s thoughts end up relating back to there emotions and how situations make them feel. This is why it can be difficult for clients to differentiate between the two. Our emotions are based off of our thought process and how they affect how we feel. If a client is not able to determine the difference of thoughts and emotions, it will impact their negative automatic thoughts. This will make it harder to identify the pattern of your own thoughts and how they may relate to your feelings. Being able to identify thoughts and emotions, independently, can positively impact your therapy sessions and your thought process.

    Reply

    • Lexi
      Feb 23, 2022 @ 18:49:49

      Hello Lauren
      I agree with you that Mark should have a focus on making the most of his morning, you went even more granular than I was thinking in terms of planning out each activity (wake up, shower, breakfast) but I think that getting as granular as possible can be helpful in guiding his morning in a more positive direction.
      I also agree that monitoring will result in more awareness of what activities spark joy or pleasure for Mark and may help him gain additional insight into how he can make additional improvements after the monitoring activity. Sometimes I think we can be in a state of autopilot and so these exercises help with identifying areas to keep and areas to change, and what patterns of thought to address and change.

      Reply

    • Victoria Cestodio
      Feb 24, 2022 @ 16:13:25

      Hi Lauren,
      I like how you mentioned Mark has specific times he does certain activities, such as eat breakfast, get ready for work, etc. I think this would be beneficial for Mark!! Also, having a walk in the morning with his dog would be a great way to start his day. I also agree that looking at his thoughts and emotions will show us what has more positive outcomes for Mark and what makes him have more negative outcomes. We share a lot of the same thoughts!

      Great post!
      Victoria

      Reply

    • Moises Chauca
      Feb 25, 2022 @ 14:51:53

      Hello Lauren,
      Your post was great! I agree with the points you made. I agree that Mark needs a routine for morning as he feels rushed most of the time. I agree with your point about creating some time to take his dog out or have a good breakfast can be beneficial to start as his day with a positive mindset. Second, i agree that monitoring and processing Mark believability and severity rating can be beneficial and introduce adaptive patterns rather than maladaptive thinking for him. Lastly, your point about the benefits of being able to differentiate between thought and emotions hold truth because the therapy session and the person thought process would greatly improve.

      Reply

  6. Lexi
    Feb 23, 2022 @ 17:29:40

    I think it would be great if Mark was able to make more of his mornings, he seems to really struggle with waking up and having a start to the day that he feels good about and it’s so true that having a better morning sets a more positive tone for the rest of the day. Mark has mentioned a few times that the morning is a more difficult or stressful time for him. I would love to see him make time on the daily activity schedule for making breakfast, and some kind of morning activity that he enjoys like listening to music, meditating – or like Dr.V recommends a short walk with the dog and Melissa before work. Eating a real meal, and enjoying a few moments of pleasurable activity before his day really “begins” I think would be really beneficial for Mark. I would also love to see a social activity perhaps after work as well, we have learned throughout the videos with Mark that he is happier when he is more social.

    Monitoring Mark’s thoughts / believability, and emotions will be helpful for future cognitive work because gaining insight into what dysfunctional thoughts he experiences and to what degree he believes them is important to understand as a precursor for addressing and altering those thoughts. Mark has shared in past videos that he tends to get anxious be before going out worrying about things, he has identified that he engages in self-doubts about how capable he is or how others feel or think about him and common styles of thinking including catastrophizing, minimizing and black and white thinking. Cognitive work involves identifying these patterns and making strategic alterations. Being aware of emotions is equally important for a few reasons – first it can often help to uncover thoughts that cause the emotion, second it can be helpful in understanding the level and nature of psychological distress more generally, and also understand what situations / triggers may be linked to distress in the person’s (Mark’s) life. Alternatively, identifying points in the clients’ day that have positive emotion, or result in feelings of accomplishment can help identify what behaviors / situations can be beneficial to engage in more frequently.

