Topic 5: Behavioral Activation & Automatic Thoughts {by 2/25}

[Behavioral Activation] – Watch MDD-8: Behavioral Activation – Reviewing Completed Daily Activity Schedule (also includes Graded Task Assignment).  Answer the following: (1) What additional questions would you ask Mark about his Daily Activity Schedule to assist you in moving forward with additional Daily Activity Schedules and future techniques with his negative automatic thoughts and maladaptive behaviors (see Table 6.5).  In other words, what additional information do you want to know? (2) What automatic thoughts (or core beliefs) do you think warrant further attention moving forward with more cognitive techniques?

 

[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 2/25.  Have your two replies posted no later than 2/27.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

68 Comments (+add yours?)

  1. Althea Hermitt- Mcpherson
    Feb 20, 2021 @ 02:00:44

    1. (1) What additional questions would you ask Mark about his Daily Activity Schedule to assist you in moving forward with additional Daily Activity Schedules and future techniques with his negative automatic thoughts and maladaptive behaviors.
    What planned activity and actual activity were completed or not completed?
    What was his expected pleasure and actual pleasure felt from each planned activity?
    What was his level of accomplishment felt doing each task?
    What negative automatic thoughts and emotions did he experience while doing these tasks. How believable or intense his thoughts and emotions were?
    What obstacles were faced in doing each task and how he maneuvered the obstacle (avoided or solved)?
    What negative predictions were disproven if any?
    His level of pleasure at an activity could be used to develop future techniques that can reinforce adaptive behaviors. Tracking recurring negative automatic thoughts could help to steer future technique because the daily activity schedule would give insight as to what these negative automatic thoughts are and will serve as a guide to implementing specific techniques that will be used to restructure these cognitive distortions.

    2) What automatic thoughts (or core beliefs) do you think warrant further attention moving forward with more cognitive techniques?

    The automatic thought would warrant further attention would be
    1. Personalizing: This is the most recurrent theme in Mark’s conversation. He focused on people not applying or accepting the job offer and personalize this as a reflection of him not doing a good job he even stated “Is it me or is it the company” which shows some kind of blame for things that are out of his control. He also constantly personalized his friend not being able to come for dinner, he stated Do they even want to be friends with me? Do they value me? Do they value this relationship? He then withdraws to his room due to the phone call. It would be helpful to examine the evidence with Mark about personalization. Also, another cognitive technique could be to have Mark separating himself from his negative automatic thoughts as demonstrated in the video where Dr. V asked mark what would you tell a friend that was going through a similar situation?
    2. Mind Reading: Mark tends to make assumptions about what others are thinking and oftentimes will fill in the blank when enough information is not available. For example, he assumed why his friend didn’t want to come for dinner and attributed that to them not wanting to be his friend or not liking him. He, therefore, tortures himself with the thinking of not being valued or loved by his friends instead of asking them what really happened and why they couldn’t come over. It would be helpful for Mark to test the reliability of his thoughts or look for alternative explanations.
    3. Jumping to Conclusion: Mark jumped to conclusions about his friends not being able to come over to dinner he stated “do they even want to be friends with me” even though they told him they had some family issues so I would want to explore possible alternative explanations with Mark. It would also be helpful to practice thought-stopping, checking the facts about these conclusions, and remind him about past positive outcomes.
    4. Magnification: Mark magnifies or exaggerates the negative significance of an event and minimizes or shrinks the importance of things that he does well or things that went well. This was evident when he spoke about the work training, he exaggerated all the negative things that happened and downplayed the things he did well and the fact that he was able to pull it off despite the hiccup. It could be helpful to shift Mark’s attributional biases so he could understand that other people or factors could have contributed to the event.

    Mark has recurring negative thoughts of being unlikable and unworthy which tends to cause him a lot of distress. The Core Beliefs that I think warrant attention would be Mark’s belief of being unlovable/ unlikable he demonstrated this when he stated “Do they even want to be friends with me? Do they value me? Do they value this relationship?. He also has a belief of being unworthy, he stated “I think it’s kind of silly to be proud of myself for waking up 30 minutes early”. He was also angry with himself about making breakfast and not being able to sit and eat it without acknowledging that he was able to wake up and make breakfast.

    1. What are some possible reasons why it is difficult for some clients to differentiate thoughts from emotions?
    Thoughts create feelings or emotions, these emotions are feelings that influence behaviors. However, Thoughts and emotions are so closely occurring and reciprocal, that people do not reflect upon these principles of CBT as separate entities because thoughts are the silent influencers. We feel emotions but we don’t often label them and that’s one of the reasons why we might find it difficult to differentiate between thoughts and emotions. Thoughts tend to be quick and rapid however emotions last longer and have more effects so individuals may have a thought, but will focus more on the emotion because that was what was most impactful due to the physical or psychological sensation experienced.

    2. Why is it important to know the difference?
    It is vital to know the difference between thoughts and emotions because they are the basic principles of CBT and they influence our behavior and life circumstances. Thoughts are very important because the main aim of CBT is to identify and modify negative automatic thoughts. Emotions are secondary because it’s the thoughts that create the emotion. Modifying thoughts can help to determine validity and rationality which can improve individuals’ emotions since emotions are personally influenced by our experiences or biases hence that is much harder to modify. If clients have an understanding of the difference between thoughts and emotions they will be more cognizant of the relationship and influence of both on their behaviors. Knowing the difference between thoughts and emotions is absolutely important because it helps the clinician to determine treatment planning and techniques to use with the client.

    Reply

    • Abby Robinson
      Feb 24, 2021 @ 18:18:50

      Hi Althea!
      I really like what you said about how thoughts tend to be put on the back burner when going through emotions and feelings. I totally agree. Since learning more about automatic thoughts, I have been trying to focus on my own thoughts that sometimes bring strong emotions, rather than just the emotion itself- this ‘reasoning’ has definitely helped me sort through emotions better! Being able to think “this is why I feel like this” makes me realize my negative thoughts more!
      See you in class!

      Reply

    • Yen Pham
      Feb 25, 2021 @ 12:30:42

      Hi Althea,
      Thank you for the posting!
      I agree with you that the automatic thought would warrant further attention would be in the future in the case of Mark are personalization, jumping to conclusion, magnification and mind reading. In my posting, I don’t mention the mind reading and magnification automatic thought, but I have learned from your posting. You are right, it is helpful for Mark to look for alternative explanations of his issues rather than his mind reading thought as well as shift Mark’s attribution biases so he could understand that other people or factors could have contributed to the event. At that point, your posting makes me think about the internal and external control. Thus, I think that it also helpful for Mark if he consider balancing between his internal and external control because in the case of Mark, the fallacy of internal control has Mark assuming responsibility for his friend’s absence. For example, he thought that, his friends could not come to his dinner because they might not values his friendships or Mark might not deserve with them so they did not care about his feelings.

      Reply

    • Nicole Giannetto
      Mar 01, 2021 @ 17:58:11

      Hi Althea! You came up with a lot of great questions. I especially thought your question about asking Mark what activities did he plan that he did not end up doing was important. What we’ve learned about Mark’s experience with the activity monitoring log is mainly about things he has been able to do, and a few things he hoped to do. I think focusing on the activities that were missed, or may have no been planned, but that Mark did want to do, are important and can give us more insight into how to make treatment even more effective by finding ways to fit these activities in.

      Reply

  2. Lilly Brochu
    Feb 23, 2021 @ 12:53:16

    [Behavioral Activation]

    (1) Overall, Mark did a great job providing feedback of his experience completing the Daily Activity Schedule assignment. However, I would want to explore his daily activities deeper, and see what adjustments could be made to limit any negative automatic thoughts and maladaptive behaviors. Some follow up questions to ask Mark would be:
    • “What activities did you have planned out that were followed through with?”
    • “How did it feel when you completed the activity?”
    • “What was your level of pleasure when you completed the activity?
    • “What was your level of achievement when you completed the activity?
    • “What activities did you have planned that you did not complete?”
    • “How did it feel when you did not complete the activity you had planned?”
    • “Even though some of your planned activities did not go as you thought, what were your general thoughts and feelings about completing the Daily Activity Schedule?”
    • “Was this activity helpful or not helpful? Why or why not?”

    (2) Throughout the videos we have watched so far, there has been a reoccurring pattern of automatic thoughts that are stemming from an overarching core belief of “unlovable or unlikableness”. I have noticed that this core belief is seems to be related to Mark’s social environments, such as his marriage, friendships, and at his job. For example, when Mark’s dinner plans with his wife and friends fell through, he began to internalize and ruminate on thoughts like, “Do they value me? “and “Do they even want to be friends with me?”. Instead of understanding that life can be spontaneous, and unexpected things happen, Mark immediately personalizes, jumps to conclusions, and makes assumptions about himself that have caused his friends to cancel plans with him. However, when Dr. V gave him evidence as to why these negative automatic thoughts are false (e.g., “Wouldn’t they have not agreed to have dinner with you if they didn’t consider you a friend?”), he was able to slightly rationalize and understand that his thoughts may have been a bit untrue. Moreover, Mark personalizes a lot of situations at his own job that are most likely reflected by the nature of the job or company itself rather than his recruitment abilities. He internalizes a lot of work-related problems and blames himself for things that are *most likely* out of his control. This also stems from a “perfectionistic” attitude he has when it comes to his job. Mark seems to hold high standards for himself at his job, and when they are not met, he is extremely hard on himself. Additionally, Dr. V points out that there are themes of distress when there is an “ambiguous” element involved, such as when Mark is unable to understand or determine why a situation or response occurs that is subjectively undesirable (e.g., positions not being filled at his job, his friends cancelling last minute without a detailed response). Moving forward, I think it would be important to tackle Mark’s core belief of “unlovable” or “unlikableness” first to gain a larger understanding of where the negative automatic thoughts are stemming from.

    [Automatic Thoughts]

    (1) When clients are in distress, it can be difficult for them to differentiate their thoughts from their feelings. When they are are overwhelmed and are experiencing several thoughts and emotions, they may become unclear or mesh together. Moreover, some clients may understand the difference between the two, but struggle to apply their understanding to real life situations. A major goal within CBT is to be able to identify the negative automatic thoughts and modify them in a way that allows the individual to feel fewer distressing emotions and feelings. It is important to know that the content of the thoughts is what can be modified rather than one’s emotions. Not only would it be invalidating, but it would be unhelpful to try and modify a client’s emotions because it would not be targeting the exact source of the distress (e.g., core beliefs, negative automatic thoughts). By distinguishing the difference between thoughts from emotions, the client will be able to understand that thoughts precede their emotions, how to correctly label their emotions, and bring awareness to what thoughts are connected to specific emotions.

    Reply

    • Yen Pham
      Feb 25, 2021 @ 12:31:32

      Hi Lilly,
      Thanks for your posting!
      I agree with you that distress is an important factor that makes it difficult for clients to discern feelings and thoughts. When in distress, clients easily mistake and label their feelings as thinking and vice versa. So, we are, a therapist or counselor are responsible to guide our clients in understanding this difference. The thoughts lead one’s emotion so we can be modified the thoughts rather than the emotions.

