Topic 5: Behavioral Activation & Automatic Thoughts {by 10/13}

[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 10/13.  Have your two replies posted no later than 10/15.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

45 Comments (+add yours?)

  1. Bekah Riley
    Oct 10, 2022 @ 12:12:15

    Based on the information I have on Dr. V’s client so far such as information from his assessment as well as his Weekly Activity Monitoring Log (WAML), there are certain activities and tasks I would like to see on his Daily Activity Schedule. Specifically, I would want to see the client’s morning routine broken down. As the client has previously discussed in session, his mornings feel very rushed because he has not been able to find the motivation he needs to get out of bed earlier before heading to work. His lack of pleasure in his work environment contributes to his lack of desire to get out of bed each morning. However, the client has stated that having more time in the morning to himself to make breakfast or even take his dog outside would be more beneficial to his outlook on the day ahead. In completing his Daily Activity Schedule, I think it would be beneficial for the client to plan out his daily activities as well as his expected pleasure in those activities the night before and try to find ways to make them more attainable. For example, as he mentioned in session, putting his alarm clock farther from his bed so he has to physically get out of bed to shut it off may help him get up earlier. Another activity I would like to see on this client’s Daily Activity Schedule is participating in a social activity with his friends. If this client has a date night with his girlfriend planned, including other couples they are friends with may be a pleasurable and attainable way for the client to socialize with others. In addition, the client mentions that watching football is a very pleasurable activity. Inviting friends over to watch the game may be a desired way for this client to have more social interaction. Having others over may also motivate this client to do some cleaning tasks around his place, which will add to his level of accomplishment.

    Monitoring the client’s thoughts and emotions as they complete a Daily Activity Schedule will be very helpful in terms of further cognitive work. Specifically, the client’s believability rating for their thoughts and intensity rating for their experienced emotions will be informational in terms of why they fall into specific behavioral patterns. If the client does not complete a planned activity, their thoughts may be negative in terms of their ability to ever complete desired activities. When the believability rating for these negative or maladaptive thoughts is high, the motivation or drive to plan to complete that activity again may be low. This is where focusing on negative automatic thoughts moving forward may be beneficial for cognitive work. In addition, if the client is experiencing negative thoughts with a high believability that those thoughts are true, that will in turn effect their emotions. The intensity of emotions they are experiencing may also provide the therapist with information on further interventions to help the client shift their thoughts and emotions to something more desirable or adaptive. On the other hand, if the client is able to complete a planned activity, their thoughts and emotions may be more positive. If the client is able to believe these thoughts are true and feel positive emotions, they may be more apt to continue participating in desirable behaviors. In terms of cognitive work, it may be beneficial to emphasize these positive thoughts and emotions in session to provide further motivation to the client.

    Some clients may find it challenging to differentiate their thoughts from their emotions. Specifically, if a client is experiencing negative automatic thoughts, they may find it challenging to label them as thoughts and not emotions. Negative automatic thoughts are those that occur quickly and automatically and are believed by the client to be both valid and true. Since these negative automatic thoughts happen so fast, the client may tend to focus more on the emotion they are experiencing from that thought, making it difficult to separate the two. In addition, in that thoughts precede emotions, when a thought is very negative, emotions will be immediately negative, causing the client to have a greater awareness of how they are feeling in that moment rather than what thought caused that feeling. However, it is important for the client to learn and understand the difference between thoughts and emotions. When a client experiences a negative automatic thought, that will then lead them to have a negative emotion. If the client is able to differentiate the two and identify the negative automatic thoughts they are having, that will then help them identify the cause of their negative emotions. Creating a table of different thoughts that align with different emotions a client is experiencing may help them separate the two and see how they affect one another. Keeping this record may ultimately help the client shift their thoughts in order to experience more desirable emotions.

    Reply

    • Tom Mandozzi
      Oct 12, 2022 @ 13:12:44

      Hi Bekah,

      I really resonated with your point about how important and informative the believability rating of a specific thought may be when it comes to treatment interventions and treatment outcomes. Cognitive work moving forward is informed by how high or low the believability rating is for positive or negative automatic thoughts. The level of believability will have an impact on how they feel emotionally as a result, and to what degree the emotion is experienced. Further interventions can be implemented appropriately after this information is evaluated and hopefully yield more beneficial treatment outcomes for the client. Great post!

      Reply

    • Ashley Torres
      Oct 12, 2022 @ 20:59:25

      Hi Bekah, I really enjoyed reading your response. I like how you mentioned the client wants to spend some time in the morning taking out his dog and eating breakfast. I do believe setting his alarm clock away from him will help him wake up earlier and it would also be beneficial if he went to be earlier. It will probably still be hard for him to wake up if he is not getting enough sleep therefore he will not have a lot of energy. The client can also engage in a relaxing activity before bed in order to prep him for his sleeping schedule shift.

      Reply

  2. Patricia Ortiz
    Oct 10, 2022 @ 12:50:53

    [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?

    Based on what I know from this client so far from his weekly activity monitoring log, in his first daily activity schedule, I would like to see how he is doing with waking up earlier and focusing more in the mornings. This includes preparing a good breakfast and waking up half an hour earlier. He says that he would like to change his morning routine because he feels like sleeping more than before and that even waking up half an hour earlier will feel like an accomplishment to him. Also, a follow-up on how he is managing not to snooze his alarm would be helpful because this is what is going to help him attain his morning goals.

    Also, I think it is important to check on how he did with deciding what he is going to do for date nights with his girlfriend. Since it takes a lot of time for him to decide, I would like to know if this time, it was easier for him to get to a conclusion without stressing out a lot or having anxiety. I would check if he planned everything the day before because this will make him have less anxiety and stress about the whole process and logistics of going out.

    I believe it is helpful to monitor his thoughts (and believability) and emotions (and severity) because positive emotions will foster resilience and a sense of physical and psychological well-being, all of which are critical both during and after CBT. When clients have a negative emotion, they often narrow their attention and experience autonomic arousal. Also, positive emotions reduce their arousal while expanding their attention, cognitions, and behavioral tendencies. On the other hand, clinicians can prevent moving on too quickly to another cognition or issue by rating how strongly a client experiences a certain emotion before and after the therapeutic intervention. This will help decide whether to employ additional interventions or techniques. By noting which thoughts and emotions are less or more intense to him, we would be able to know which ones to focus on more and which ones he is not distressed about anymore and follow through.

    Also, this client has times when he feels stressed out or anxious when he doesn’t get things done or figured out right away. For example, when deciding what to eat or what to do on date nights with his girlfriend. Monitor his thoughts and emotions can be a method to manage his resources and ask himself questions about the interpretations he makes of reality and how this differs from the real facts, being able to be more consistent in understanding when he feels anxious or discouraged, what are its triggers and the distortions or beliefs that trigger it, and in this way being possible to appreciate the improvements during the process.

    [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)?

    I think it is difficult for some clients to differentiate thoughts from emotions because, in a way, they are interconnected. In general, thoughts and emotions are considered bidirectional because sometimes emotions provoke thoughts, and other times thoughts generate associated emotions. Some people use the term “I feel” to describe thoughts. For instance, “I feel like I always fail” or “I feel unworthy” and they cannot make a differentiation between those thoughts and the actual emotion that they are feeling.

    Thoughts are ideas, perceptions, or beliefs that are created by thinking or that emerge unexpectedly in the mind. Emotions are physical reactions and frequently result from external influences; they occasionally have an internal source, such as a memory or thought, rather than being directly influenced by something external. In CBT is critical that clients know the difference between thought and emotion because when clinicians use the thought record, for example, they teach clients how to evaluate their thinking, so it is important that they know how to recognize their thoughts and differentiate them from emotions. Also, it is given as a task to guide clients to become aware of their
    cognitive distortions that previously passed automatically and were not questioned. They need to be able to recognize them and learn to identify them when they appear to be able to change the underlying behavior.