    It can be difficult for clients to differentiate between thoughts and emotions because sometimes clients are aware of emotions, but not able to relate those emotions to the thought which preceded the emotional response. This is especially true if you are talking about the emotional response to automatic thoughts. Some people more generally just lack awareness about the patterns of their thoughts, and may not pay attention to any patterns that do exist in their thinking, or they may not have awareness about what maladaptive styles of thinking they might be engaging in. We know them as catastrophizing, black and white thinking, minimizing etc, but a client may be unaware of these tendencies all together. Clients may be unaware how their thinking is affecting emotion… Your thoughts too can be influenced positively or negatively by emotional states, so that can help to understand in coping situations. I think for some people who don’t make a point to self-monitor or to engage in purposeful metacognition – they are just unaware in general of these relationships and on their ability to improve the level of regulation.

    Reply

    • Monika
      Feb 24, 2022 @ 13:07:52

      Hi Lexi,
      Great Post! I liked the point where you mentioned Mark being happy when he is more social, I agree with you and I think it’s a great idea for him to spend more time with friends and his girlfriend. I didn’t think of the point when he tends to get anxious worrying about what others think or feel about him, it makes sense to me now why he tends to doubt himself. Also, I liked the point that identifying negative thoughts can help us understand the level of nature of psychological distress which is crucial to address when making a treatment plan and help us get to the root of his depression. You made really good points!
      Thanks
      Monika

      Reply

    • Pilar Betts
      Feb 26, 2022 @ 23:26:46

      Hey Lexi,

      I really liked that you mentioned the reasons why being aware of emotions can be helpful in uncovering the thoughts that caused them and understanding the nature of your distress as well. I also think it’s really important that you addressed the fact that identifying the clients positive emotions as well as the negative emotions is important as well and can encourage the client to want to engage in those positive emotions, thoughts and behaviors more.

      Reply

  7. Madelyn Haas
    Feb 23, 2022 @ 17:50:18

    With everything that I know about Mark, I would like to see how he got up in the morning and would also like to see his planned date night with his girlfriend. He has mentioned repeatedly that he would like to get up earlier, as rushing makes him anxious, but he feels like he cannot get up early. For that reason, it is important for him to attempt to get up earlier (even if by 15 mins) so that he can test out if he can get up and how it makes him feel when he has extra time. I also think it would be important to see how his plans with Melissa compare to the actual date. If they plan out a night, he may have a better, less anxious time. Both of these activities have the possibility to show him that things can be easier with planning and/or extra time. Even if he does not follow through with one or both, we would have an idea of what he did and said and could look into the discrepancies. Mark, like other clients, would also benefit from monitoring his thoughts and emotions. Although it may not seem big, monitoring one’s thoughts and emotions can show someone what is holding them back from doing activities. For example, someone may hate showering, so their thoughts before, during, and after showering would be good data that allows us to best help them. The added believability and severity are also important. We do not want to waste our client’s time by discussing something that they do not believe very much and/or does not cause them much distress. All of this information can give us insight to why they are struggling and how we can best help them.

    Although it may come natural for some clients, others struggle with differentiating between their thoughts and emotions. Thoughts and emotions often go hand and hand, so it may be difficult to tell which is which. Often times when people have thoughts, their emotions follow immediately after. For this reason, it may be difficult to untangle them from one another. Plus, thoughts can include emotions (e.g., I am so sad right now) which can further add to the confusion. Even though some clients have trouble differentiating their thoughts and emotions, it is important that we as clinicians teach them the differences. If a client is not able to differentiate between their thoughts and feelings, it will be hard to use certain helpful interventions with them. A lot of interventions involve identifying one’s negative (or even positive) automatic thoughts; If a client cannot do this, it will be no help to them. Identifying automatic thoughts can help us figure out a client’s core beliefs and understand why they are feeling the way they do. All of this is contingent on a client understanding their thoughts, the emotions that follow, and the differences between the two.