      Reply

    • Althea Hermitt- Mcpherson
      Feb 25, 2021 @ 21:20:20

      Hi Lilly, I like that you mentioned that Mark did a great job providing feedback on his experience completing his daily activity schedule homework. I also like that you mentioned exploring his daily activities deeper, and see what adjustments could be made to limit any negative automatic thoughts and maladaptive behaviors. Some of the questions you asked were similar to the ones I ask as well. I like that you would ask Mark if the activity was helpful or not and why or why not.

      Reply

  3. Cassandra Miller
    Feb 23, 2021 @ 21:21:22

    After watching the Daily Activity Schedule review video with Mark it was clear that he made some significant progress with his goals. Some additional questions that I would ask him about his goals would be:

    – Did he accomplish every planned activity that he had on his sheet?
    – What actual activities took less/more time than he originally predicted?
    – Where was he the most surprised about his expected pleasure vs his actual pleasure and accomplishment?
    – How did he feel when he did not complete/did complete a planned activity?
    – How did this feeling perhaps influence his next planned activity?
    – Where did he experience the most difficulty or least amount of enjoyment?
    – What thoughts and feelings was he experiencing at this time?
    – What activity brought him the most pleasure and feeling of accomplishment?
    – What thoughts and feelings was he experiencing at this time?

    These questions would help me understand more about the type of cognitions he is experiencing during periods of perceived success and failure. In addition, it allows me to focus on areas of growth and strength where I could highlight success for him. Focusing on a client’s success/strengths can be very beneficial as it can help motivate them towards growth and allow them to see themselves as more capable of achieving their goals. I also would be interested to see what activities he tended to prioritize over others, so that I could consider what types of effects they may have on his level of functioning. Some automatic thoughts that warrant more attention would have to be his consistent thought that his friends do not like him when they cancel plans or have to hang up with him on a phone call. In addition, I would focus on the thought that he did not work hard enough when recruiting, which represents his tendency to turn inward instead of thinking about external influences. These automatic thoughts that often pop up reflect his core belief of being unlovable and perhaps thinking, “I am bad” since he does not hold a high opinion of his own capabilities. He often questions others beliefs about him, which usually leads him to think within the framework that others do not really like him and they only say yes to plans because they feel bad. His constant negative questioning/conclusions when there is any ambiguity signals an insecurity of his own likeability. However, I would make sure to focus on his surprise and hopefulness when doing this assignment, since he seemed to keep repeating the phrase, “I was surprised” and “it went better than I thought it would.” By reminding him of his own ability to overcome negative expectations this can help move therapy in a positive direction.

    It can be very difficult for clients to differentiate thoughts from emotions, especially since emotions can come on so strongly. Automatic thoughts and core beliefs can trigger emotions without the client even realizing. Core beliefs group negative and similar thought patterns together to support the client’s overall negative view of themself. Therefore, the emotion is already attached to the common negative thought that the client often has when perceived adverse experiences arise. Thus, it takes practice and effort to pull the thought from the experienced emotion, especially since acknowledging the thought causes the individual to reflect on the negative opinion that they feel about themselves; which they may rather avoid. In addition, the feeling that the thought leaves them with can seem so overpowering as it represents these festering beliefs that they are not completely aware of. For example, Marks feelings of disappointment often lead to feeling disheartened and discouraged, which make him feel even worse. In addition, his feeling of insecurity can lead him to feel inadequate. Thus, it becomes very important to understand the difference between a thought and emotion so that the individual can test the validity of their own thought. They can challenge these broad conclusions and core beliefs using a more logical approach with prior information that they have to prove otherwise. Thus, it is important to always validate the emotions, but challenge the negative thoughts.

    Reply

    • Lina Boothby-Zapata
      Feb 23, 2021 @ 21:34:47

      1) Mark is thorough with the information he provides to Dr. V, and he is engaged in the process. It is easier to appreciate that Mark has the motivation to work in his therapy process, and he wants changes in his life. He looks like the “ideal” client to work in the therapy process. I also think Dr. V uses the appropriate Socratic Questions, such as what activities were initiated but not completed? What activities were no initiated? What are the reported levels or pleasure and accomplishment for each activity? What are the reported thoughts (and believability) and emotions (and intensity) for each activity? Hence, the counselor and the client have met the goals by exploring and reviewing this homework. One element that got my attention in Mark’s Daily Activity Schedule is that he plans the “perfect” day; however, it didn’t happen what was intended. The Daily Activity Schedule is about Behavioral Activation; furthermore, it shows us how people experience multiple situations in the environment that are out of control. For example, Mark invited his friends (something that he was expecting) for dinner and canceled the appointment. Then, as an opportunity, Dr.V can identify some Automatic Thoughts.

      Instead of asking more questions, I thought about one technique that J Beck illustrates in her book called “Testing your Thoughts” pg 196. This technique can be useful for Mark when he does these socialization efforts, meaning reaching out his friends and not getting the “expected”. This technique could probably help him reduce his withdrawn behaviors, sadness, and automatic thoughts, such as believing that he is “worthless.” Instead of waiting until his next session, he can address the situation immediately, this also will promote autonomy knowing that as a counselor we want the client to learn new techniques and strategies to intervene his Automatic Thoughts and wanted to try again even though if he exposes to other situations that it doesn’t result in which what he was expecting”

      2) As a counselor, I will initially focus on three automatic thoughts that Mark has shown during his conversations. Situation 1 = friend doesn’t show up; thought (Dichotomous thinking) = I am worthless; emotion = sadness; behavior =Withdrawn. This pattern is identified in different sessions when Mark tries to connect with friends or coworkers but is receiving an unexpected outcome. Another pattern of Mark’s automatic thoughts is at work, situation 2 = He offers the job. The client turns down the offer; thought (personalization) = He is incompetent; emotion = sad, worried, disappointed; behavior- withdraw. Situation 3= The trainees don’t show up for the CPR training; thought (overgeneralization) = It’s my fault, I did the contact; emotion= embarrassment; behavior= come out with a plan (he thinks, his presentation wasn’t that good)

      In general, Mark identifies that it is difficult for him to start activities such as; waking up in the morning, going out for dinner, doing his chores at home, laundry, dishes, etc. Also, Dr. V does in MDD-6 vignette he stated that this could be related with anxiety and ruminating thoughts. However, for me is not clear what Automatic Thoughts could be involved there.

      3) When the counselor and the client try to identify automatic thoughts. One of the counselor’s red flags is to invite the client to reflect on the situations that activate the client’s intense emotions and ask the client to describe and rate the feelings and thoughts that came through their mind before the emotion. Sometimes, the client can not differentiate between emotions and thoughts. There are different reasons; first, the emotion is so intense that the client is overwhelmed and can’t difference, second the client has poor vocabulary related to the emotions and he doesn’t have the words to express what he is feeling, third have problems labeling the emotion and getting confused for example doing the difference between being sad or anxious.

      Emotions are primarily important for the CBT model. The major goal of treatment is the reduction of the symptom of the patient and his suffering. Intense negative emotions can interfere with the CBT therapy process if the client doesn’t know to differentiate between thoughts and emotions. The client needs to understand the difference between thoughts and emotions because strong emotions may become dysfunctional when interfering with the client’s capacity to think clearly, solve problems, act effectively, or gain satisfaction. Hence, intense negative emotions can interfere person’s behaviors. It is also important to the client and the therapist to identify them because then it is possible to recognize the strengths of the automatic thoughts and the beliefs that have been activated. In other words, if the therapist guides the client to talk about his “intense negative emotions,” then the automatic thoughts will become behind them and will be easier to reveal, identify and treat within the therapy process.

      Reply

      • Beth Martin
        Feb 24, 2021 @ 04:51:11

        Hi Lina,

        Your post was so thorough, and it certainly helped me make sense of some concepts I was struggling with. Being able to differentiate between thoughts and feelings seems like a no-brainer to me, but I couldn’t really word it. Your breakdown of why that’s so important was extremely helpful!
        I think the automatic thoughts that you’d tackle are definitely issues for Mark, and I liked that you added in his emotional responses too! I thought it was interesting that Mark seem to strive for perfection with his day – do you think that that might be an area you’d work on with him too? I’m starting to get the impression that Mark holds himself to unrealistically high standards.

        I hope you’re keeping warm!
        Beth

        Reply

      • Michelle McClure
        Feb 25, 2021 @ 00:23:05

        Hi Lina! I really like how you refer to Judith Beck’s Testing Your Thoughts technique. I agree that this technique would be useful for Mark when he reaches out to his friends and things do not go the way he “expected” them too. I also agree that this technique would likely help him reduce his avoidance and withdrawing behaviors and improve his depression as well. I hope you have a great week!

        Reply

    • Beth Martin
      Feb 24, 2021 @ 04:55:09

      Hi Cassie,

      I liked the question you pose to Mark focusing on on any areas he was surprised by in his activity log. I agree that it’d be a great motivator and reinforcer for him to realise that there are areas he’s achieving in! I also liked the phrase you ended your entry with; validation of emotions is hugely important, especially to help keep that therapeutic relationship/rapport strong.

      Thanks for posting!
      Beth

      Reply

    • Lilly Brochu
      Feb 24, 2021 @ 10:52:48

      Hi Cassie,

      Highlighting the client’s strengths and areas of growth are a great place to start after assigning and reviewing any homework assignment. With Mark, I think it is very important to highlight and remind him of his own personal strengths and abilities because he seems to have low confidence or self-esteem, or low self-efficacy in himself, his career, or his social relationships. Moreover, this type of homework assignment can give the client a visual of activities that they are completing each day (small activities can be big achievements for some individuals with depression) as well as a way to outline activities that are not being completed. This type of homework gives a lot of insight on what is happening in the client’s daily life that can give the therapist insight on other areas of the client’s life that they may be poorly functioning in or adapting to. Thanks for your insight, Cass. 🙂

      Reply

    • Pawel Zawistowski
      Feb 25, 2021 @ 13:31:00

      Cassie,
      I agree with your take on why it is difficult for clients to differentiate thoughts from emotions. I think you make a very good point when you said that automatic thoughts and core beliefs can trigger emotions without the client even realizing. I believe that intensely emotional situations can make it difficult to separate the thoughts from emotions and be able to perceive them as separate experiences since they are both occurring simultaneously. However, I do think it is important to be able to separate the two that way we can help the clients understand themselves better, come up with coping strategies, identify where the problem is, and how to monitor and regulate each one more effectively.

      Reply

  4. Beth Martin
    Feb 24, 2021 @ 04:48:07

    Behavioral Activation
    There’s quite a bit of additional information I’d like to get from Mark in order to move forward with any activity schedules and dealing with his negative automatic thoughts/maladaptive behaviors. While he’s generally open with how his experience for the most part, I would like to know more about how he felt filling out the form. I’d ask:
    • “How did you feel when you started an activity at the scheduled time?”
    • “How did you feel when you were unable to stick to your schedule?”
    • “Were there any activities you didn’t schedule on this day on purpose? If so, why?”
    • “What were your overall thoughts about this activity?”
    • “Do you feel like this helped you keep on schedule/track your pleasure and achievement?”