    Reply

    • Bekah Riley
      Oct 12, 2022 @ 12:36:26

      Hi Patricia,
      I really enjoyed reading your post this week! I agree that focusing on this client’s morning routine will be very beneficial. As you stated, waking up a half hour to an hour earlier will provide this client with more time to participate in desired activities such as making a substantial breakfast. In getting up earlier to be productive prior to going to work, this will allow the client to start his day off feeling a sense of accomplishment! I also liked how you suggested that it would be beneficial for this client to work on finding strategies to help him and his girlfriend plan date nights without conflict. I think this would make date nights more enjoyable and the lead up less stressful for this client. In addition, I thought you really hit the mark when describing how having the client focus on the believability of his thoughts as well as the intensity of his emotions will help both the client and therapist figure out what thoughts and emotions are causing the most distress and need to be worked on.
      Overall, great response!

      Reply

    • Ashley Torres
      Oct 12, 2022 @ 20:59:58

      Hi Patricia, I liked your response because we had a similar idea! For example, you mentioned you would like to know how he decided on his social activity. I thought it would be important for the client to really break down the steps he took in making a decision. I would like to know how long it took him, who he decided to invite, his stress level, what were his automatic thoughts, and why he chose the specific activity? It would be very beneficial to plan this out a few nights ahead and compare it to his experience when him and his girlfriend try to plan on a date the day of.

      Reply

  3. Amanda L Bara
    Oct 11, 2022 @ 10:57:52

    1. Based on what we know about the client so far in his assessment and Weekly Monitoring Log there are some specific tasks that would be important to target in the Daily Activity Schedule. The client talks a lot about valuing time with his girlfriend and spending time outside. This would be important to schedule in the Daily Activity Schedule specifically the time with his girlfriend as it has been indicated that there are struggles to plan date nights smoothly. The client has also shown to be struggle socially and feels positive emotions when interacting with others. Adding in an activity with his friends like inviting them over for the football game or going out for a drink would be beneficial. Engaging in other social interactions outside of his romantic relationship is a goal that I would like to see. It would also be a good idea to target the client’s morning routine as he wishes to get up earlier and not be in such a rush getting to work. This could be affecting his time at work therefore, making a change in the routine could bring about more positive emotions heading into work.

    Monitoring client’s thoughts (believability rating) and emotions (severity rating) is helpful for future cognitive work because it allows the client and the therapist to see things more broadly. It can pick out patterns of why the client engages in specific behaviors that may not be providing much benefit. It is easy for clients to get stuck in behavior patterns if their thoughts about certain tasks and emotions are negative and increase in rating. For example, if a client believes that their friends will not want to make plans with them they may engage in avoidant behaviors and resist reaching out to them for plans. This would make the client feel strong emotions of sadness and retreat into sitting on the couch and sulking. Changing these thought patterns and activating the client to reach out to their friends and plan events with subsequently change emotions and avoidant behaviors. Monitoring these thoughts and emotions in cognitive work can show specific areas that need to be focused on and how one’s behavior ties into their cognitions.

    2. Clients may have difficulty differentiating thoughts and emotions for a variety of reasons. Sometimes the distress that one is facing could be impairing their ability to understand this difference. Because of the strong connection between thoughts and emotions and the pattern of these cognitions, it can be difficult to separate them. Most thoughts bring out specific emotions therefore, it can be hard to distinguish what comes first. it may feel that the thought and emotion are happening at the same time making it hard to distinguish what is actually happening. Emotions can be powerful and blur someone’s ability to understand this concept. It is important to know the difference between thoughts and emotions in order to modify thoughts for cognitive work. Understanding how events can trigger automatic thoughts and subsequent emotions is an important concept for clients in order to make changes in their thought patterns. An inability to recognize and differentiate between these two ideas will make it harder for clients to stop engaging in negative automatic thoughts.

    Reply

    • Bekah Riley
      Oct 12, 2022 @ 12:44:21

      Hi Amanda,
      I really enjoyed reading your response this week! I completely agree that focusing on this client’s interactions with both his girlfriend as well others will be beneficial. Specifically, focusing on helping this client find strategies to make the lead up to date night with his girlfriend less stressful will overall make their time together more enjoyable. In addition, in that this client does struggle to participate in social interactions with others, while also having the desire to be more social, I think that it would be very beneficial for him to invite his friends either to watch football or even to go out with him and his girlfriend.
      I also thought you did a great job explaining why clients may have a difficult time separating their thoughts from their emotions. In that thoughts precede emotions, it can be challenging to differentiate the two, especially when a thought triggers a strong emotion.
      Overall, great response!

      Reply

    • Yoana Catano
      Oct 15, 2022 @ 12:32:04

      Hi Amanda,
      I agree with you on how the client needs to engage in more social activity, also, as the therapy progress, he will be able to deal with social situations easier without affecting the perception of himself. Monitoring thoughts and emotions will show how his behaviors tie into his cognitions as you said. We know that even when he made a big effort and planned a night with friends, they canceled at the last minute. I think with more control over his perception of the situation, he will gain more confidence and try to plan more social activities.

      Reply

    • Teresia Maina
      Oct 16, 2022 @ 00:24:08

      Hi Amanda,
      I also wrote something similar about Mark. I agree that some of the big tasks on his schedule should be his morning routine and more social interactions. Completing both of these tasks will bring him pleasure. You did a great job explaining the importance of monitoring thoughts and emotions. I especially liked your example. Monitoring their thoughts and emotions is vital to see what areas the client needs more support to change their patterns. It also informs us if our therapeutic interventions are working.

      Reply

  4. NikkiAnn Ryan
    Oct 11, 2022 @ 21:11:58

    One thing that the client pointed out is that mornings, including waking up and completing his morning routine, can be tough for him. Therefore, I would like to see an attempt to make his morning routine more pleasurable such as making a nice breakfast, waking up a little bit earlier and hitting the snooze button fewer times, or incorporating some other pleasurable activity such as going for a quick walk with his dog if he has time. The client has also historically identified wanting to spend more time outside. Therefore, I would like to see an outdoor activity on his daily activity schedule. It seems like his dog is a great source of pleasure so taking his dog for a walk may be a good motivator for him. He also stated that he likes gardening so perhaps he can do some work in his garden. If he scheduled time to garden and did not follow through with it, it may be nice to see what he did during that time instead, such as doing research into gardening and what supplies/products he may need. Additionally, the client expressed wanting to engage in more social activities and has reviewed it in therapy on multiple occasions. I would, therefore, want to see if the client scheduled a social activity, such as going on another date with his girlfriend, or potentially calling a friend to chat or schedule a future activity to do together. If none of the above were included in the daily activity schedule, I would bring up that observation during the session, but I would also want to see if the client included any other type of pleasurable activity in his day because he appears to be working on incorporating more pleasurable activities into his life and it would be important to see if he scheduled a pleasurable activity that he had not yet discussed during therapy sessions.

    Generally, it is important to monitor clients’ thoughts and feelings on their daily activity schedule because it helps with exploring which activities do and do not contribute to their distress and it can assist with identifying negative automatic thoughts. Additionally, the believability and severity ratings can help to determine which emotions are the most intense, and therefore should be focused on, and which thoughts may be emerging from deeper core beliefs. With this client, in particular, it will be important to monitor his thoughts and emotions related to activities he scheduled but did not follow through on. He identified that he had concerns about scheduling something but not following through on it. Exploring his thoughts and feelings related to this can assist in identifying negative automatic thoughts and potentially some barriers to completing certain activities. In contrast, it would also be beneficial to explore his thoughts and feelings related to activities he scheduled and followed through on. Doing this can help to identify what worked for him and hopefully foster a sense of autonomy and control after scheduling something and following through with it. The specific areas listed above including his morning routine, getting outside, and engaging in social activities would be important areas to review. In the past, he has also identified that certain parts of his job can cause distress so it would be helpful to review his thoughts and feelings related to his different work activities which can provide an area of focus for treatment and eventually a less distressing experience.