    Reply

    • Emily Barefield
      Feb 28, 2022 @ 10:58:19

      Hi Madelyn,

      I think focusing on Mark’s morning and on his dates with his girlfriend are great ideas. In both instances, allowing himself more time to plan things out certainly seems like it could be beneficial to him. I appreciated that you noted that even if Mark is initially unable to follow through with one or both of these tasks, it would still be beneficial to the therapeutic process. The therapist would be able to learn what is getting in the way of Mark being able to do these things and could work through that with Mark.

      You also did a great job of showing how difficult it can be to distinguish thoughts and emotions from each other, especially when our thoughts include emotions. But being able to distinguish these two from each other has important therapeutic value. Teaching clients on the differences between thoughts and emotions is an important part of psychoeducation that occurs during the initial part of therapy. Great post!

      Reply

  8. Emily Barefield
    Feb 23, 2022 @ 22:56:26

    The primary target for Mark’s daily activity schedule is the mornings. I would encourage Mark to have an enjoyable component to his morning routine. Perhaps he could schedule ten minutes outside with his dog or sitting down with Melissa for coffee and breakfast. It may be helpful to suggest to Mark that, as simple as it sounds, not being rushed and not having to race the clock can be a reward in and of itself. I might also suggest a short, relaxing evening routine for Mark that can prompt him to wind down sooner, so that he has enough sleep to wake up in the mornings. I also think Mark should schedule in activities with his friends. This could start as simply lunch with a coworker he enjoys. He could then plan dinner or another activity with friends outside of work. Monitoring Mark’s thoughts and emotions will help with future cognitive work because it will help with identifying what specifically is working against Mark when he is trying to reach his goals. It can also help identify which activities are highly rewarding and what thoughts and emotions are encouraging to Mark as he is working towards his goals.

    Clients may struggle with differentiating thoughts and emotions for a number of reasons. They may need practice with metacognition. It is possible that they are not used to thinking about their thoughts- it is a new skill that takes practice. They may also not have much experience with expressing their emotions. Perhaps their learned experience is that it is necessary to suppress emotions, and so they have a difficult time labeling their experience. It is important to distinguish between thoughts and emotions because thoughts can be targeted for change and emotions should be validated. Because thoughts proceed emotions, it is important to address these thoughts in order to change the emotion instead of attempting to target the emotion. Targeting the emotion for change can be very invalidating for the client and does not address the root cause of the distress.

    Reply

    • Sandra Karic
      Feb 28, 2022 @ 00:23:43

      Hi Emily,
      I really liked how you highlighted that not feeling rushed can be a rewarding experience itself and the ideas of having coffee with Melissa or taking his dog out. I also like how you addressed the evening routine component by suggesting relaxation techniques so Mark can get to bed earlier—great idea! I also agree that activities with friends could prove to be very beneficial for Mark. I think you did an awesome job explaining why it can be hard to differentiate between thoughts and emotions. I especially liked that you emphasized that thoughts often come before emotions and that trying to modify a client’s emotion can feel very invalidating.

      Reply

  9. Will Roche
    Feb 24, 2022 @ 11:36:52

    First and foremost, I think one of the most specific activities Mark should focus on would be building a more structured and lengthy morning routine. It is evident that Mark does not give himself enough time in the morning to conduct what he needs to do at an even pace. He rushes himself, which makes him uneasy and anxious prior to getting to work in the morning. Like Dr. V said, it is important that Mark breaks up his morning routine into different parts and setting certain times for when he should do certain things. Dr. V also suggests that Mark tries to wake up a little earlier in order to give himself enough time to complete some of these morning routine tasks such as eating, taking a shower and getting dressed so that he’s not rushing to get out the house. In order for Mark to start getting into this routine, it is imperative that he continues to consistently get up at the same time for work so that he develops a sleep schedule, as changing your circadian rhythms and sleep patterns will not change overnight. I also like how Dr. V encourages Mark to try and engage in more outdoor activities. This is important because this can help depressive symptoms whilst also improving his engagement outdoors and potential social activities. I think honing in on Mark’s thoughts and emotions during these events will be helpful for future cognitive work because Dr. V can narrow down specific areas in which Mark’s emotions or thoughts are negative. From there, they can work collaboratively on improving these specific times where Mark’s thoughts are not where they should be.