    As Mark seems to be generally compliant with suggestions Dr. V makes for homework and fills them in successfully, I’m less concerned about going through specific activities and asking how he felt about them (unless one or two have very low/high ratings in comparison to the others, or they’re a target area spoken about in the past, such as the time he wakes up in the morning). I’m curious as to how he felt when he was filling out the Daily Activity Schedule; there was a little bit of reluctance and uncertainty when it was introduced, and I’d like to know how he worked through that. It could be an area to point out as a “win”, and therefore an encourager for Mark. I’m also asking about if he’s been purposefully selective with his plans for personal reasons, as I know that’s something I did when filling out my own activity schedule this week. I’d want to try and get a grasp on if there are any areas he feels he cannot control and therefore avoids, just in case.

    There are a handful of automatic thoughts that seem to be consistently bothering Mark, and therefore warrant further attention. Mark seems to really struggle with personalization. Throughout the videos, he has made comments along the lines of “do they really want to be my friend?”. He seems to be very concerned about friends not contacting him, or blowing him off for more nefarious reasons than might be at play. This seems to highly impact his self-worth, believing he is unlovable or worthless. He also seems to hold himself to high standards, perhaps due to perfectionist automatic thoughts. He criticizes himself for not working hard enough when trying to find new workers, seemingly for no justified reason other than he sets himself high standards. He also takes the blame, unnecessarily, for the training session not going to plan a few sessions ago. This is something completely out of his control, but he seems to believe that, because he found this particular company, it is on his shoulders. He also jumps to conclusions, as seen in how he reacts to his friends being unable to talk etc. – it must be because of him, not due to other things going on in their lives. This is also an example of mind-reading, where he presumes to know what others are thinking with a lack of evidence to prove he’s correct.

    [Automatic Thoughts]
    I believe that it’s difficult for some clients to know the difference between emotions and thoughts because they’re usually so instantaneous. Thoughts, especially negative automatic thoughts and core beliefs, will trigger negative emotions in many individuals, so the two often go hand in hand. I’d imagine that, if every time you had a negative thought, your emotional response was instant and intense, the lines between the two would blur, and thus would be extremely difficult to distinguish between the two. Furthermore, these intense emotions are rarely positive, and can be extremely overwhelming, where our cognitive skills aren’t necessarily at their best. I do think that most people understand the difference in theory, but due to how blurred they can be, may not be able to tell when they’re experiencing a thought vs emotion, especially in times of stress.

    It’s important for clients to be able to distinguish between their thoughts and emotions when it comes to CBT. CBT focuses in on identifying and tackling negative automatic thoughts, and if an individual can’t tell when something is a thought vs feeling, discovering automatic thoughts could be difficult. Additionally, CBT strives to lessen emotional responses to said negative automatic thoughts and adverse stimuli, so a client will need to be able to recognize when they are experiencing sadness, happiness etc. vs. a thought.

    Reply

    • Lilly Brochu
      Feb 24, 2021 @ 10:58:14

      Hi Beth,

      I think that it was interesting that you would take a different approach to assessing Mark’s experience with the Daily Activity Schedule. Instead of asking about the specifics of the completed/incomplete activities, you would assess the overall experience, including how his previous feelings changed from when the homework was first introduced to understanding the process of him working through and completing the assigned homework. I think it is important that the client’s perception and experience are understood and validated to assess the overall utility of any homework assignment given to the client. For some individuals, the Daily Activity Schedule may not work for them, and that is okay! Finding what helps the client manage their presenting problem(s) best is what is most essential in leading them towards adaptive functioning and coping on their own. Thanks for your post, Beth! 🙂

      Reply

    • Tayler Weathers
      Feb 24, 2021 @ 13:41:53

      Hi Beth! I think you’re right about the speed of thoughts and emotions. Plus, I feel like the physical experience of emotions gets associated so quickly with the thought that it almost validates it – the intensity becomes “truth,” even if the person doesn’t necessarily know that’s the case. So the understanding helps to combat the automatic acceptance and “leaning in” to the negative emotion.

      Reply

    • Michelle McClure
      Feb 25, 2021 @ 00:29:07

      Hi Beth! I completely agree with you that it is difficult for some clients to know the difference between emotions and thoughts because thoughts are usually so instantaneous and they happen so fast and yet are so fleeting. It would be easy to like you said to blur the lines and confuse the emotion for the thought or even vice versa. Thoughts, especially negative automatic thoughts like you said happen quickly but will trigger negative emotions that last for a much longer period of time. Also because of the negative emotions that are produced the experience can be overwhelming for many people I completely agree, especially if they are stressed. Have a great weekend!

      Reply

    • Althea Hermitt- Mcpherson
      Feb 25, 2021 @ 21:36:02

      Hi Beth, I totally agree with you that It’s important for clients to be able to distinguish between their thoughts and emotions especially in relation to Cognitive Behavioral Therapy. I liked that you mentioned that CBT focus on identifying and tackling negative automatic thoughts, and if the individual can’t differentiate between thought and feeling. It will be really hard to identify automatic thoughts without being cognizant of the thoughts and emotions that cause them. Knowing the difference between thoughts and emotions is absolutely important to the clinicians because it helps the clinician to impart psychoeducation. It helps to determine treatment planning and techniques to use with the client.

      Reply

    • Brianna Walls
      Feb 26, 2021 @ 17:59:33

      Hi Beth! I agree, negative automatic thoughts and core beliefs do trigger negative emotions in almost all people, so yes I believe it is difficult for an individual to know the difference between them. I like how you said how they might blur together, and this might be a reason why individuals confuse the two.
      I also enjoyed reading the questions you would want to ask Mark. “Were there any activities you didn’t schedule on this day on purpose? If so, why?” I think this is a great question because the therapist will be able to see if Mark was avoiding specific activities or not.

      Reply

    • Lina Boothby-Zapata
      Feb 26, 2021 @ 21:41:09

      Hi Beth
      Thank you for referring to Mark’s Automatic Thoughts. I guess it has been a little bit challenging for me because the way that I have seen psychology is from the humanistic and psychodynamic perspective and in general the sessions with the clients are more in the direction about “tell me your childhood, tell me about your family, what challenges did you have in your past and how these experiences interfere in your daily life. Definably, from the CBT perspective for me in a new way to intervene in the clinical practice. Hence, I see that you are adding a couple of AT that I didn’t see during the video such as having “high standards and being not only worthless but unlovable” I think with all of these plethoras of AT the next step is to evaluate and assess which deserve to be treated and intervene within the therapy process.

      Reply

    • Lina Boothby-Zapata
      Feb 26, 2021 @ 21:43:31

      Hi Beth
      thank you for referring to Mark’s Automatic Thoughts in my post. I guess it has been a little bit challenging for me because the way that I have seen psychology is from the humanistic and psychodynamic perspective and in general the sessions with the clients are more in the direction about “tell me your childhood, tell me about your family, what challenges did you have in your past and how these experiences interfere in your daily life. Definably for me, from the CBT perspective is a new way to intervene in the clinical practice. Hence, I see that you are adding a couple of AT that I didn’t see during the video such as having “high standards and being not only worthless but unlovable” I think with all of these plethoras of AT the next step is to evaluate and assess which deserve to be treated and intervene within the therapy process.

      Reply

  5. Christina DeMalia
    Feb 24, 2021 @ 13:24:38

    (1)
    One question I would ask Mark is what amount of time he thinks he would need in order to do his full morning routine without being rushed. He pointed out that he had time to make a good breakfast, but not sit down to eat in. In the moment, he also noted being angry at himself for still feeling rushed. It seems as though the small improvement in his morning routine did get Mark off to a better start, so focusing on that seems important to improving his day overall. If Mark can identify how much longer he would need in order to eat breakfast as well, I would then want to find out how he thinks he could add some time to his morning schedule. For example, I might want to know if he already plans out his clothes the night before. He mentions that he could have gotten dressed a little bit quicker to have time for breakfast. He also mentions that he couldn’t fall asleep at 10 pm and got back up until 11. If mark could use that time from 10 pm – 11pm to set out his clothes for the next day, doing some preparation work for breakfast the next morning, packing a lunch ahead of time, etc. he might be able to open up some time in the morning.

    Aside from asking more questions about his morning routine, I would want to know more about the foundation for his thoughts about the recruitment process. Mark mentions that he worries that the reason people don’t accept job offers might be his fault or because of him. Although it seems like Mark is personalizing here, as he seems to do often, I would want to know more about this. There is a chance that Mark has some knowledge that makes these thoughts seem more valid to him than to someone hearing him say it. I would want to know what evidence he has to support that as well as what evidence he has against it. By following these steps for monitoring automatic thoughts, I could better understand how to help Mark translate those thoughts into something useful for him.

    (2)

    One major automatic thought I think warrants further attention is “they don’t want to be friends with me.” Mark had thoughts like this when his friends cancelled plans for dinner, when his coworker said he was too busy to go to lunch, and when one of his friends didn’t return his phone call. The thought that “this person doesn’t want to be friends with me,” seems to stem from a core belief mark has about himself not being someone that people want to be friends with. If every time a person is busy or has to cancel plans on Mark, he ruminates on it believing that no one wants to be his friend, he will wind up causing more negative thoughts for himself rather than being able to recover from the setback.

    Another core belief Mark seems to have is that he doesn’t do a good enough job or that he is to blame when things go wrong. This has manifest in a few situations, such as the CPR training that was supposed to be offered through his job. Even though the company not showing up for the training was completely out of control, Mark still felt responsible. Even then, he was able to successfully put together a last minute training on diversity, which seems like a success. Despite that, Mark still sees it as a failure on his part and beats himself up about it. Mark does the same thing when he makes himself breakfast but does not have time to eat it. Even though this is a huge improvement and step in the right direction to wake up earlier than he has in a long time, he still finds fault in himself. He remembers feeling angry that he still had to rush a little and didn’t have time to sit down and eat. From an outside perspective, this seems like an accomplishment, but Mark has an automatic thought that tells himself that he hasn’t done a good enough job.

    (3)

    Often, when people think about or recall how a situation went, they will recall their emotions. This could likely be because emotions are the most strongly felt. However, they are also the most identifiable. When someone feels angry, they can see their body outwardly express that emotion. When someone feels anxious they can notice their rapid heartbeat and flush feeling. Because of this, when a person is asked what they thought about a situation, they are likely to respond by saying things such as: I felt hurt, I was upset, She made me angry, I was annoyed with it. Although the client does experience those emotions, the emotions do not appear out of nowhere. Instead, they are a reaction to the thought that popped into that persons head either before, during, or after the event occurred. Using Mark as an example, when he was asked about his friend cancelling for dinner, his first response was to say he felt hurt. Since this is an emotion, though, he was then asked to think more deeply about what he believed or interpreted in that moment to make him feel hurt. At that point he was able to recognize that he had the thought that they may not want to be friends with him. Understanding this difference is important because emotions alone can’t be changed. Telling Mark “well your girlfriend wasn’t too upset and she got over it, so you should try being less upset,” would do nothing to benefit Mark. Instead, helping him identify what thoughts led to those emotions will actually help Mark. If he can recognize that he thought “they don’t want to be friends with me,” he can follow the next steps for assessing those thoughts. He can decide if that is a valid thought by examining what evidence supports that, as well as what evidence contradicts it. The fact that his friend initially did agree to dinner seems to act as evidence to contradict that automatic thought, and there are likely other pieces of evidence that could do the same. By being able to change that automatic thought, Mark will then naturally see his emotional reactions to the event change as a result.