    One reason that clients may have difficulty differentiating thoughts from emotions is that they do not have an extensive vocabulary for emotions or may not be able to connect a particular feeling with the word to describe it. For instance, they may feel the physical aspects of anxiety but may not be able to recognize that it is anxiety or articulate it. In this case, individuals may describe thoughts as feelings by saying “I feel…” before stating a thought. When it comes to automatic thoughts, it may be difficult for clients to differentiate between thoughts and emotions because they are so closely related. Individuals experience automatic thoughts for a very quick moment, but the emotions associated with the thought last longer therefore it may be difficult to separate the thoughts from the emotions. However, it is important to know the difference between thoughts and emotions to modify thoughts and behaviors. Clients cannot change their emotions because they are based on thoughts, however, they can change their thoughts which can in turn change their emotions and behaviors. It would be invalidating to attempt to change a client’s emotion, especially when they may make sense given their thoughts. It is, therefore, important for clients to understand the difference. Some of the CBT resources can be helpful for understanding and practicing this, such as the thought record. Tables 7.3 and 7.4 can also be helpful tools for improving vocabulary for different emotions and for practicing distinguishing between thoughts and emotions.

    Reply

    • Tom Mandozzi
      Oct 12, 2022 @ 13:02:19

      Hi NikkiAnn,

      I agree with your point about the ability for the client to connect an emotion to a particular feeling. I think the feeling can be so distressing and overwhelming that we are often unable to link the feeling back to a specific thought or experience. Emphasizing that link through the framework of CBT principles is so important to educate clients on the ways in which thoughts and feelings are different but also so related and linked to one another. It is so easy to group them together and struggle to point out the differences. Strategies for identifying and labeling thoughts and feelings are so important for helping the client independently notice patterns in their thoughts and associated feelings. Thanks so much for providing this insight and highlighting this point!

      Reply

    • Patricia Ortiz
      Oct 14, 2022 @ 21:36:42

      Hi NikkiAnn, you are right. I also think that clients may have difficulty differentiating thoughts from emotions because they do not have an extensive vocabulary for emotions or may be unable to connect a particular feeling with the word to describe it. Being aware of our emotions helps us speak clearly about our feelings, avoid or resolve conflicts better, and work through complicated feelings more easily.
      Also, there are no “bad” or “good” emotions, but there are good and bad ways of expressing emotions (or acting on them). An excellent way to teach clients to understand emotions better is by teaching them to share their feelings with the people closest to them. It is the best way to practice putting emotions into words, a skill that helps us feel closer to anyone around us.

      Reply

  5. Tom Mandozzi
    Oct 12, 2022 @ 12:54:18

    After watching the video demonstration of implementing the daily activity schedule and the WAML, I think it would be helpful for the client to break down his morning routine into more specific steps. The client has indicated that the morning is a particularly overwhelming time in his daily and weekly routine based on the weekly activity log. Also specifically documenting what time the client can get up and start his morning routine would be helpful to gain insight into how sleep schedule and hygiene might affect routine and pleasure throughout the following day. As Dr. V mentioned in the video demonstration, it may be helpful for the client to plan out daily activities and expected pleasure the night before so that the expected pleasure and experienced pleasure can be compared to further improve routine and schedule. Seeing how the client structures his morning may also support determining if more time to himself is needed and how the daily routine can be adjusted accordingly. Participating in social opportunities with friends and his girlfriend would also be something I would want to see on this client’s daily activity schedule. Implementing this structure will allow the client to gauge experienced pleasure compared to expected pleasure and then, with the help of the clinician, reassess and re-evaluate the daily log during next session to continue to work toward behavior activation interventions and increased pleasure.

    I think monitoring the client’s thoughts and emotions is so important under the scope of CBT treatment, because it supports identification of thoughts, emotions and behaviors and the interrelated function of these three aspects. By practicing monitoring the client’s thoughts and emotions that are related to their behavior, the client can develop a more comprehensive understanding of how challenging thoughts and changing behaviors can have a positive impact on behavioral presentation and functioning. Monitoring the believability of the client’s thoughts can help with prioritizing what thoughts to challenge and inform the course of action to target challenging these thoughts. If the client strongly believes the thoughts, then monitoring can help determine how intensely the thought needs to be challenged. By monitoring the accompanying emotions and severity rating, the client and clinician can have a tangible and measurable way to track the strength and degree of distress as a result of the thoughts being experienced. Moving forward, a client can take the cognitive work and the impact on feelings and behavior with them after discharge of CBT treatment to initiate cognitive restructuring and thought monitoring as it relates to behavior on their own and utilize these skills independently. Changes to thoughts and behaviors can be made to ultimately improve the client’s life over time.

    I think for anybody it can be challenging at times to differentiate our thoughts from our feelings and how they differ from one another. Because automatic thoughts occur so rapidly, or even instantaneously, clients may often associate negative circumstances or distress with the feeling they are experiencing and have a hard time identifying the cognition associated with the intense or unpleasant emotion. Therefore, monitoring and tracking automatic thoughts is so important, as these thoughts may ultimately inform core beliefs. By knowing the difference between thoughts and feelings, an individual can understand how they impact one another and make changes accordingly. Tracking these thoughts and feelings and separating them with the use of a visual tracker or log can help the client identify patterns of thinking and work alongside their therapist to implement appropriate and effective treatment interventions.

    Reply

    • Rylee Ferguson
      Oct 13, 2022 @ 11:51:23

      Hi Tom, I liked your point about how at times it can be hard for anyone to distinguish between thoughts and emotions. Without actively examining your own internal dialogue then thoughts and emotions can get jumbled. Trying to tell the difference is not most people’s priority as they go throughout their day. They are focused on other tasks and do not realize how helpful it may be to take the time to figure out what is thought versus a feeling. I think we should keep in mind how asking people to do this can be a very new thing and can take practice. We should be patient as we encourage our clients to take up this new habit.

      Reply

    • Kristin Blair
      Oct 14, 2022 @ 15:23:25

      Hi Tom,

      I agree with Rylee’s comment about your statement that everyone can struggle to know the difference between thoughts and emotions; it’s very humanizing. I also really liked your idea of comparing expected and experienced pleasure! I think this could be helpful and easily overlooked. Insightful post!

      Kristin

      Reply

  6. Sarah Kendrick
    Oct 12, 2022 @ 20:31:41

    For this individual’s Daily Activity Schedule, I agree with Dr. V in that I would like to see activities/tasks based around being more social, getting outside more/being more active, and being more productive in the morning. It was specifically identified that perhaps a date night or night with friends should be included, as well as activities with his dog like going to the park. The main struggle in engaging in more activities/tasks for this individual was that he identified finding mornings difficult as he dreads going to work (whereas getting up to spend time with his girlfriend is more pleasurable and therefore, he is more willing and able to motivate himself to get up to do so). Dr. V did a great job with troubleshooting and defining the obstacles, including getting up earlier in the morning (go to bed a half hour earlier or put alarm somewhere where he has to physically get up to turn it off) and more effectively planning a date or night out with friends (utilizing the DAS and trying to plan a day or two in advance to better prevent the “last minute” stress). While the more “mundane” and daily tasks are still important to include, it would be beneficial to see more planning for the more therapeutic activities/tasks (doesn’t need to overwhelm himself with these, rather, there should be the effort towards smaller steps and the beginnings of becoming more engaged).

    Monitoring the client’s thoughts and emotions would be very helpful for future cognitive work. Especially when presented with the physical/written examples of individuals’ behaviors and their associated thoughts and emotions, this may present patterns of thoughts/emotions and how these impact or are impacted by their behaviors. If Mark, for example, plans to wake up earlier in the morning but does not believe that he is capable of doing so and feels anxious about this, he may be less likely to follow through with actually completing the planned activity. If he does not accomplish this task, he may then believe that he can never wake up earlier and that he’ll always feel anxious about wanting to change but “not being able to.” This may even further cycle into him losing interest in completing any task as he may think that due to his “inability” to wake up earlier, that he is now unable to do even the “simplest” of tasks or perhaps stops going to work or shows up later to work etc. If he does complete the task despite his initial hesitation, this may boost his self-efficacy and make him more confident in his ability to complete tasks. This is also again where troubleshooting is very effective: while he may dread the idea of waking up earlier and can’t fathom being able to do so, making small changes (half hour vs one hour) may make this task seem more feasible and realistic to accomplish. Overall, this may provide beneficial to work further on automatic thoughts, as well as helps provide an example of the basis of CBT (how behaviors, thoughts, and emotions effect one another).