    The reasons why discerning the differences between thoughts and emotions is so difficult is because of how fast and instinctual automatic thoughts can become. These automatic thoughts are so reflexive that people only start recognizing the emotion that comes after it and never stop to think why they had that emotion in the first place. Therefore, it becomes really important to gain this form of metacognition where when you feel a strong emotion about something, you can stop to think what automatic thoughts caused you to have this type of emotion and then work on how you would like to alter these automatic thoughts, which will in turn change your emotions from those specific stimuli.

    Reply

    • Sandra Karic
      Feb 28, 2022 @ 00:15:22

      Hi Will,
      I agree with you completely regarding Mark’s morning routine. Starting the morning stressed and rushing is sure to set him up for an unpleasant time at work, which is particularly bad considering how he’s talked about his moods fluctuating at work. I also like that you brought up increasing social and outdoor activities. Finally, I really liked how you described how the reflexive nature of automatic thoughts make them difficult to distinguish from emotions.

      Reply

  10. Sandra Karic
    Feb 24, 2022 @ 12:10:43

    It appears that mornings are particularly difficult for Mark. I would like to see him get out of bed earlier and have more time before work. Ideally he would be able to use this time to make breakfast and actually be able to sit down and eat before work. However, even having enough time to not feel super rushed and stressed in the morning would be beneficial. I would also like to see a social activity or planning for a social activity in his activity log. It seems like Mark has trouble making decisions when it comes to social activities, especially in regards to planning dinner dates with Melissa. So even if Mark doesn’t have a social activity scheduled, it would be nice to see him mark down a time to start discussing/planning a social event maybe a day or two before the event is supposed to occur.

    I think it is important to rate thought believability and emotion severity in order to determine which thoughts and emotions are most salient and contributing the most to Mark’s distress. Determining when these thought patterns and emotions become activated would also be a helpful part of the process. This is useful because patterns of strongly believed automatic thoughts and the negative emotions they elicit will help the therapist and Mark identify negative core beliefs. You cannot begin to modify negative automatic thoughts and core beliefs without first identifying them and assessing their intensity. Modifying the thoughts that most contribute to Mark’s distress would likely be most effective at decreasing his distress.

    Thoughts and emotions are so interconnected that differentiating between the two can be extremely challenging. One’s thoughts almost always influence emotions, but sometimes thoughts, particularly automatic thoughts, can be so quick and reflexive that they are not even registered as thoughts. Emotions are often very physical experiences which can make them harder to miss. Thus, people may have a strong unpleasant emotion that’s based on a thought, but because they didn’t really register the thought they link the emotion to an event. This can be problematic because believing that your emotions are directly tied to an event leaves very little room for change, especially if the event cannot be changed. It is very difficult to try and directly modify emotions, and often not helpful, however modifying a thought can lead to a much more pleasant emotional experience. In order for this to occur, both the thought and the emotion need to be properly identified. In addition, to thoughts being hard to identify at times, I think the trouble with differentiating between thoughts and emotions is exacerbated by the way we use language. Think of how many times you or someone else has said “I feel like…” and then continued to state a thought/opinion not an emotion.

    Reply

    • Will Roche
      Feb 25, 2022 @ 11:32:25

      Hi Sandra,

      I like the points you make about Mark scheduling more social activities into his weekly routines, particularly with Melissa. Mark often mentions his feelings of withdrawal from not only people in general, but particularly Melissa. As damaging this could be to a relationship, it can also be damaging to Mark’s support system without even knowing it. I think your point about scheduling more activities with Melissa would be very important because it would help him become more engaged in their relationship. I think the less engaged Mark is in the relationship, the worse it could get. Without this relationship it could severely affect Mark’s emotional balance and that would not be something that either Mark or Dr. V would want for him. Therefore, I think it is important for Mark to become more involved with his relationship and scheduling more activities for them to do. I think this would benefit Mark more than he knows.