    Reply

    • Tayler Weathers
      Feb 24, 2021 @ 13:44:30

      Hi Christina! I think your point about prep is a good one. What does Mark do the night before? Or even the week before – meal prep can be an awesome thing! In addition, I wonder why the stress is on the morning going so smoothly – does he think that’s a reflection of the day? Is it just because it sets up his mindset? Like I asked, why is he so focused on sitting down to eat? What about that seems like it would make the day better, or make him feel better – and how can that principle apply even when he is rushed?

      Reply

    • Brianna Walls
      Feb 26, 2021 @ 18:05:31

      Hi Christina! I agree with you, I think it is very important to further discuss Mark’s automatic thought of how people don’t want to be friends with him just because they cancel or deny plans with Mark. Further, I also believe that Mark is causing himself to have more negative thoughts because he is ruminating on that one core belief that no one wants to be friends with him. So yes, I think it is extremely important for Mark and the therapist to work on this negative automatic thought.

      Reply

    • Lina Boothby-Zapata
      Feb 26, 2021 @ 21:58:12

      Hi Christina,
      I was glad to read in your post moving from Automatic Thoughts to Core Believes. I agreed that they are two strong AT that may end it as a core belief, there is a lot of evidence that for Mark socialization is very important and he is emotionally suffering from being rejected, at least this is what he is thinking about it. Another AT that can become a core belief as you point it out, is that he perceives himself as a failure. It will be interesting to see in the videos how these worthless and unlovable AT turn out into Core believes and observe during the sessions the process of AT becoming Core Beliefs.

      Reply

  6. Tayler Weathers
    Feb 24, 2021 @ 13:39:14

    1. I have a few questions for Mark. First, I think I would try to get him to identify what is so tough about feeling words: is it that he doesn’t know a lot of feeling words, or does the one feeling word (overwhelmed, dread) just come up a lot? Parsing out what feelings are where (which Dr. V tries, but Mark isn’t very specific) might help differentiate tasks better and help him feel less “blah” about his whole day. I also wonder what his thoughts are when he sets his alarm for 30 mins earlier versus his normal time – is he thinking “I won’t actually do this” or “this will be great!!” or what? Finally, I’m curious what he values about sitting and eating at home in the morning. What benefit does he think that will be?
    2. For automatic thoughts/core beliefs, I feel like Dr. V covered a lot of them. But, personalization of his job and the company’s success seems like a big one (does it extend to when the company does something well? does working for a company that “isn’t doing well” make him feel like a failure?). Also, the perfectionism (which I guess would be a core belief, that he has to do everything perfect or people won’t like him/he won’t be valuable). He puts that on others, too, like his friends who canceled dinner. Working through that might help a lot.
    3 [Automatic Thoughts] I think it is difficult for clients to differentiate thoughts versus emotions based on how their family growing up and those around them talk about them. I think popular culture has disregarded “feeling” words for stuff like “blah” or “meh” that has meaning, but isn’t very specific. When thinking about your feelings, the more specific the better, because it allows you to compare situations and nuances more effectively. For example, if a friend stands you up for lunch, you might feel lonely at the table when you eat and angry they didn’t show, but if a friend is late for lunch, you might feel worried they won’t come, insecure by yourself, etc. They both feel negative, and are changed drastically by your friend appearing (or not), despite being similar situations. So I think having clients work through the difference might keep them from being too general (I don’t like being at a restaurant alone – because the disliked feeling might actually be about nerves they won’t show, or maybe others watching) and also being able to see the bright side, because they can greater contrast those emotions (instead of feeling lonely at the table, they can seek out some other friends by calling or texting on their way home) to uplift the day.

    Reply

    • Abby Robinson
      Feb 24, 2021 @ 18:28:39

      Hi Tayler!
      I definitely think your point about Mark personalizing his job spilling over into other aspect of his life would be a good thing to bring up. Especially if it is a core belief, I would think that there are other areas of his life that he holds himself to a high standard and then feels like he lets others down when he doesn’t meet his standard. Having him understand this, I think, would help him and his motivation a lot!
      See you in class!

      Reply

    • Maya Lopez
      Feb 25, 2021 @ 10:32:27

      Hey Tayler,

      I think you brought up a great point that it would be interesting to know what value having breakfast at home means to him. Does it have a deeper meaning to him? Or perhaps it just has to do with having a good routine. Either way, this knowledge could be useful when thinking of other activities for him to come up with. I also think gently “forcing” him to think more critically about his feelings and specific thoughts will help him and the therapist to find more meaning to work with. If he can identify oh this is an automatic thought and it’s making me feel __ he may take away the power of it a bit, by just identifying it alone which is what we want for clients. I do agree his main core belief seems to be that he is unlikeable which is why he tries so hard to not make others upset like he thought he did at work when the people canceled. It is likely he had an automatic thought like “now everyone hates me because I failed”

      Reply

  7. Elizabeth Baker
    Feb 24, 2021 @ 13:47:16

    [Behavioral Activation]
    1) During the session, there were a lot of planned activities that Mark expressed had not gone as planned, but little talk about what tasks DID go as planned. So questioning what went well may relieve feelings of disappointment from his unexpected outcomes, since he may have unintentionally dismissed successfully completed activities that were unplanned or on his activity sheet.
    After Mark’s friends canceled dinner, he stated that he felt disappointed and questioned if they really wanted to be friends with him. Asking when the last time he had dinner or had seen his friends could help understand any additional negative (if he had not seen his friends in a while) or positive (if he had seen his friends recently) emotions that emerged when he received the call from his friends. That is, if he had seen his friends recently, that encounter could disprove his automatic thoughts of his friends not liking him, whereas, if he had not seen his friends in a long time it would contribute to this automatic thought. Asking if he had discussed his disappointed feelings with his girlfriend would also be helpful as it seems that his girlfriend was less upset about his friends not making dinner, she could have given him other adaptive perspectives of his friends not being able to make it to dinner. Asking him how he would feel about offering to reschedule could help Mark think of adaptive responses to unexpected situations as well, if he is able to reschedule with his friends then he may feel less upset about their absence. Asking him what coping mechanisms followed after receiving the call from his friends could help to identify both of Mark’s maladaptive and adaptive coping mechanisms, which can be altered or strengthen as therapy continues.
    Mark also expressed a sense of accomplishment when he woke up early and had a relaxing morning. Asking him how he feels about making backup plans if his alarm does not wake him up in the mornings would possibly influence him to start thinking ahead and to prepare himself for when events do not go as planned.
    Mark also noted that he feels pressure from his job, asking him what adaptive behaviors will help regulate these feelings of uncertainty and feelings of pressure may help decrease his automatic thoughts of incompetence. Doing so will influence him to think of multiple adaptive behaviors that can increase his confidence during his work tasks, it may also help identify maladaptive behaviors that he engages in when he is working.

    Questions:
    What activities went well? What were your pleasure ratings on these activities?
    When was the last time you have seen your friends?
    What did and what could you do to manage these negative feelings after your friends canceled?
    Are there any other ways to help you wake up in the morning?
    Are there coping strategies that help you regulate these thoughts of incompetence and feelings of pressure at work?

    [Automatic Thoughts]
    It is often hard to separate thoughts and feelings when it comes to distressing events, as both seem to merge into a tsunami of negativity. I feel that clients are not aware of automatic thoughts that trigger emotions, so it is easy for them to say, “I suddenly felt angry,” without understanding what sudden thoughts emerged before they became frustrated. I also feel that emotions or thoughts may overpower the other in a distressing situation, as either one is overcome by an intense negative thought or an intense negative emotion with little understanding as to what caused these intense cognitions. People tend to have a hard time understanding the origin of their thoughts and emotions until they discuss it with others or learn about the influences of automatic thoughts through CBT. As I said earlier, there are varying thoughts and emotions that compile into either a general feeling of negativity or excitement, and people often have a hard time identifying which emotion(s) followed their thoughts. It is important to know the difference between thoughts and emotions because it allows us to adaptively analyze our responses to positive and distressing situations. With the help of CBT, we can find the source of these, for example, automatic thoughts that produce negative feelings. From there, we can challenge and alter these thoughts to think and behave more adaptively when we encounter situations that induce negative thinking or emotions. All in all, it is important to differentiate thoughts from feelings so we can learn to function adaptively when encountering situations that are unexpected, uncomfortable, challenging, and fearful.

    Reply

    • Elizabeth Baker
      Feb 24, 2021 @ 13:49:09

      I accidentally left out my response to [Behavioral Activation] question 2, here’s my response:

      2) Some automatic thoughts that warrant further attention include personalizing negative events and putting himself down when something does not go as expected, jumping to conclusions when an event does not go as expected, his sense of perfectionism when it comes to completing tasks and not feeling more accomplished even though the task had a positive outcome, and minimizing his accomplishments due to the overall doubt of his competency skills.

      Reply

  8. Michelle McClure
    Feb 25, 2021 @ 00:17:17

    1. I would want to know when Mark said that he liked seeing that he enjoyed things. I would be curious what activities he found more enjoyable then he thought he would find them. I would be curious what strategies Mark would be willing to try in the morning so that he will not feel so rushed. I am curious if he would be willing to wake up 15-20 minutes earlier so he could walk his dog or make a breakfast. I would also want to know what activities he wanted to do or attempted to do but did not do or did not complete and why he thought he did not get to them or complete them. I would be curious to know what Mark would be willing to do to help him not feel so self-defeated over life hiccups/work hiccups and help him to accept and move on from those little hiccups instead of ruminating on them. Would it be possible to talk to Melissa when he is feeling overwhelmed from life’s hiccups instead of withdrawing into video games? I would also like to know what types of emotions he was feeling when he was doing each activity and how strong of an emotion.
    2. I think that Mark has some concerning negative automatic thoughts around being likable and around being valued by the people in his life. Mark really personalizes things even things that are out of his control and he really has a hard time letting go of the things that bother him and really magnetizes them out of proportion. Mark also seems to jump to negative conclusions really quickly when things do not go as planned. It would be helpful for Mark to pay more attention to his negative thinking patterns so that he can start to recognize when he is thinking more negatively and hopefully turn those thoughts around so that his emotional state improves.
    3. Some possible reasons that it may be difficult for some clients to differentiate emotions from thoughts is because thoughts precede emotions, but because the experience happens so fast, there is more awareness of the emotions then the thoughts behind the emotions. Also because thoughts are often fleeting and fast it may be hard to remember or catch the thought but the emotions that are felt can last for a long time and are therefore more notable. It is important to know the difference between thoughts and emotions because thoughts often are the cause of the emotion. Modifying the thoughts can therefore change the emotion. If the automatic thoughts are negative they most likely produce more negative emotions like anger or sadness. If the negative thought can be changed to something more neutral or even positive that will change the negative emotions that the thought produces and make them more positive
    as well.

    Reply

    • Elizabeth Baker
      Feb 27, 2021 @ 21:31:54

      Hello Michelle!
      I like how you questioned what activities Mark had found more enjoyable than he initially thought, I think that is a phenomenal way for him to reflect on his activities. He may have written down activities that he might dread, so remembering that he enjoyed those activities as well as activities he knew he was going to enjoy may help him feel more accomplished with his day/activity completion. The question about him waking up 12-20 minutes earlier was one I was thinking of as well, because I was not sure if he was stating it was impossible due to him not wanting to wake up that early OR because waking up earlier just was not possible. He made it sound like there was absolutely no way that he would wake up earlier than he initially planned. Overall, you posed great questions!