    Generally, individuals may find it difficult to differentiate between thoughts and emotions as they may genuinely find it confusing and may not know the difference. A big way in which individuals confuse thoughts and emotions is utilizing “I feel” for both thoughts and emotions. Individuals may often experience the emotion associated with a negative automatic thought so intensely that they focus more on the emotion than the thought, leading them to mislabel their thoughts as emotions (“I feel like they don’t care about me” as opposed to “I feel betrayed and anxious because I think they don’t care about me”). One way to help individuals differentiate the two is to identify that emotions are often a single word (sad, angry, anxious) whereas thoughts are typically a string of words (“I can’t believe my boss didn’t give me the day off I requested”). In viewing the two tables, these would help individuals to better differentiate thoughts from emotions, especially when using examples from the individual (by having them write specific thoughts they have had that are associated with common negative emotions or identifying specific events that would produce negative emotions). Overall, it is important to know the difference between thoughts and emotions so that individuals can better organize these as well as identify the patterns so that they may further identify what to change. If, for example, an individual feels sad, you can’t just change their emotion and make them feel happy. The thought associated with the feeling (perhaps “I can’t do anything right”) however, can indeed be changed if properly recognized, which will further affect the individual’s emotions (or if mislabeled and the individual states that they feel like they can’t do anything right, separating the thought [I can’t do anything right] from the feeling [sad]). This may allow individuals to later recognize other ways in which their thoughts affect their emotions and vice versa so that when other situations arise (especially helps if some are already identified with the tables!), they may better learn to manage their symptoms and how to cope.

    Reply

    • Tuyen Phung
      Oct 14, 2022 @ 21:59:36

      Hi Sarah,
      Your analysis of why people usually have difficulty distinguishing thoughts and emotions is interesting. I have not paid attention to the way people use the same verbs to talk about their thoughts and emotions until I read your ideas. Since English is my second language, I can tell the confusion in people when they use the same word “feel” for both thoughts and emotions. It hardly happens in my language in which people use clearly verbs for thoughts different from words for emotions. For thoughts, it can be “I think”, “I believe”, or “I doubt”. For emotion, it can be “I feel”. Also, you did a good job describing how distinguishing thoughts and emotions can be beneficial for the therapeutic process. I also think that it is more crucial in CBT than other approaches because when people distinguish the two terms, they can change one in order to reach the change on the other. I am still wondering how distinguishing can be beneficial for people with cognitive impairment when they are even unable to be aware of what are thoughts and what are emotions.

      Reply

    • Yoana Catano
      Oct 15, 2022 @ 12:49:24

      Hi Sarah,
      I like the explanation you provide about monitoring clients’ thoughts and emotions. If Mark understands clearly why this is important, he will do better completing small tasks, because they are not small if they are part of the whole pattern or cycle, and they will modify other areas including emotions and cognitions.
      I also agree with Tuyen in your explanation about the confusion in thoughts and emotions; the use of examples you presented, made it clear to comprehend why is easy to get confused with emotions and thoughts. Emotions are usually very strong while thoughts just show up quickly and disappear, in this case, tracking behaviors and associating them with emotions is helpful, it could be a grammar game for some individuals, and language could provide some help, like learning new vocabulary to explain feelings, but at the end, when those thoughts are modified, individuals can experience different emotions towards a positive change, as it is explained in CBT.

      Reply

  7. Rachel Marsh
    Oct 12, 2022 @ 20:49:46

    Behavioral Activation-1

    Some activities and tasks I would want to see Mark on his first activity schedule include waking up, self-care, leisure, social, and work-related tasks. In last week’s discussion, the video with Mark highlighted how he demonstrates avoidance and has lost interest in social activities. Additionally, he experiences stress when planning social activities, especially with his significant other, Melissa. Planning these activities out may decrease some of the negative thoughts and emotions associated with his social activities. Moreover, by assessing his associated thoughts and feelings, a therapist could gain more insight into the aspects of social activities contributing to Mark’s loss of interest.
    Another area that Mark highlighted in the previous video and this video was his lack of motivation to get out of bed in the morning. Mark says that he would like to wake up earlier to give himself more time to enjoy his morning before work, but he also feels tired despite sleeping more. Mark suggests this might be because he believes he does not have anything to look forward to and finds it easier to get up on days he does have something to look forward to. Having this as a planned activity might be beneficial to track Mark’s expected pleasure, beliefs, and emotions associated with getting out of bed to see what contributes to this barrier.
    Mark also linked several areas of his life to lacking the motivation to get out of bed in the morning. For example, Mark stated that he previously enjoyed his job but has lost interest in his work. Subsequently, Mark has less motivation to get out of bed on workdays. Having Mark write in the tasks he completes at work would be beneficial to gain insight into his thoughts, pleasure, and emotions associated with his work tasks to address in subsequent sessions.
    Mark also indicated that he had lost interest in participating in self-care activities because he felt he did not get any satisfaction from them. Tracking these activities
    would be beneficial to understand what aspects of his tasks he finds unsatisfying. Finally, I want to see Mark put some leisure activities on his first activity schedule. Mark has decreasingly participated in activities he enjoys, such as being outside and playing with his dog. Having some activities to enjoy himself that are not work-related or social activities would also be beneficial.

    Behavioral Activation-2

    Generally, it is beneficial to monitor the client’s thoughts and emotions to help identify activities/tasks that result in positive thoughts/emotions and those that result in negative thoughts/emotions. For example, rating thoughts and feelings of associated activities can pinpoint what the client views as unenjoyable or unsatisfying in an activity and the thoughts that prevent them from initiating and completing an activity. For example, clients with depression often have a decrease in activity which they recognize; because of their awareness of the reduction in action, they have automatic negative thoughts about their inactivity, leading to a depressed mood and continued inaction (Beck, 2021). In the video, Mark tended to have negative thoughts about waking up in the morning, working, and engaging in self-care activities. He thought it was not worth participating in these activities because he did not identify anything to look forward to.
    In a positive sense, as clients increase their activity, they experience more positive automatic thoughts about the activity, leading to increased hopefulness and a sense of purpose stemming from positive thoughts about increased engagement and activity completion (Beck, 2021). For example, in the video, Mark discusses how he does feel happy once he gets going in the morning. He says this makes him more likely to engage in other activities throughout the day.
    Rating the believability and severity is also beneficial to gauge the magnitude of the client’s thoughts and emotions regarding their behaviors. For example, at the moment, a client may enjoy an activity but, when looking back, may believe the experience is more negative than what they experienced. Having the client track their thoughts and emotions at the moment can give a more accurate picture of the impact of these constructs on their behavior than if they were to recall how they felt in a session. Often our memory of an experience is more negative than the actual experience at the moment.
    Moreover, assessing the believability and severity can help ascertain what should be prioritized in future sessions. For example, if a client has several negative automatic thoughts rated as low believability, but one as high believability, the one being of high believability is likely more impactful and should be addressed first. Likewise, if a client has several distressing activities but rates several as being higher in severity, the more severe ones should be a priority to process if the client agrees that they would like to do so.

    Automatic Thoughts

    Clients may experience difficulty when differentiating emotions from thoughts for several reasons. Firstly, clients often mislabel their thoughts as emotions by using the word “feel” to describe both thoughts and emotions (ex. I feel like this person hates me because they have not responded to my text”). Clients may also have difficulty communicating and identifying their emotions. For example, they may not possess the adequate vocabulary to describe their emotions. So, the best way they know to communicate their emotion, in this case, is to describe it in terms of their associated thoughts with the emotion. Finally, the client may understand the difference between their thoughts and emotions but may have difficulty addressing a certain aspect of their distress or identifying the source of their emotions (Beck, 2021; Volungis, 2019).
    It is imperative for clients to understand the distinction between their thoughts and emotions to gain a better understanding of how these, both separately and together, influence each other. One of the main goals of CBT is to help clients see how their thoughts and emotions influence their behavior. Part of this process is learning how their thoughts often precede their emotions. Thus, differentiating between the two is integral to understanding this difference.
    For example, Table 7.3 highlights a method for helping clients categorize aspects of their experience using the cognitive model with the event, the automatic thoughts, and subsequent emotions and behaviors. In this exercise, the client views one column with associated words for emotions (i.e., sad, disappointed) and an adjacent column where the client would write automatic negative thoughts they had that may have led to these feelings. Something that stood out to me with this exercise is how it cultivates reflection in the client to identify thoughts they had before they felt a certain way. In a broader sense, this can also instill the message that emotions often stem from thoughts. By understanding the automatic negative thoughts that lead to negative emotions, the client and therapist can collaborate to find ways to modify these thoughts positively. In turn, this would lead to a change in positive emotions.