      Reply

    • Moises Chauca
      Feb 25, 2022 @ 14:33:14

      Hello Sandra,
      I enjoyed reading your post. You made great points about Mark activity log and the differences between thoughts and emotions. I agree with your point about Mark needing to schedule his mornings better and having breakfast but having more time to relax. This is important because these activities can have Mark feeling positive and good about their day. Second, your point about assessing and identifying automatic negative thoughts is a perfect one because we need to know the context of these thoughts, so we can use them to weight their validity and their reliability in his life. Lastly, you made an awesome point about thoughts and emotions. Your point made me see it from a different perspective. People do tend to validate their thoughts as emotions at times, which can lead to an actual emotion.

      Reply

  11. jeremy
    Feb 24, 2022 @ 14:50:58

    I would be interested in first seeing how he set his up, planning the daily active schedule is often a reflection of prioritization. Seeing what the client views as valuable and useful can be a good place to find insight. Beyond that I would expect that he had a good morning routine including getting up and stretching as part of the plan. I hope he has incorporated more time for each task he performs in the morning to better slow down. I would expect in reality Mark did not meet all of his expected morning tasks on time, but by budging more time he was able to breathe and slow down, hopefully leading to an increase in pleasure or better thoughts. Hopefully he better budgeted his social time as well, perhaps by creating the active sheet he had discussed the planned activity with more forewarning so the conversation of what to do would be less overwhelming. I would be interested to see what automatic thoughts came up for him as he completed the form throughout the day. Often the reactions to the daily active schedule are largely negative and may influence his perspective on the rest of the day. I would like to see what he rated as low pleasure so that you can identify ways to increase the pleasure associated with the task.
    It can be incredibly difficult to identify thoughts from emotions especially as shorter thoughts and automatic thoughts can be experienced simultaneously with strong emotion, leading them to be perceived as the same input. Thoughts like I will never get better, will only go to serve more negative emotions and increase the speed and reliability that thought will trigger the corresponding emotions. Being aware of what events and environments trigger these responses can help a therapeutic duo figure out wich thoughts are affecting the client the most and begin to dismantle it.

    Reply

  12. Pilar Betts
    Feb 24, 2022 @ 15:21:38

    I would really like to see Mark’s sleep schedule and social activities on his first daily activity log because these are two things he really seems to struggle with. He has trouble getting up in the morning, which can be hard for anyone but especially if you are a person who suffers from depression and your day begins with those negative automatic thoughts and beliefs about the day. Depressed mood can include anger, fatigue and extreme sadness. When you experience depression in the morning you have trouble waking up, lack energy to begin the day, frustrated, lack of interest and concentration. This is what Mark seems to struggle with, the way you start your day influences the remainder of the day so when Mark starts his day lacking motivation the rest of his day doesn’t look good to him so he is less likely to engage in activities he enjoys such as spending time with his girlfriend and dog. If we can help Mark to see the pattern in his thoughts in the morning he can actively try to have more positive thoughts in the morning and over time practicing something like saying one thing that could be good about the day will turn those thoughts and in turn the behaviors in a more positive direction. With activities we want to see Mark doing more and more activities he enjoys included in his daily schedules because that will increase mood and productivity.

    Monitoring Mark’s thoughts and emotions would be super helpful in later cognitive work because since he struggles with depression it is important to identify what activities he is doing that trigger those negative automatic thoughts and lead to behaviors that aren’t necessarily healthy. Mark really struggles with his sleep schedule, this is definitely something to keep an eye on. Bringing this issue up in future sessions and bringing it to Mark’s attention by utilizing weekly and daily activity logs may lead him to be more conscious of when he is and isn;’t sleeping and may encourage him to actively work on having a better sleep schedule. You can’t fix a habit overnight. It takes time and discipline so addressing the changes that need to be made, implementing them and then learning to celebrate the small victories is important to the therapeutic process. Also being in tune with your thoughts and emotions can help you to better manage them because then you begin to recognize what situations bring up those negative thoughts and learn how to better navigate them for example when Mark was feeling a certain way about an interaction he had with a friend , by becoming in tune with those thoughts he will learn to consider other possibilities of why someone may have responded to him in a certain way rather than going straight to the negative thoughts and shutting down.