      Reply

  9. Yen Pham
    Feb 25, 2021 @ 00:25:51

    1. Behavioral Activation
    1.a. What additional information do you want to know?

    After watching the MDD- 8, I realize that Mark was consciously practicing a daily schedule that his therapist had set forth. Mark was motivated to follow his plan for a day, but there are something didn’t happen as he planned, for example he planned to invite friends come over for dinner. But in the last minute they said they could not come. They did not give Mark a reason why they couldn’t make it. Mark was upset about that. He had some negative automatic thoughts, and maladaptive behaviors. He talks to himself that “Do they want to be friends with me?” “Do they value me?”

    Dr. V provides for us a Table 6.5 with some meaningful questions which help us reviewing Mark’s daily schedule. Dr. V suggests that we can ask Mark, for example:
    1. What activities were initiated and completed?
    2. What activities were initiated but not completed?
    3. What activities were not initiated?
    4. What are the reported levels of pleasure and accomplishment for each activity?

    However, in my own opinion, and from my experience that I had when I did my daily schedule this Monday, so I will prefer to ask Mark the reasons why did he cannot complete his plans. Like Mark, I realize that something I have planned for a day, they were not play well as I planned. For example, I have planned that I wake up at 6 am but the actual time I woke up was 7: 30 am because I forgot to set up my alarm clock before I went to bed. I felt discomfort about myself because I have not enough time to prepare a breakfast as I wish. Thus, I think in the case of Mark, first, I focus on what his activities were initiated and those that were not (or those initiated but not completed). Then I may ask:
    1. Can you think of any reasons why certain activities were not initiated and/ or not completed?
    2. Do you think you can explore your thoughts related to your friends’ absence? How do you plan that out?

    Second, I review his possible changes in pleasure before and after each activity and levels of accomplishment. Then, I may ask some questions:
    1. Were there particular activities that were more/less pleasurable than expected?
    2. Did you notice any of your negative automatic thoughts or maladaptive behaviors?
    3. Have ever you might think your friends could not come to your diner because of their emergency reasons, instead they did not value your friendship?
    4. Are there any activities that you would like to continue and stop?
    5. Are there any activities that you did not do but would like to do in the future?

    I believe that these questions will assist me in moving forward with additional Daily Activity Schedules and future techniques with Mark’s negative automatic thoughts and maladaptive behaviors

    1.b. What automatic thoughts (or core beliefs) do you think warrant further attention moving forward with more cognitive techniques?

    In the case of Mark, there are some automatic thoughts (or core beliefs) that I think warrant further attention moving forward with more cognitive techniques. If so, we can provide Mark some helpful techniques to overcome his distress. Specifically, we know that the automatic thoughts or core beliefs may are caused by some common cognitive distortions. They are personalization and jumping to conclusions.

    First, personalization is a distortion where a person believes that everything others do or say is some kind of direct, personal reaction to them. They literally take virtually everything personally, even when something is not meant in that way. In the case of Mark, he experiences this kind of thinking, he compares himself to his friends, and tries to determine who respects for this relationship, he or his friends? Mark also sees himself as the cause of some unhealthy external event that he was not responsible for. For example, he said “I had called the first time to invite them and then I called again to confirm . . . and then . . . something came up. They didn’t tell me what it was, but there’s that inkling of do they really, value me? Do they value this relationship?

    Second, jumping to conclusions is a form of cognitive distortion. Often, a person will make a negative assumption when it is not fully supported by the facts. In the case of Mark, he makes a hasty judgment before learning or considering all the facts that might cause his friends’ absence. Finally, control fallacies i.e., the fallacy of internal control has Mark assuming responsibility for his friends absence. For example, he thought that, his friends could not come to his dinner because they might not values his friendships or Mark might not deserve with them so they did not care about his feelings.
    It is helpful if in the future we guide Mark to explore his internal control, and how to balance his external and internal control. It also helpful if we guide Mark understands more about his personalization as well as his jumping to conclusion. We can ask him to consider to take more time to think why his friends cloud not come.

    2. Automatic Thoughts
    2.a. What are some possible reasons why it is difficult for some clients to differentiate thoughts from emotions?

    Some clients are difficult to differentiate thoughts from emotions because they may conceptually understand the difference between thoughts and emotions when reviewing the CBT model but struggle with actual application when asked to review a specific, personal event. In fact, this may be indicative, at least in part, of some the distress they are experiencing (i.e., difficulty processing the source of distress).

    2. b. Why is it important to know the difference (see Tables 7.3 & 7.4)?

    It is important to know the difference between thoughts and emotions because thoughts (i.e., full sentences) that influences emotions (i.e., a single word). We can also remind our clients that in the near future, they will learn how to modify their thoughts in order to have different, less distressing emotions. Dr. V claims that emotions are not modified, as this would be a futile task because, in many ways, their emotions are understandable based on their thoughts. Having a good understanding of our clients’ CBT case conceptualization can provide some assistance in recognizing if there are any inconsistences between how the event connects with their emotions and automatic thoughts. If clients report emotions that appear to not connect with their automatic thoughts and the context of the event, we should follow up for clarification.

    Reply

    • Cailee Norton
      Feb 27, 2021 @ 16:10:45

      Yen,

      I think you raise a really good question for mark by asking for him to use some insight into understanding why some of the activities weren’t initiated or completed. This allows for a great discussion in terms of uncovering some discomforts and possible automatic thoughts that may have deterred him from completing the tasks or even beginning some of them. I also like that you ask him to explore his thoughts in terms of his friends’ absence. Here we can process the occurrence together, and if we find certain core beliefs or negative automatic thoughts pop up we can directly challenge them with Mark instead of after the fact. I think these are great questions. I also agree with you that Mark tends to have personalization distortions whenever someone doesn’t go exactly as planned or someone can’t be present with him in the moment. This is a great area for further exploration that could uncover some great opportunities for Socratic techniques. Great job!

      Reply

  10. Abby Robinson
    Feb 25, 2021 @ 03:12:35

    Behavioral Activation
    1. After listening to Mark in this session, there is some more information that may be helpful to know.
    How did you feel when you were able to accomplish the task on your activity sheet?
    What are your thoughts about how well you did or didn’t stay on task?
    Why do you think you weren’t able to accomplish this task?
    Is there something you can do differently to stay on schedule?
    Can these positive task accomplishments promote you to make more small goals for yourself?
    Would this be something you’d be interested in? Could you push yourself to do more?
    Are there any feelings that spill over from your home life into your work life/and vice versa?
    Are you able to decompress after a hard day at work to start fresh at home? What activities can you do to do this?
    2. I think that some automatic thoughts that warrant further discussion with Mark are that he automatically thinks his friends don’t like him when they aren’t able to make his plans. This seems to create a snowball effect into how other type of negative situations make him feel – i.e. a person not taking the job because of him. This seems to be a core belief where he holds himself very accountable for the ‘bad’ situations, even though they were not intensely negative, but it sets him back. He seems to have a hard time coming out of this. Also, from previous sessions we’ve learned that his positive and successful moments at work/home aren’t as satisfying as they should be; when he was able to bring together a presentation on the fly at work. This is something that Mark should be proud of yet he seems to push it aside. This may be a core belief where he doesn’t believe he was the reason for such success, that it was just luck?
    Automatic Thoughts
    I think it’s difficult for some clients to find the difference in their thoughts and emotions because negative automatic thoughts bring on such strong emotions, they can be distracting when trying to understand these thoughts and process why/where they are coming from. As table 7.4 displays, a way to start this process is to know the event/trigger, what the negative automatic thought is and then talk about what the emotions are. Where many clients skip the thought phase and go right to the emotion since it can be so debilitating. It is important to know the difference because this can show where the thought is coming from and how to tackle it. This allows the client to see the reasoning behind this intense emotion, which can help get a handle on in for treatment goals.

    Reply

    • Maya Lopez
      Feb 25, 2021 @ 10:39:21

      Hey Abby,

      I liked the question where you asked are there any feelings that spillover from your home life into your work life or vice versa. On the day Mark was unable to get the training people to come in, he was not feeling good about his likeability. I am curious if when he then came home still had strong automatic thoughts surrounding his likeability. If that had been the same day he went out and saw the sushi guy remember his name, I wonder if he would have externalized that and had thoughts like “I’m sure he just knows my name because I’m always here not because he actually likes me”. In other words, it would be important for him to determine that his automatic thoughts and feelings may affect his perspectives on his home life as well as other aspects. They may contribute to his overall feeling in life and having him see that generalization could be helpful for him to notice it is all fixable by using the cognitive model in therapy.

      Reply

    • Anna Lindgren
      Feb 25, 2021 @ 12:53:33

      Hi Abby,

      I think the questions you have for Mark are well thought out and would give you more insight into the thoughts and feelings surrounding the different parts of his schedule. I especially like the question about him being able to decompress after a hard day of work, to help him see that he can set up a habit to keep a bad workday from spilling over into a bad evening at home. I also agree with your observation that Mark tends to minimize his accomplishments and maximize his failures, leading to negative emotions about his own self-worth. Great post! See you in class – Anna

      Reply

    • Cailee Norton
      Feb 27, 2021 @ 16:14:13

      Abby,

      I think some of your questions ask for Mark to perform a bit of insight and I love that! I think Mark has a lot of thoughts that overanalyze situations (leading to some of his personalization issues) and your questions really allow for Mark to stop and examine the activities, how he felt about them, and what some of the other factors could have been that lead to either the completion or inability to complete a task. These are important tasks for Mark and would provide you as a clinician the opportunity to use different techniques to better understand what automatic thoughts could be present for Mark as well as using this as an opportunity to challenge such thoughts. I also agree with your take on automatic thoughts and how emotions are just so strong for people that that can be where the confusion between the two comes into play. Great job!

      Reply

  11. Maya Lopez
    Feb 25, 2021 @ 10:18:57

    Watch MDD-8: Behavioral Activation – Reviewing Completed Daily Activity Schedule (also includes Graded Task Assignment).
    (1) What additional questions would you ask Mark about his Daily Activity Schedule to assist you in moving forward with additional Daily Activity Schedules and future techniques with his negative automatic thoughts and maladaptive behaviors (see Table 6.5). In other words, what additional information do you want to know?
    I would ask Mark, in those moments he is filling in the holes when his friends cancel on him, what thoughts are going through his head? I would also want to know how he views himself during those moments? If he had to rate his self-worth, I would be curious how low it would drop, in other words, how much the act of his friends candling on him and then his interpretation of them not liking him affects him. I would ask him if he had any suggestions of other ways to reframe the situation before offering my own suggestions. If he is able to think of other rational ways we could practice working on a more rational technique when he does a behavioral experiment. I then would ask his thoughts and how he rated his distress and self-worth after that to see if the new technique has had a positive effect on him.
    (2) What automatic thoughts (or core beliefs) do you think warrant further attention moving forward with more cognitive techniques?
    It seems like one of Mark’s core beliefs is “I’m unlikeable” because when his friends canceled on him, he immediately jumped to the conclusion that it was because he was “not good enough”. He also was really affected when the sushi guy remembered his name and said hi to him, it leads me to believe this felt so validating to him that even someone who is not considered a friend “liked” him enough to say hello. The severity of his core beliefs should be examined and warrant further attention when moving forward in sessions.
    [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 very hard for some clients to differentiate their automatic thoughts from their emotions because the thoughts are often so quick and sometimes subconscious that the person is not able to register them. However, the feelings and emotions caused by the thoughts, linger and is usually why clients speak about how they feel. It can be hard even for adaptively functioning individuals to separate thoughts from emotions especially if in a stressful situation. A lot of times during socialization, people speak about how they felt in the moment so people also become more accustomed to paying attention to how they feel rather than remembering what they were thinking. An example is that people always say hey how are you (feeling)? I less often hear people say “hey what’s on your mind?” It is important to know the difference so we can better understand how the thoughts reflect the person’s view of themself, their abilities, and competencies AKA core beliefs which is a step in the right direction for therapy.