    References
    Beck, J. S. (2021). Cognitive therapy: Basics and beyond (3rd ed.). Guilford.
    Volungis, A. M. (2018). Cognitive-behavioral therapy: Theory into practice. Rowman &
    Littlefield.

    Reply

    • Tuyen Phung
      Oct 14, 2022 @ 22:22:46

      Hi Rachel,
      You have got interesting details in the session between Dr. V and Mark. You gave me more insight into Mark’s motivation for work. You have a good connection between his unpleasant feeling after waking up in the morning and his motivation for work. I can think of this reference as an opening door to finding a reason for his depression and treatment. Also, you had good observation of his self-care. I think that if Mark continues ignoring his self-care and if the therapist does not pay attention, it can be an obstacle to his treatment.

      Reply

  8. Ashley Torres
    Oct 12, 2022 @ 20:58:14

    To start off, I would like to see the client waking up earlier and having energy to start his day. It would be great if he made himself a full breakfast and had enough time to sit down and eat his meal. It would be important for the client to break down his morning routine because he has expressed that he does not have any motivation in the mornings. I would also like to see him log work tasks because it is important to know what triggers/ if any does he experience. This will be useful because work is one of the reasons he is having a tough time with his morning routine and feels like he is dragging himself out the door. The client mentioned he could go to bed half an hour earlier than he usually does and that would be a realistic goal that will benefit his morning routine. I would like to see him engage in some form of self care or reflection before going to bed because it could help him relax. This may help him get to bed earlier, as he wishes. It would be great for the client to plan a social activity with his friends in advance and map out the date. The client should include how he came up with the plan, how long did it take, was he stressed out, and what did he do when he felt stuck? Monitoring the client’s thoughts and emotions would be helpful for future cognitive work because it will create a baseline for the next session. Examining the severity of emotions will be useful because the pair can discuss why specific emotions were severe and work on those. The client and therapist will examine the relationship between his thoughts and emotions and distinguish a pattern. This will help the client gain insight and motivate him to engage in pleasurable activities he’s discovered or change his thoughts that are severe and not realistic.
    It is difficult for clients to differentiate thoughts from emotions because negative automatic thoughts happen quickly and suddenly. The client experiences emotions based on their thoughts or how they refrain from them. Thoughts are like an automatic voice in our head that is random and most of the time negative in clients. They include people’s opinions, beliefs, and ideas. When an individual experiences a negative automatic thought they genuinely believe it is true which can be detrimental. Emotions is our psychological reaction to a situation based on what we believe. It is feelings we experience everyday like joy, sadness, anger, or fear. Our emotions are much stronger and felt than our thoughts which is why it may be hard for clients to differentiate between the two. It is important for a client to learn the difference because in therapy, a client learns how our thoughts may influence negative emotions. A client will need to learn how to catch their negative automatic thoughts and reframe to adaptive thinking, which will improve their emotions and behaviors.

    Reply

    • NikkiAnn Ryan
      Oct 14, 2022 @ 08:41:57

      Hi Ashley,

      I like the way you highlighted the importance of monitoring how the client starts his day. Particularly, I like the connection you pointed out between his distress regarding work makes his morning routine tough. This is probably a reciprocal situation in which his tough time with his morning routine then also influences his tough time at work. I think it was also a good point about him incorporating self-care or reflection before bed to benefit his nighttime routine which would then, hopefully, benefit his morning routine too. Great post!

      Reply

  9. Tuyen Phung
    Oct 12, 2022 @ 22:07:17

    Based on the information in the sessions on the videos between the client and Dr. V, I think of several activities that I would like to see on his first Daily Activity Schedule. First, I would like to see how motivated he is with the change in his sleep routine. In the session, he mentions waking up earlier as an attempt for next week. It was one of his problems leading to his rushing time for work in the previous session. Therefore, it is necessary to see how much he affords to break his routine and change his behavior. Second, I would like to see how social he is in the following week. His isolation can be one of the reasons leading to his depression. Therefore, seeing him become more social can be a remarkable change in helping him to recover from his issues. His social time can be expected to see in his gathering with friends to watch games that he likes. In the video, the client and therapist talk more about the idea of whether the client spending more time with his girlfriend on a date or hang out with her. This can be one of the topics to talk about in the next session, especially his emotion in the event, either his pleasure or expected emotion during the event. Finally, I would like to check how much time he spends outside, either spending doing exercise or walking the dog. Understanding the client’s engagement and emotions in these activities can be an important step toward improving his daily activities and emotions.

    Monitoring the client’s thoughts and emotions can be helpful for future cognitive work because of some reasons. First, monitoring thoughts and actions helps therapists discover what thoughts and emotions contribute significantly to the client’s problem, leading to specific case conceptualization. Second, the monitoring helps the client himself be aware of how maladaptive thoughts play a role in their problems as well as which thoughts they should be promoted to develop. Moreover, looking through the monitoring activity, therapists can see what thoughts the client values, leading to appropriate treatment. Finally, monitoring the client’s thoughts and emotions can help therapists determine which thoughts the client has struggled to deal with, even though the client may recognize it as problematic and find it challenging to change.

    Misunderstanding between thoughts and emotions can occur in people with mentally healthy people. It is even more difficult to distinguish these two in people with mental issues. These two factors are misunderstood because of their characteristics. First of all, thoughts occur in a short period of time and emotions quickly come after that. Therefore, people tend not to be aware of thoughts that contribute to their emotions. Moreover, people tend to focus and “stay to live” in emotions, especially negative emotions rather than knowing their thoughts. Also, automatic thoughts are usually experienced as emotions because thoughts precede emotions, leading to more awareness of emotions. In therapy, it is important to know the difference between thoughts and emotions in clients. On the one hand, it is helpful to provide psychoeducation about how their thoughts contribute to their emotions and vice versa. On the other hand, therapists can find appropriate interventions and help clients in dealing with negative automatic thoughts by looking validity of thoughts, and its conclusion, and finding coping skills.

    Reply

    • Rylee Ferguson
      Oct 13, 2022 @ 11:47:18

      Hi Tuyen, I think you made a great point about how having a client record their thoughts and emotions can improve their own awareness. I had mostly thought about how the tracking could be useful to the clinician and developing treatment goals. However, the client themselves might benefit initially from the recording as well. Prior to the exercise they may not be able to see the power their thoughts and emotions have over their mood and how they go about their day. This practice might give them more perspective that will ultimately help them engage with these thoughts further as they work to replace them with more appropriate beliefs. Thank you for bringing this up!

      Reply

  10. Vanessa U.
    Oct 12, 2022 @ 23:44:35

    [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?

    1.) It would be seemingly positive to see an earlier AM wake-up time with a planned hike before work with Melissa!
    2.) It is essential to monitor this client and his emotions because the client needs reminders of accomplishments and appears rot respond well to positive reinforcement.

    [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)?

    1.) It can be difficult for some to differentiate thoughts from emotions because of how closely they interact.
    2.) The critical difference is that thoughts are the precipitating factors of emotions. The way we feel and the various ways we express our feelings are directly related to how and what we think at that moment.

    Reply

    • Teresia Maina
      Oct 16, 2022 @ 00:29:47

      Hi Vanessa
      I agree that it would be nice to see Mark wake up early, so he has time to get a good breakfast and is not rushing out of the house in the morning. Thoughts and emotions interact closely, making it difficult for clients to differentiate between the two. I also think that some clients may struggle to differentiate the two because they use the word “feel” when describing the two. Great post!