    Clients are more likely to be aware of the emotion that was the result of the thought than the thought or what caused them to have that particular thought. Automatic thoughts happen quickly, they come and go, but the emotions last longer. If it is brought to the attention of the client how tight knit thoughts and emotions are, Having an understanding of what causes these thoughts and when they occur is super important to working toward changing the thoughts to more positive ones because you will start to see an improvement in the regulation of negative emotions and how often and extreme they are. We can change our thought process but emotions we can not because they are a reaction to something else and once you discover the cause of the emotion you can get to work changing the thoughts and behaviors that lead to them.

    Reply

    • jeremy
      Feb 27, 2022 @ 22:23:52

      Hey Pilar,

      I really enjoyed your discussion post, I had completely overlooked Marks’s sleep schedule despite that being a big area of concern. Seeing how sleep affects mood the next day is often fairly faint and may take a lot of time to truly see, but definitely can be used to point at larger trends and lifestyle changes that could benefit mark. That can take time to work up to and to change, and helping him schedule more short-term activities will help him develop the confidence to do that.

      I definitely agree with your assessment of managing emotions by being aware of them. especially in the case of the subs, Mark let his automatic thoughts spiral into negative emotions quite quickly, instead of noting the thoughts and then recognizing that the friend could have other reasons not to get lunch.

      Seeing how our thoughts influence our emotions we can be genin to see patterns in our lives that maintain negative emotions. and though this recognition we can begin to change our thoughts to eliminate the patterns that lead to negative emotions

      Reply

  13. Moises Chauca
    Feb 25, 2022 @ 14:13:22

    Based on the information we know about Mark, I would like to see how he plans his mornings and afternoons. Some activities that I would like to see better time management with their morning routine, so he has more time and is not rushing to do stuff. I would like to see relaxing and meditation activities throughout their day as well. The purpose of these activities would be for Mark to start his day in a more positive and relaxing way. For later in the afternoon, I would like Mark to incorporate some enjoyable and pleasurable activities like going out with friends or spending time with his girlfriend.
    Furthermore, it is important to monitor the client’s believability rating and severity rating on their weekly activity log. The rating from these sections helps the counselor identify successful activities and challenging activities. From this information, the counselor can focus on why are these activities challenging and how can they modify to make them easier. In addition, the counselor and client can work together on cognitive reconstructing that can help with his emotions when experiencing a challenging situation.
    For some clients is it hard to differentiate thoughts from emotions and thoughts because we tend to experience automatic thoughts that happen so fast and leave an intense emotion that leads to people only recognizing their emotions. After, people mentions and thoughts work in a reciprocal way. This means that their emotions influence their thoughts and their emotions or their behavior. It is critical to understand the differences between emotions and thoughts because emotions are mostly valid, but thoughts can be valid or invalid. An emotion is a feeling that we feel and that can create changes in our bodies. However, thoughts are our perception of the environment and others which at times cannot be valid because we do not look at all the information in front of us, or sometimes we want to disregard important information. How we perceive our environment depends on our core beliefs and these beliefs can influence our thinking even when things look different.

    Reply

    • Emily Barefield
      Feb 28, 2022 @ 10:47:57

      Hi Moises,

      I agree with time management and the creation of a morning routine and I like the idea of adding relaxation and meditation into his day. Going out with his girlfriends and with his friends would certainly be beneficial for Mark. I like how you pointed out the importance of believability ratings. For Mark, many negative thoughts regarding other people’s view of him tend to be very believable for him.

      I appreciate how you described the relative validity of emotions and opposed to thoughts. Our thoughts may not be accurate, and we are often missing information, but that does not mean the emotions we experience are any less real. Good post!

      Reply

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Adam M. Volungis, PhD, LMHC

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