    Reply

    • Anna Lindgren
      Feb 25, 2021 @ 13:02:55

      Hi Maya,

      I like your line of questions for Mark regarding his automatic thoughts about how his friends see him. I think a good way to gauge the validity of the thought might be to ask him if there was ever a time when he had to cancel plans with a friend and if he did so because he didn’t like the friend or if there was another reason he had to cancel? This could get Mark to start to see the event from the perspective of his friend, and maybe he could start a conversation with George about what it is that’s going on with his family so that he can be of support and feel closer to his friend. Great observation on the importance of the restaurant worker remembering him and the importance of that, it gives us an idea of just how lonely Mark may be feeling at this point in treatment. See you in class! – Anna

      Reply

  12. Carly Moris
    Feb 25, 2021 @ 12:42:45

    1)
    I think I would want to ask Mark which activity brought him the greatest amount of achievement and pleasure and which brought the least. I think this would be helpful with being able to plan more activities like the one that brought him a large amount of pleasure and accomplishment. While, we can not have pleasure and accomplishment in everything we do, I think it would also help to examine which activity had the least amount of pleasure and accomplishment. Looking into the thought processes behind it may help uncover more negative automatic thoughts or core beliefs. In the video one of the activities he was most looking forward to was the dinner with his girlfriend and friends, Dr. V mentioned his expected pleasure and accomplishment were both 8’s, which was high for Mark. But then he was disappointed when they canceled and he started to withdraw and internalize the reasons why they canceled. I would want to ask him more about what he thinks and feels about trying to reschedule the dinner. He mentioned that he did what he was supposed to by calling in advance and double checking they were coming and they still ended up canceling. I think this may be an important to look into, because he used one of the strategies mentioned in previous sessions (calling to make plans in advance instead of the day before/night of) and it didn’t work. I would want to know how he feels about trying again despite it not working out the first time. I would also want to ask how he would feel if something like this happened again, and maybe work on or come up with strategies on how to deal with events like this in the future. This may also be a good opportunity to discuss what to do if events don’t go as planned and what coping strategies Mark can use, or what to do if the first coping strategy he tried didn’t work. From here it may be helpful to ask Mark about how he felt when other activities didn’t go as planned and how he felt when he had to adjust his schedule. This can be helpful in determining if any alterations to the schedule make him feel bad, or if its just specific events. This can help determine how much flexibility there should be in the next daily activity schedule. Especially because Mark repetitively mentioned feeling overwhelmed, I would want to know how the schedule effects those feelings. If altering the schedule increases his feelings of being overwhelmed, it may be important to discuss how he can alter his schedule for the next week to reduce the need for altering the schedule.

    2)
    I think moving forward I would want to focus on Mark’s core belief of being unlikeable because that’s were a number of his negative automatic thoughts seem to stem from. I think one of the most prominent types of negative automatic thought that Mark has is personalization. He seems to highly internalize negative events. He thought his friends canceled dinner last minute because they didn’t want to spend time with him, even though they mentioned a family emergancy. For work he also wonders if he is the reason that their recruitment rate is down. That it was because of him or something he did that made people not want to work for their company. His core belief of being unlikable seems to cause him to internalize these events, “I’m unlikable so of course they canceled dinner because they don’t want to spend time with me” or “I’m unlikable so of course people don’t want to work for a company I represent”. While mark does demonstrate other types of automatic thoughts like overgeneralization and dichotomous thinking, it seems like a lot of these thoughts stem from his over internalization of negative events. So I think moving forward it may be helpful to focus on his personalization and how it relates to his core belief of being unlikable, because I think addressing this internalization will help address some of the other negative automatic thoughts he is experiencing. Though it will be important to address his other negative automatic thoughts as they come up in session. But I wonder if it would be helpful to see if and how these automatic thoughts relate to his personalization and internalization.

    3)
    It can be difficult for clients to differentiate between thoughts and emotions if they are experiencing a large number of automatic thoughts. Due to the nature of automatic thoughts it can be hard to recognize when they occur and the client may only notice the emotion that they caused. I think this is especially true if clients are not used to examining their own thoughts or engaging in metacognition. I also think that if the emotion is particularly strong or distressing to the client it can be hard for them to work backwards from it to the thought, because the emotion is prevalent and possibly overwhelming. It is important to different between thoughts and emotions because thoughts can be modified while emotions can not. An individuals thoughts may be invalid and can be challenged. However, an individual’s emotions are always valid because it is how they feel about an event and that cannot be changed. Challenging a clients emotions can lead to increased distress and it will likely hurt the therapeutic relationship. You can not tell some to just feel or not feel a certain way, but you can help them shift how they see an event or the thoughts they have about it. You need to be able to identify and challenge thought patterns if you want to help produce therapeutic change in your client.

    Reply

    • Pawel Zawistowski
      Feb 25, 2021 @ 22:32:02

      Carly,
      I like your idea to ask Mark about which activities brought Mark the greatest amount of achievement and pleasure and which brought the least. I also believe it would benefit Mark to get an understanding on how he perceives his daily activities and be able to point out what gives him the greatest sense of pleasure and accomplishment. Also, I think he struggles with some core beliefs and has a tendency to not give himself enough credit, as we saw with his situation at work. I believe he deserves to feel a greater sense of accomplishment for his dedication at work, even if he ends up staying longer for his shift. However, it would be important to figure out what is going on there because if he constantly does not feel satisfied with the job he’s done perhaps it would benefit for him to explore other career options or what his plans for the future are there.

      Reply

    • Christina DeMalia
      Feb 26, 2021 @ 10:37:12

      Hi Carly,

      I definitely agree with your evaluation of Mark’s core beliefs and automatic thoughts. Although there are a few apparent ones, unlikability seems to be the one Mark believes deeply and effects him most often. I am really curious to learn more about Mark and start to figure out where those beliefs come from and how much validity some of his automatic thoughts might have. Of course Mark is not an unlikable person as the core belief would suggest. However, there is a good chance that something caused that belief in Mark over time. I would be interested to know more about what his childhood was like, past romantic relationships, and friendships over time. If Mark has had a string of people in his life not appreciating him or treating him well, it could be understandable why he translates that to his relationships now.

      Reply

  13. Pawel Zawistowski
    Feb 25, 2021 @ 13:19:41

    Behavioral Activation
    1.
    In order to get further information in regard to Mark’s daily activity schedule to assist with his negative automatic thoughts and maladaptive behaviors I would ask about his general thoughts in response to the overall schedule. I think that he did a pretty good job describing which activities were initiated and completed and not completed. I would now want to know his overall general thoughts in regards to how he feels about monitoring his schedule, if it helps him stay on tasks and process each day. Additionally, I would like to know his thoughts for the items he may have graded poorly and apply cognitive restructuring techniques for things such as being stressed out with work and arranging his date with Melissa. I would also like him to have him establish goals on how he will spend more time with his friends and his dog, and follow up with me next week with his daily activity schedule.
    2.
    I think some automatic thoughts and core beliefs that warrant attention are the way he described the situation about planning his dinner date with Melissa. I believe that if you get that stressed out about making dinner plans then more challenging life stressors may seriously overwhelm Mark. It would beneficial to breakdown some of those negative automatic thoughts and come up with strategies to make dinner plans in a more effective way such as having the details worked out in advance and it may be helpful to keep a list of restaurants which Melissa likes to frequently visit to make it a bit simpler for him. I also think that Mark demonstrated very good organizational skills and competence with the instance going at work. It would be beneficial to highlight how he was able to overcome an extremely stressful situation and make best of a bad situation.

    Automatic Thoughts
    1.
    Some possible reasons for why it is difficult for clients to differentiate thoughts from emotions is because many people associate the physical sensation of emotion and thoughts as a single experience and it is not until we begin to analyze this experience that we are able to differentiate between thoughts and emotions. Additionally, thoughts and emotions have a bidirectional influence on one another. Our thoughts can control the way we feel about a particular event, and likewise our emotions can also trigger our thoughts. Highly emotionally stressful situations can be overwhelming and difficult to understand, it is very easy to get wrapped up in an intensely emotional situation and think irrationally. Such illogical reasoning can also make it difficult to differentiate between thoughts and emotions. It is important to understand thoughts and emotions as separate experiences in order to get a better understanding of ourselves and how we can cope with emotionally intense situations, as well as use cognitive techniques to avoid negative automatic thoughts and maladaptive tendencies.

    Reply

    • Christina DeMalia
      Feb 26, 2021 @ 10:44:56

      Hi Pawel,

      I think that pointing out Mark’s strengths is a really good suggestion, because it can help him to recognize some positive things about himself, rather than just the ways he has functioned maladaptively. By highlighting strengths he may feel slightly more optimistic and hopeful. I also agree that it seems to be a problem that Mark gets so stressed out just trying to make dinner plans, get there, park, etc. Although I agree that making the process more effective and simple for Mark could help, I also believe that addressing some of his underlying thinking could help as well. Mark tends to think dichotomously, believing that it has to either be a good night or a bad one, a good date or a bad one. Because of this thinking, as soon as one thing goes wrong, such as running late, Mark begins to overthink and assume the rest of the night will go poorly. He thinks “If I am taking too long to get ready we’ll leave late. If we leave late we might not be able to find parking. If it takes us too long to find parking we’ll have to wait longer to get seated..” and follows this chain of worst case scenario thinking. If Mark were to work on this dichotomous thinking it wouldn’t only improve his experiences planning and going on dates. It would also help him assess other aspects of his day more positively. When Mark is in a rush in the morning and running late, he can be frustrated with himself or think that means the whole day is going to be bad. If Mark can accept that things can start off poorly, but turn around, he’ll be able to recover from stressful moments rather than dwelling on them for the rest of the day.

      Reply

  14. Pawel Zawistowski
    Feb 25, 2021 @ 13:25:47

    Carly,
    I like your idea to ask Mark about which activities brought Mark the greatest amount of achievement and pleasure and which brought the least. I also believe it would benefit Mark to get an understanding on how he perceives his daily activities and be able to point out what gives him the greatest sense of pleasure and accomplishment. Also, I think he struggles with some core beliefs and has a tendency to not give himself enough credit, as we saw with his situation at work. I believe he deserves to feel a greater sense of accomplishment for his dedication at work, even if he ends up staying longer for his shift. However, it would be important to figure out what is going on there because if he constantly does not feel satisfied with the job he’s done perhaps it would benefit for him to explore other career options or what his plans for the future are there.