      Reply

  11. Rylee Ferguson
    Oct 13, 2022 @ 11:43:21

    Based on my familiarity with the client so far I would like to see him make big changes to his morning routine on his activity schedule. It would be good if he set a goal to get up earlier before work. This would give him more time to wake up and get ready before leaving the house. He could aim to cook himself a good breakfast that he enjoys instead of being in such a rush he barely eats and is still foggy once at work. Additionally, it would be great to see him put social activities on the activity schedule. If he could set aside a dedicated time to connect with friends he may really see improvements in his mood. Lastly, I would also hope to see the client incorporate outside time on his activity schedule. Because he has found pleasure in this type of thing in the past, making space for it would likely be helpful in avoiding some of his isolating tendencies. This could look like taking his fog for walks or to the park or it could incorporate his partner so as to also act as a social activity. I would not expect all of these on the very first day of the activity schedule as it might be overwhelming and too much to tackle at once. However, it would be good to see him include at least one of the things mentioned above on his first activity schedule.

    The monitoring of thoughts and emotions on the schedule would be helpful in regard to core beliefs and automatic thoughts in future cognitive work. People’s core beliefs can lead to momentary negative thoughts that are automatically accepted and this may be visible in what people record on the worksheet. You may be able to see a pattern of thinking automatic thoughts about one’s worth. This can suggest the individual has an overarching core belief about worthlessness. This can inform future work as dismantling this belief and replacing it with a more hopeful one will be important to the client experiencing relief. The intensity and believability will be helpful in indicating the strength of the underlying belief. If the client has frequent negative thoughts that they really internalize then this would likely signal to the clinician that a significant portion of treatment will need to involve tackling this core belief. On the other hand if the thoughts and emotions are less intense and believable to the client then that might mean they will be easier to dismantle and so less time can be dedicated to it.

    Automatic thoughts can be fleeting while the emotions they instill can stick with clients. This means that oftentimes clients may have trouble being able to identify the thoughts that precede emotions. They may not realize the role their thoughts play and assume all they are experiencing is emotions. Additionally, because thoughts and emotions are so interconnected and can influence each other so significantly, clients may have a hard time untangling them and distinguishing between them. Nonetheless it is important to do so as a big part of CBT is putting thoughts to the test to see if they are valid and useful to the client. This process would be tough to engage in with emotions as they can always feel valid. It would also lack empathy to tell clients their emotions are invalid and this would probably damage the therapeutic relationship. It is better to look at evidence to start dismantling the thought patterns in order to eventually improve one’s emotions. By helping clients reject negative thoughts about their work ethic then instead of feeling useless they begin to feel more competent.

    Reply

    • Sam Keller
      Oct 13, 2022 @ 19:43:36

      Hi Rylee!

      I agree that automatic negative thoughts are so brief that we need to assist the client in order for them to be able to identify them. It is understandable that people feel these thoughts as emotions due to the nature of how fast they happen. What is nice about it is that once we can educate clients about automatic negative thoughts we can show them that they have more control than they realized in being able to modify these things that make them feel bad. This could be very empowering for our clients and can give them a sense of agency. We also really need to make sure we validate their thoughts so clients don’t feel hurt or misunderstood.

      Reply

  12. Tayler Shea
    Oct 13, 2022 @ 12:02:52

    On the client’s first day of his daily activity schedule, I would like to see the client plan a morning activity. The client made multiple comments about lacking confidence that he would be able to complete morning activities and I think that it would start his day off positively. The client has shared that he struggles to enjoy the mornings because he is often rushing to get ready for work. I hope he will wake up at least 1 hour before needing to leave his house, break his morning routine down, and highlight some positive aspects of the morning. I think that if the client starts his day off on the right foot by engaging in an activity that he enjoys, he will notice that his workday attitude will improve also. Finally, I hope that in the first day of his schedule, he plans time with Melissa to schedule a date night. The client shared that it causes him a lot of anxiety when the location and plans are not set ahead of time. This anxiety makes him reluctant to want to spend time being social. I hope to see that he and Melissa were able to plan a double date with their friends at a location and day that works for all involved! Monitoring the client’s thoughts and emotions will help the therapist know what is working and what is not working. Monitoring will help the client and therapist notice patterns in behaviors and the triggers for certain feelings and emotions. Monitoring his believability of thoughts at times when he is experiencing low motivation to complete tasks, may help the client interrupt his negative automatic thoughts, once he is aware of the situation. If this becomes a pattern, the therapist will know that more cognitive work needs to be done to remove those negative thoughts. When the client is experiencing severe emotions, it is likely that those emotions are paired with maladaptive automatic thoughts and resulting in less positive behaviors. Monitoring thoughts and emotions in CBT is very important because they highly influence how the client’s behaviors. Additionally, how the client behaves influences their thoughts and emotions.

    Clients may find it very difficult to differentiate thoughts and emotions. Specifically, clients with negative automatic thoughts are likely to find this especially challenging. This is because automatic thoughts occur rapidly in response to a situation, and they are often intense. These thoughts are typically no more than a couple of words or a quick image. Clients believe these thoughts to be true, even if they do not have validity because they are based on past experiences. Sometimes, clients with maladaptive automatic thoughts interpret even positive situations to be negative. These thoughts can feel very similar to emotion, and they are likely to elicit severe emotions. It is important to help your client learn the difference between automatic thoughts and emotions by using psychoeducation. Tables 7.3 and 7.4 in the text provide great CBT recourses to help our clients expand their vocabulary for emotions and automatic thoughts. They are also a tool that clients can use during a situation to differentiate between if they are experiencing a negative automatic thought or an emotion. Once clients know the difference between automatic thoughts and emotions, they will be better able to communicate with their therapist and with their loved ones regarding how they feel. It is important to know the difference between thoughts and emotions so that the client can better understand their behaviors. Clients’ emotions are influenced by their thoughts, and their behaviors are influenced by the combination of their thoughts and emotions. It is important for the client to understand thoughts, emotions, and behaviors individually, as well as how they influence one another.

    Reply

    • Rachel Marsh
      Oct 15, 2022 @ 21:51:07

      Hello Tayler,

      Hello Tayler,

      I enjoyed reading your post! Specifically, I appreciate your insights into differentiating thoughts and emotions. You make a great point when you discuss the importance of clients understanding the difference between thoughts and emotions to help them see the relationship between the two, separately and together. The theory that our thoughts influence our emotions and behaviors is central to CBT. Thus, cultivating an understanding of this for our future clients is essential.
      Moreover, I like how you mentioned that automatic thoughts could feel similar to emotions or are associated with strong emotions. Because of the reflexive nature of automatic thoughts, we are often unaware of them initially. But, we are more aware of the emotions or behaviors that stem from them. Helping clients be aware of their automatic thoughts and subsequent emotions can also help instill the idea that thoughts and emotions are distinct constructs.
      Overall, great post!

      Reply

  13. Yoana Catano
    Oct 13, 2022 @ 13:03:03

    I would like to see more specific activities that are rewarding for Mark, for example, he has stated that he struggles with the morning schedule, so a description of activities like waking up, making his bed, taking a shower, preparing his breakfast, would be a better view of accomplishments in the morning routine. It is initially difficult for Mark to think he can get up earlier, however, the idea of the Daily Activity Schedule is to help him to move out of the vicious cycle. If Mark completes at least one activity during the week that is different from the vicious cycle, he will feel he can complete other tasks, this sense of accomplishment or self-efficacy will lead toward the right direction. Mark also needs to include more pleasurable activities in his daily schedule, like walking the dogs or going out for dinner with Melissa. The idea of planning these activities, will take the stress of the last minute planning and direct its completion. On the other hand, monitoring his thoughts and emotions is the initial step for cognitive restructuring. Mark needs to identify what is the focus of distress, and how he is reacting to it. The severity with which the emotion is experienced or perceived is going to change the behaviors such as avoidance or withdrawal; in the same way, the believability assigned to a thought will connect with his emotional experience. Mark will understand that the interaction of negative automatic thoughts and emotions makes it hard to initiate and complete basic daily tasks and activities. Mark needs to learn the connection in the cognitive triad, thoughts-behaviors-emotions are always interacting, but this is not so evident for the client in his daily life, identifying some patterns will bring strategies to modify in one or more focus of attention, and this will also bring some automatic thoughts and core beliefs that need to be worked on during the therapy.