    Reply

  15. Cailee Norton
    Feb 25, 2021 @ 13:40:27

    Behavioral Activation:
    1. I think overall we can see that Mark is gaining some really good insight into how his thought patterns work, and with further instruction and help from the worksheets and homework he will be able to really challenge these thoughts he’s having. He is still being pushed to examine things in a different way, and this brings out some discomfort, but he understands this is important for him to examine and make changes to as it will improve his well-being. Some additional questions I would want to know from Mark would be:
    a. “How does it feel for you to see how things did (or did not) go as planned?”
    b. “What from this activity brought you the most pleasure? Why do you think that is?”
    c. “Where did you feel troubled the most or even stuck on?”
    d. “How do you think you could apply this to another day?”
    e. “Would you do anything differently?”
    f. “What are your thoughts going through this now?”
    g. “How are you feeling seeing this completed and accomplished?”
    h. “Do you think this would be helpful when you have a busy day or would it inhibit you?”
    i. “Tell me about how you felt before completing this activity and how you feel now that it’s completed.”
    j. “How can we improve your sense of accomplishments/pleasure?”
    k. “What is your biggest take away from an activity like this?”

    2. In this case I think his core belief of being unlikable or even in some cases unworthy of friendship really warrants some further attention. Specifically, having Mark be able to question what these thoughts are “do they even like me” or “why don’t they want to spend time with me” are core targets in terms of evaluation. He tends to have a real lack of self-worth that is often enflamed by environmental factors, seemingly most often from social interactions with friends. Mark also tends to exhibit a lot of black and white thinking, and often in life very little is that way. These two tendencies definitely play on one another and inhibit him from making real progress without the intervention of CBT techniques. Opening Mark up to the possibility that such thinking is only inhibiting him and causing him additional distress could allow for the adoption of more adaptively functioning thinking to eventually help ease some of these core beliefs into more adaptive beliefs about his self-worth.

    Automatic Thoughts

    I think that it’s very difficult for some clients to differentiate thoughts from emotions because the thoughts are so intertwined with emotions. With automatic thoughts specifically, they occur so fast and almost in the back of your mind, that maladaptively you perceive them as valid feelings you’re having. This misunderstanding if you will further exasperates feelings elicited by a stimulus, and this can be really difficult for clients to slow down this process and examine what is going on. Emotions are very strong and real experiences. Often we feel something and it can consume us (like anger, sadness, even happiness), so when we feel these things the thoughts that pushed those emotions almost don’t matter to maladaptively functioning people. It’s important for clinicians to work with clients to understand the true differences between thoughts and emotions so as they don’t cause themselves more undue stress. With table 7.3 we can use this chart to really separate out these feelings and what the thoughts that are somewhat orchestrating those feelings are really saying. If your automatic thought is something in which says “Why would anyone want to love someone like me” then you can understand the emotion of feeling unloved, unhappy, or even lonely. Separation of these feelings and thoughts helps clients to eventually witness these automatic thoughts and decide what value they have. Are they valid? Does this benefit me or fit the situation? Is there an alternate explanation? These metacognition techniques stops the process of the thoughts leading to distressing emotions. The 7.4 Table allows for the same process, but for clients to fill out what a negative thought for them could look like. This again shows the client the emotions that are really the secondary processes after the negative thoughts.

    Reply

    • Zoe DiPinto
      Feb 25, 2021 @ 14:48:07

      Hi Cailee,
      You targeted a great point that Mark is sensitive to when things do not go as planned. I noticed this as well when he talked about his behavioral activation worksheet. Dr V was encouraging that even though things did not go as planned, that doesn’t mean the day was bad. I found myself wondering if Mark or others with MDD may tend to misinterpret the homework assignment. I believe it’s extremely important for the clinician to stress that we should not only be okay with, but also expect things to not go as planned sometimes. I do not want my clients to feel as if they failed a homework assignment like this because their plans did not line up the way they planned. Instead, I’d want them to expect changes and feel empowered when the change did not result in depressive symptoms.

      Reply

    • Anne Marie
      Feb 25, 2021 @ 20:16:44

      Hi Cailee, I think your follow up questions are excellent! They are inquisitive to what he was feeling which prompts insight. They are also simultaneously positive and strength based. All of which is important in order to keep a client focused on hope of improvement. I think you also made a good point that client’s emotions are real. While their automatic thoughts may be distorted they are absolutely experiencing all the physiological symptoms that uncomfortable feelings bring. Whether or not the thinking behind the feeling is found to be faulty it does not diminish the validity of the feeling.

      Reply

  16. Anna Lindgren
    Feb 25, 2021 @ 14:01:29

    [Behavior Activation]
    1. In reviewing the daily activity schedule with Mark, in addition to the questions Dr. V asked, I would want to ask Mark what he is most proud of from the day and what he would do differently if he had a second shot at this day. This could start to get him thinking about what strengths he already is building and where he still has some work to do. I would also want to know if after doing this activity schedule for a day, he thinks that it was a realistic schedule to set for himself. There is nothing wrong with modifying a schedule to be more doable for where a client is at in their treatment. We don’t want it to be so easy that he isn’t pushing himself at all, but we also don’t want it to be too ambitious because as we’ve seen, Mark can maximize his failures and take them very personally.
    2. The automatic thoughts of personalization, minimizing/maximizing, and dichotomous thinking seem to be the most repeated for Mark, and so that is where I would focus my attention. Both in work and in his home life/friendships, Mark tends to take things very personally as a negative reflection on himself (e.g., when his friends cancel plans and when candidates decline job offers). Because this comes up frequently, I think there is an unlovability core belief that may be at play here. He also tends to maximize and ruminate on his failures or shortcomings and minimize his successes. In this video, for example, he says he feels silly for being proud of himself for waking up 30 minutes early, even though it is a pattern of behavior that he has been struggling with. Finally, it appears that Mark struggles with dichotomous thinking, or thinks that if things don’t go perfectly, then they are a complete failure. A lot of this dichotomous thinking ends up with him thinking poorly of himself and his own performance. One example of Mark’s dichotomous thinking was the strong feeling of anger he felt toward himself for not making the exact kind of breakfast he originally wanted and not having the amount of time he had originally planned for. Reflecting back on it, he was able to see that there was a moderate amount of success in his morning that day and he no longer felt angry. However, at the moment, this automatic thought made him feel very strongly that he was not doing as well as he wanted to.
    [Automatic Thoughts]
    Automatic thoughts are often in shorthand and are so quick and routine that clients may not notice them, but instead notice the string emotion that they felt as a result of the thought. This is why most of the time it is easier for clients to identify the emotion they were feeling, and then work backward to identify the thought by asking them what was going through their mind at the time. It’s important to know the difference because counselors should validate the emotions their client is having, but the negative automatic thoughts are often not valid, and the counselor can work with the client to identify, challenge, and modify those thoughts. This way, the client can slowly over time train themselves to notice these automatic thoughts and modify their response to them, lessening the strong negative emotions that they can induce.

    Reply

    • Zoe DiPinto
      Feb 25, 2021 @ 14:35:46

      Hi Anna,
      You make a great point about a therapist’s duty to validate emotions as they arise. Sometimes thoughts will fuel maladaptive emotions. The negative emotion is usually completely reasonable in response to the thought. As you said, this opens a gateway to target thoughts instead. This makes me wonder about the natural occurrence of emotions. If emotional responses often happen organically and should be validated, do you think this means that emotional responses are often innate? Or are emotional responses learned? Perhaps reactive thoughts are learned, but the emotional responses to these thoughts are not. I often think of psychology as reconstructing things that we have learned. However, emotional responses alone do not seem to fit into this category, which I find surprising.

      Reply

    • Zoe DiPinto
      Feb 25, 2021 @ 14:37:10

      Hi Anna,
      You make a great point about a therapist’s duty to validate emotions as they arise. Sometimes thoughts will fuel maladaptive emotions. The negative emotion is usually completely reasonable in response to the thought. As you said, this opens a gateway to target thoughts instead. This makes me wonder about the natural occurrence of emotions. If emotional responses often happen organically and should be validated, do you think this means that emotional responses are often innate? Or are emotional responses learned? Perhaps reactive thoughts are learned, but the emotional responses to these thoughts are not. I often think of psychology as reconstructing things that we have learned. However, emotional responses alone do not seem to fit into this category, which I find surprising.

      Reply

  17. Zoe DiPinto
    Feb 25, 2021 @ 14:29:30

    1) I believe the exploration of Mark’s activity sheet was beneficial in pointing out a few patterns. One of which was Mark’s tendency to withdraw which we talked about in class. Specifically, after his friends cancelled the dinner plans, Mark reported a “mini-withdrawal” from helping cook the food and feeling engaged with his wife. I would want to ask questions to target the specific automatic thoughts he was having as a result of his friends cancelling dinner, and how he perceived those thoughts having an affect on his behavior. Examples:
    Can you tell me what thoughts were going through your head when your friends called?
    What about after you hung up the phone?
    How do you think these thoughts influenced your emotions?
    How do you think those feelings affected what you did next?
    How do you think Melissa interpreted your behavior?
    What were some things that you thought about that helped save the night from complete sadness?
    Finding patterns of what makes Mark’s behavior maladaptive is important, but I’d also want to explore the positive thoughts that he had that prevented complete withdrawal. In the video, we see Dr V address that the night was still “saved” after the friends cancelled. This is a direct reflection of Mark’s ability to cope. Coping behaviors should be well-understood and reinforced. We see Dr V pay attention to coping/ positive change when they discuss Mark’s ability to wake up half an hour earlier than normal. They talk about the effectiveness of the loud alarm. I’d like to know more about the thoughts Mark had when he heard the alarm, got out of bed, and started making breakfast.
    2) There were a few core beliefs and automatic thoughts that were recurring throughout this session. Mark has a tendency to beat himself up for not being better which perpetuates depressive symptoms and decreases motivation. These feelings of internal disappointment and anger seem to be fueled by Mark not completing tasks as planned. Similarly, he has internal attribution for work-related failures. He says at one point that he takes it personally when his professional work does not go well. I believe this warrants more attention. Finally, Mark has a tendency of negatively “filling in the holes” when things are unknown. The assumption that people are against him should be further explored.

    It is difficult for some clients to differentiate between thoughts and emotions because they are both internal processes that are happening quickly. An easy way to differentiate between them examines the length of the phrase that runs through the mind. Sentences are often thoughts while words and short phrases may be feelings. It is important to know the difference because one may be consistently affecting another. A thought has power to place blame, create a sense of danger, or other maladaptive powers that inspire upsetting emotions that trigger maladaptive behavior. The cognitive model is dependent on the differentiation of thoughts and emotions.

    Reply

    • Elizabeth Baker
      Feb 27, 2021 @ 21:54:34

      Hello Zoe!
      I like how you not only identified Mark’s maladaptive behaviors, but also posed questions to identify his adaptive patterns. By that I mean your questions that helped to identify ways in which he prevented complete withdrawal. This not only helps the therapist identify his strengths, but it helps Mark recognize his own adaptive behaviors as well. This will act as a reminder to continue improving and using these adaptive behaviors when Mark finds himself withdrawing from unexpected/unwanted encounters.
      Also, I thought your explanation of why it is difficult to differentiate thoughts and emotions was very interesting! You describe thoughts are these massive catastrophic cognitions, and that really emphasizes their significant influence on one’s behaviors when encountering distressing situations. Great job with this explanation!