    Automatic thoughts are especially quick and hard to perceive, they come to our mind as a cognitive reflex, spontaneously and last a short period of time, they bring immediate emotions that last longer than the thoughts, this makes the differentiation difficult, in other words, it is easier to identify the emotion because the thoughts appear and disappear quickly. For example, when presenting in public the client experience anxiety or fear, these emotions can feel valid and directly related to the event, because thoughts of “I am not prepared enough to answer questions”, “They might think I am stupid”, are sudden and they don’t stay. The client will argue that their fear is what they feel when presenting in public, instead of differentiating the middle step in the process, which is their perception of the presentation and the thoughts around it.
    It is important to know the difference because it will help the client to modify behaviors by managing those thoughts. Tables 7.3 and 7.4 help clients to identify emotions, especially if the vocabulary is not sufficient, and associate those emotions to specific negative automatic thoughts, and specific events. The client will be able to understand that different events can bring different emotions, according to the perception or thoughts around the event.

    Reply

    • Sam Keller
      Oct 13, 2022 @ 19:31:45

      Hi Yoana!

      I really like the idea you had about Mark being able to monitor his stress and how he is reacting to it. It might be helpful for him to break down what he was feeling about each task and acknowledge the positives in addition to the negative areas. This can help him have a more accurate picture of his daily life that isn’t so focused on the negative and can give him successes to build off of. It is one thing to educate clients about automatic negative thoughts but it is another to show them the specific areas where it might be impacting their life. Once those issues have been identified we can start working with them to identify and target specific automatic thoughts.

      Reply

    • Tayler Shea
      Oct 15, 2022 @ 20:32:24

      Hi Yoana,

      I like you described the emotional reaction after an automatic thought to last longer than the actual thought itself. That is a great way to explain automatic thoughts while talking to the client. I agree it is very important for clients to understand the difference between thoughts and emotions so that they can understand how to change their thoughts to influence the way that they feel and behave. Psychoeducation plays a huge role in the elimination of negative automatic thoughts. Great post!

      Reply

  14. Sam Keller
    Oct 13, 2022 @ 15:00:03

    (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?

    Based on his previous Weekly Activity Monitoring Log I would really like to see him do some small changes such as getting up earlier or planning to do some hiking. I think doing a few things that he views as slightly unpleasant but once he gets into them he actually likes can set him up for a future pattern of behavior when he moves on to harder changes. This can also help decrease stress/improve positive feelings which is important with depression and anxiety. One of the other things I would like to see him do is plan another outing with his wife. I would want him to plan in advance where they would go and what they would do so he could see the difference that it would make on his overall enjoyment of the experience. He did say that that was an activity that once he got past the indecision he really enjoyed. This could be helpful because it can lower barriers to doing this ultimately pleasurable activity that he might have avoided because of the conflict it caused without advance planning.

    (2) How would monitoring this client’s thoughts (and believability rating) and emotions (and severity rating) be helpful for future cognitive work?

    At this stage, Mark is just starting to try behavioral activation and modification. Keeping track of how he thought he would feel/what he thought he would think before and after the activity can hopefully provide some proof that it wasn’t as bad as he thought it might be. This can provide Mark with direct evidence illustrating how his anxiety and beliefs are becoming roadblocks to things he actually enjoys or are beneficial to him. This can be used as evidence to build off of as he moves on to making harder changes or doing riskier ‘experiments’. It can also help by showing a change (hopefully positive) in his overall attitudes and thought patterns as he progresses through therapy. You can review this data with him later to help boost his confidence and give him a sense of accomplishment. I think that feeling accomplished could be a huge factor for Mark, and starting slow with easy wins can give him accomplishments to fall back on. if you can do this thing, then maybe you can also be successful at this as well. It could also be used to troubleshoot areas where he is rating items consistently with low scores or is not making improvements. This can help you target interventions to specific areas of his life.

    (3) [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)?

    In general, automatic negative thoughts usually happen so fast that it is the emotion they elicit that often gets the attention in the brain. Clients need to be trained to be able to identify the thought that came before the feeling. For some clients, it might be difficult to understand or believe that thoughts can cause emotions. They might view the emotions as the thing that causes the thoughts, which has a certain amount of truth to it. They may also not be able to label things in more than general terms such as ‘I feel bad’. You can help by teaching them the ‘full sentence = thought, single word = emotion’ trick. Having them also write down the emotion and guide them to tell you what they were thinking at the time is also a good exercise.

    Reply

    • NikkiAnn Ryan
      Oct 14, 2022 @ 08:52:24

      Hi Sam,

      I think you did a great job breaking down the specific activities you would like to see the client schedule and the advantages of monitoring the client’s thoughts and emotions. I really liked some of the points you made regarding differentiating between thoughts and emotions, specifically that it does require training/practice for clients to get to a point where they can identify the thought before the feeling. I think the suggestion to start with the emotion and guide the client to figure out what they were thinking can be a good way to practice this. When I was doing my daily activity schedule, there were a couple of times during the day when I could very easily identify the emotion I was feeling but would think to myself, “what was I thinking?” and I found working backward from the emotion was very helpful to put me back in the moment and determine what thoughts were going through my mind. Nice post!

      Reply

  15. Kat Gatto
    Oct 13, 2022 @ 15:17:59

    (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?

    Going to bed earlier and waking up earlier would be a great activity to see on his Daily Activity Schedule. This would definitely help him feel less flustered every morning. In addition, it would decrease his anxieties related to his job performance if he felt like he could consistently get to work on time. Another previously mentioned activity that would aid this earlier morning venture would be meal planning and prepping. He could pick times on his Daily Activity Schedule in the morning to grab a prepped breakfast and at night to prepare one for the next day. This is also extremely intrinsically rewarding if he preps a breakfast to eat that he finds much more enjoyable than the alternative bread and peanut butter that he had previously voiced hardly having time for. In addition, adding a date with his girlfriend and the specifics of that date would be very helpful so that he does not feel flustered when they try to spend some time together that day. Planning an activity that he might enjoy after work would be a great way to relax and unwind after a day when he may have been hard on himself, as is his cognitive tendency. They could plan to take his dog for a hike so that he combines the date with something outdoors. This would check a lot of self-care boxes for this individual as he has voiced the desire to spend more time with his partner and furry loyal companion while also finding the time to be outdoors. If he decides to go this route, he should plan exactly which state park or trail he and his girlfriend will be using. He should also pencil in time beforehand to get his dog’s treats, water, water bowl, and waste bags together if he plans on doing a more lengthy walk.

    (2) How would monitoring this client’s thoughts (and believability rating) and emotions (and severity rating) be helpful for future cognitive work?

    CBT is built on the premise that changing an individual’s cognitions can change their behaviors and emotions. Therefore, monitoring this client’s thoughts would be extremely helpful for challenging his core beliefs and maladaptive thought patterns as his therapy continues. Once he recognizes which negative emotions he believes, then he can identify what negative automatic thoughts correspond with those. For example, if he feels anxious at work it may be because he thinks he cannot do anything right and his coworkers will see. Once this thought is identified, he can come up with a more adaptive thought to fight this negative thought. For example, the positive corresponding thought, that can follow the negative thought, which is second nature to him, could be that he does do many things correctly on the job. Moreover, he can list any praise he has received from coworkers or activities at work he has completed well and on time.

    Likewise, once he recognizes what negative emotions correspond to what events then he can begin to cognitively prepare adaptive positive thoughts for said events. For example, he may think that nobody ever notices him and that he is invisible when he goes out to public places with his girlfriend. This thought may make him feel anxious. To begin to counteract this emotion, he can start counteracting the thought. He could remember when the waiter noticed him at a restaurant. Additionally, he could remember that the people who are working or going about their days in those public places are probably extremely busy and less likely to notice most people. Moreover, it is not that he is invisible. Rather, it is that people, himself included, tend to focus on their own perspectives of the world. Also, he can focus cognitively on the people who matter and do notice him in his life like his girlfriend. This may make him feel less anxious about being unnoticed over time because he can begin to cognitively recognize that his visibility and importance do not correspond with whether other people notice him. More generally and as CBT poses, changing the thought will help change the emotion.

    (3) [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)?

    It can be hard to differentiate thoughts from emotions because automatic thoughts are so fleeting. Specifically, a client may have the automatic thought that they are incompetent at everything; however, that thought comes and goes so quickly that they are far more aware of the painful emotion that corresponds said thought. Emotions linger, but thoughts come and go rapidly throughout the day. It is important to differentiate the difference between automatic thoughts and emotions so that the individual can recognize that emotions are the product of their thoughts and not necessarily their environments. That is, an environmental event can illicit any number of corresponding thoughts. This individual can practice more positive thoughts instead of negative thoughts in the specific event so that they can begin to alter the emotion said thoughts bring about. Additionally, identifying the automatic thoughts that may usually remain under the surface of their conscious awareness can help them begin to understand their maladaptive core beliefs. For example, identifying the thought that they can do nothing right at work might help them recognize and tackle the core belief that they are useless.

    Reply

    • Rachel Marsh
      Oct 14, 2022 @ 14:59:16

      Hey Kat,

      I loved reading your post. I like the suggestions you made for Mark regarding his daily activity schedule. Mark definitely seems to have difficulty getting up in the morning which tends to have secondary effects on his thoughts and emotions for the rest of the day. Therefore, having him plan on getting up early can help set the tone for the rest of his day.
      I also appreciate how you brought up the idea of setting aside time to spend with his dog and his significant other. These seem to be meaningful activities for him that he has slowly decreased his participation in. The main goal of behavioral activation is to increase opportunities for positive reinforcement. Helping him regain his sense of accomplishment and satisfaction in this area might help achieve this goal.
      Overall, great post!

      Reply

    • Tayler Shea
      Oct 15, 2022 @ 20:28:09

      Hi Kat!

      I agree – I think that is Mark focused on building a strong morning routine to help him feel less flustered in the morning! I like how you also included that you would like to see him go to bed earlier. It’s impressive how much going to bed just a little earlier can impact how well you feel the next day. I think meal prepping would go a long way for Mark. This would ensure that he has time to eat his meal before heading to work! We touched upon many of the same topics in our posts. Great work!

      Reply

  16. Teresia Maina
    Oct 13, 2022 @ 15:25:01

    Based on what we’ve learned about Mark so far, I would like to see Mark schedule his morning routine. Mark struggles with his morning routine and rushing out in the morning. I think going to bed a little earlier as the clients would be helpful in order to wake up a few minutes earlier. Waking up early, sitting down, and having breakfast could help his day start on the right foot. I would also like to see Mark schedule more social activities like going out to the park, going on dates with his girlfriend, and watching football with his friends. I would also like to see if he decided to plan a date night before the actual date and whether he found that helpful. Monitoring the client’s thoughts and emotions can be helpful for future cognitive work. It can help the clinician and clients recognize when maladaptive thoughts impact how motivated they are to complete a task. Monitoring can help us see which tasks the clients do not find pleasurable, what thoughts and emotions are tied to them, and whether or not they complete them. As the therapist works with client monitoring their thoughts and emotions can inform them if a positive change is occurring and help narrow down which therapeutic interventions will be more beneficial.
    Some clients have a difficult time differentiating thoughts and emotions. Clients who experience negative automatic thoughts tend to focus on the emotion because it’s usually easier to identify and more intense. Clients often use the word “feel” when describing thoughts and emotions. Some clients may not know how to verbally describe their emotions and others may end report the thought as a question or interpretation. It is essential to know the difference between thoughts and emotions in order to modify negative automatic thoughts. Knowing the difference helps clients identify when a specific event can trigger negative thoughts or emotions. The clients will also be able to identify the difference in order to manage and cope with the situation.

    Reply

    • Amanda L Bara
      Oct 14, 2022 @ 10:13:53

      Teresia,
      We both hit on a lot of the same points especially working on the morning routine and social outings with Mark. I like how you pointed out that recognizing maladaptive thoughts in relation to particular aspects of the schedule can help to pinpoint areas of motivation. You had a very thorough and detailed discussion post. Nice job!

      Reply

    • Kristin Blair
      Oct 14, 2022 @ 15:17:46

      Hi Teresia,

      I really liked your thoughts on the client scheduling his morning routine. This makes a lot of sense, considering how much the client is currently struggling with that. Also, at first, I remember him stating that he used to get up much earlier and have more time for his morning routine.
      We both mentioned how some clients do not have the correct vocabulary to describe their feelings fully, and I agree that this can be a significant barrier for some. I liked your point on how understanding the difference between thoughts and emotions can help the client cope with whatever situation/stressor they face.
      Nice post!

      Kristin

      Reply

    • Patricia Ortiz
      Oct 14, 2022 @ 21:55:28

      Hi Teresia, I also agree that it is essential to know the difference between thoughts and emotions in order to modify negative automatic thoughts. Negative automatic thoughts are nothing more than hypotheses that we make according to what we have lived or learned, but they determine our emotions and behaviors, and we become so used to them that we do not question them. Also, learning to identify them involves a process similar to learning any skill. Some clients catch them quickly and easily, while for others it may be more complex and require the support of words or images for example. And you are right; knowing the difference helps clients identify when a specific event can trigger negative thoughts or emotions!

      Reply

  17. Kristin Blair
    Oct 13, 2022 @ 17:25:46

    After watching the video, I think Dr. V and the client worked together to hash out some great ideas on what to add to the daily activity schedule. Since this particular client is struggling with depression and low energy and motivation, I think it would be beneficial to add some pleasurable activities that are planned out to the activity schedule. The client also expressed that he may be setting himself up for disappointment if he plans things to do and then they don’t happen. This was a good point, as I think many people with depression who are filling this out may also have that same worry. This further supports my suggestion for some pleasurable activities on the schedule because 1, it’s the first time he is trying this, and 2, pleasurable activities are typically easier to follow through on. Doing this would allow for a more successful rate the first week and will hopefully, in turn, give him the motivation to want to try it again for a second week.
    Rating the client’s thoughts and emotions is helpful for future cognitive work because it helps us see which thoughts and emotions are most intrusive and would warrant further examination. Also, insight into believability will give us an idea of how likely it will be for the client to have those specific negative automatic thoughts again. This helps pull out the thoughts and emotions that seem most problematic and could potentially create other automatic thoughts and emotions. Additionally, it is important to continue to evaluate if the client believes their negative automatic thoughts to be true, or if they eventually realize that perhaps they may not be true yet they are still having the thoughts. This can help the clinician know the interventions most helpful to the client. For example, if the client expresses an automatic thought they deem true, the clinician may opt to teach more emotion-focused coping skills. If the client expresses a seemingly “true” negative thought but is aware that it is probably not true, this would allow the clinician to teach more problem-focused coping skills while also coming up with other possible outcomes.
    Automatic thoughts can be complex for some people to differentiate because they happen so fast and spontaneous that we don’t even necessarily remember or put much emphasis on the thought because the emotion that we immediately feel from the thought is much stronger and becomes the focal point of the experience. Since emotions can be very intense and real, it can be hard to backtrack and parse out the original thought that caused the emotion. Furthermore, the nature of many automatic thoughts can stem from core beliefs or historical events that have shaped us to think the way we do. Additionally, some people genuinely just do not know the proper vocabulary to be able to express themselves in the most accurate way.

    Reply

    • Amanda L Bara
      Oct 14, 2022 @ 10:17:24

      Kristin,
      I really like you idea of inputting pleasurable activities into the schedule as it will increase the client’s motivation not only to get the schedule done but to feel some positive emotions. I agree that rating the emotions and thoughts are important to understand how frequent and intrusive they are. This activity helps to combine both thoughts, emotions and behaviors. Nice discussion post! I enjoyed reading it.

      Reply

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Adam M. Volungis, PhD, LMHC

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