      Reply

    • Nicole Giannetto
      Mar 11, 2021 @ 18:26:32

      Hi Zoe! I loved that you focused on positive patterns of thinking that you observed Mark utilizing during the session. CBT is strengths based, and so I think you did really well by acknowledging that even those who are struggling in areas do still possess strengths. By identifying and focusing on these strengths of a client, the clinician can obtain more insight into how to guide the sessions by integrating the positive into modifying the negatives.

      Reply

  18. Brianna Walls
    Feb 25, 2021 @ 15:00:41

    1. How many activities or what activities did you plan out that you followed through with?
    -How did this make you feel?
    What activities did you plan that you didn’t follow through with?
    -How did this make you feel?
    Did you enjoy completing this activity? Why or why not?
    -How could you improve this activity if you didn’t enjoy it?
    When filling out this activity what were your feelings?
    Were you surprised by your expected pleasure vs. your actual pleasure completing a specific activity?
    -Which activities most surprised you?
    Do you think you benefited from this activity? Why or why not?
    2. Mark has a handful of negative automatic thoughts and core beliefs that warrant further attention. For instance, Mark jumps to conclusions a lot and shows some personalization. He does this by automatically thinking that his friends canceled dinner plans with him because they don’t like him and they don’t want to be friends with him. Instead, he doesn’t take the time to think and realize that things come up and things don’t always go as planned. He internalizes it and makes assumptions; his mind fills in blanks in order to come to his own conclusions unless he is given a concrete excuse as to why his friends couldn’t make it to dinner. Further, Mark successfully woke up a little bit earlier but he beats himself up for not being able to finish his breakfast at home, he ends up eating it on his ride into work. He says things like “maybe if I just got dressed quicker I would have had more time to eat.” Mark doesn’t give himself the credit for accomplishing waking up a little bit earlier and not rushing as much and being able to have a good breakfast. Another automatic thought that warrants further attention is when Mark says “is it me or is it the company.” Mark believes that he isn’t doing a good enough job recruiting people to work for the company he works for, he believes people aren’t excepting the job because it is something that he isn’t doing right. He’s feeling overwhelmed and also is experiencing a little bit of personalization here as well.
    3. It may be difficult for a client to differentiate thought from emotion for a number of reasons. One reason I believe this to be true is that when a client is asked to think back to a specific moment they typically think of how they felt in the moment, not what they were thinking (at least I do). Further, I believe it is easier to remember how you felt in the moment vs. what you were thinking at that moment. Using Mark as an example, when Dr. V asked him about the time his friends canceled dinner plans he said he felt hurt, he didn’t say “I thought they didn’t want to be my friend” he only started to explain this when Dr. V and he dug deeper into the situation. Therefore, I believe it is hard for one to remember what they were thinking in a specific moment without discussing it or digging deeper into the moment. It is an automatic thought that triggers one’s emotions.
    I think it is important to understand this difference between emotions and thoughts because emotions alone can’t be changed, but a negative thought can. For instance, if Mark can recognize his thought “they don’t want to be friends with me,” he can follow the next steps in assessing these thoughts. Mark can decide if his thoughts are valid by

    Reply

    • Connor Belland
      Feb 27, 2021 @ 17:47:45

      Hi Brianna, I really like your idea of asking him what activities surprised Mark the most. This way we can see what happens and how he copes with a situation when it was unexpected. It would be interesting to see which activities cause bigger reactions when they are unexpected versus planned. Mark seems to want more time in the morning so it might be helpful for him to plan out more like getting his clothes and food ready the night before.

      Reply

  19. Tim Cody
    Feb 25, 2021 @ 16:04:42

    (1) What additional questions would you ask Mark about his Daily Activity Schedule to assist you in moving forward with additional Daily Activity Schedules and future techniques with his negative automatic thoughts and maladaptive behaviors (see Table 6.5). In other words, what additional information do you want to know?
    • Why do you think you weren’t able to fall asleep the night before you wanted to wake up?
    • How much sleep would you like to get at night?
    • How did you feel when a planned activity did not coincide with the actual activity?

    (2) When asked about his recruitment for his job, Mark immediately responded with, “Am I doing a good enough job?” I would have liked to dig deeper into this automatic thought to determine if this question comes to mind whenever he is accomplishing other tasks besides work. I would even like to determine if he finds that he is not “good enough” when he is unable to complete a task either due to cancellation or if he is experiencing withdrawals.

    (3) Often emotions are associated with automatic thoughts. When an event has occurred, it elicits a thought and emotion which in turn influences our behavior. Since these three factors (Thoughts, Emotions, and Behaviors) are interlocked and connected, they may be confused for each other, particularly because thoughts and emotions are internal aspects of our personal factors. It is important to differentiate the thoughts from those emotions, or maybe even categorize what thoughts are associated with a certain emotion because it helps paint a picture of what comes to mind for a client when they express emotions such as a sadness, happiness, or anger.

    Reply

    • Anne Marie Lemieux
      Feb 25, 2021 @ 20:04:59

      Thanks for your comments Tim. I think your comment about him being good enough struck me as it may be tied in with a core belief about worthlessness. I also thought that asking more introspective questions about emotions is the next step to digging deeper into his thought process.

      Reply

  20. Anne Marie
    Feb 25, 2021 @ 19:59:00

    Mark did a great job completing the daily activity log and assessing the pleasure that he obtained from activities. I would want to follow up about the following:
    What could you have said to yourself instead of “Do they even want to be friends?”.
    It appears that a lot of times that things didn’t go as expected, what did you do to manage that, that seemed effective, if anything?
    How do you think getting up earlier and making a great breakfast improved other behaviors?
    What were you most proud about this week? What did your self talk sound like then?
    What are some other scenarios that could have been happening (when assuming that he got dismissed).
    I would want to challenge a lot of Mark’s negative assumptions or his tendency to jump to conclusions. This is especially true when he feels like no one likes him. He may have a core belief of being unlovable. I’m not sure how to go about it yet but I would want to investigate how much power he gives others over his thoughts/feelings. I wonder if he recognizes how much control he potentially has to shift his thinking around others. The pattern of people not wanting to spend time with him appears to be a theme and may have some validity depending on his interpersonal skills. However, given his tendency to self criticize I am not sure that he can accurately assess his own skill level at this time. Mark also referred to himself as a perfectionist at one point. I was curious about what his definition of perfectionist meant and would want to explore that further.

    I think it is so difficult for client’s to distinguish thoughts from emotions because most automatic thoughts happen so quickly, it is difficult to be cognisant of them. Also, negative automatic thoughts are emotionally charged and they are assumed to be true. Plus, most people have often repeated a pattern of negative automatic thoughts for so long that it almost feels genuine or natural. In addition, people are never really taught to question the thoughts behind their feelings. It is important for people to recognize the difference so that they can validate their emotions while challenging the thoughts. They need to be able to investigate the accuracy of their thinking so that they can recognize when it is distorted and shift it as necessary. They may also determine that their thinking is accurate and need to learn techniques to cope adaptively.

    Reply

    • Cassandra Miller
      Feb 27, 2021 @ 09:56:25

      Hi Anne Marie,

      I would have to agree with you about thoughts coming on so quickly, especially your idea of negative automatic thoughts having this extra “charge”. It can be so easy to become swept up with emotion, that to think logically may seem impossible at times. In addition, this repetition of negative automatic thoughts can make the associating emotions even more cumbersome, as they seem to support the validity of the thought. As a result, I would have to agree with you that changing the thought becomes vital to the overall therapeutic process.

      Reply

    • Tim Cody
      Feb 28, 2021 @ 00:18:41

      Hi Anne Marie,
      I like the questions you asked. They definitely suggested much to Mark’s depressive symptoms and automatic thoughts he faces regularly. I think following up with what he does when things with his friends do not go as planned is important for improving his withdrawal period. Even by asking these questions you are able to measure Mark’s core beliefs in a more realistic sense. perhaps he may come to realize that his beliefs of having no friends are not true if he is able to take his mind off these automatic thoughts and focus on other tasks.

      Reply

  21. Nicole Giannetto
    Feb 26, 2021 @ 00:08:43

    1)
    One question I would ask Mark is, “What are some other ways you could take care of yourself when planned activities don’t go as anticipated?” I think this question would offer Mark an opportunity to consider activities he enjoys that he may have not mentioned yet in therapy. Additionally, it would give Mark some practice with brainstorming alternative activities that he could rely on if plans don’t go how he expected them to. By coming up with alternatives, Mark will hopefully be able to steer clear from his negative automatic thoughts when an event, initially marked as highly pleasurable, turns out to be less pleasurable or even unenjoyable all together. Identifying and utilizing alternative activities when a planned event goes poorly, or to use on their own, may improve resiliency and planning skills for Mark.

    Along the same line, I would also ask Mark, “How can you take care of yourself outside of work?” Mark mentions that work, especially the recruitment process aspect of his job, causes a particularly large amount of stress for him, and he identifies automatic thoughts relating to this activity as consisting of feelings of dread and a sickly feeling, also stating, “I don’t want to do this.” Since the recruiting process is an important and required aspect of Mark’s job, I think that starting outwards by identifying and practicing self-care and positive coping skills to use outside of work, could eventually be used by Mark during work to ease his stress. Once Mark can identify self-care activities, I would ask, “What might that look like?”. From there, Mark could work on implementing these self-care activities into his schedule. This addition could help to relieve stress, and also can serve as alternatives that Mark could implement if a planned event ,that is unrelated to work, does not go as expected in a negative way.

    (2)

    Key automatic thoughts Mark had expressed after his friends called to cancel their dinner plans last minute were, “Do they even want to be friends with me?” “Do they value me?”. Mark had originally rated this dinner with his girlfriend and the other couple as being highly pleasurable. Mark had gone out of his comfort zone to invite the friends, and had already started cooking dinner when they called to cancel. Feeling unlikeable is a core belief that Mark holds about himself. When events don’t go well or are less pleasurable than expected, Mark tends to jump to conclusions and engages in personalization, by internalizing the event. In this situation with his friends, Mark filled in the “holes” of his friends’ ambiguous reasoning for their cancelation by relying on negative automatic thoughts which created the worst case scenario explanation.
    One to respond to Mark in this example would be to challenge this type of thinking Mark used to offer an explanation for dinner plans cancellation. Asking, “Would they have said yes if they didn’t like you or Melissa?”, encourages Mark to consider his encounters with his friends at other times and essentially mentally rate how pleasurable those experiences were for him. Challenges can be helpful to bring the client back to reality in a sense as they gain self-awareness of their thinking.

    Reply

    • Connor Belland
      Feb 27, 2021 @ 18:26:05

      Hi Nicole, I really like what you said about how much of Mark’s stress comes from work, it might be important for him to develop some coping skills for that as well as figure out what the best way to relax and unwind from all that stress once he gets home. Having him identify and describe some self care activities would be good for relieving some of his stress.

      Reply

  22. Connor Belland
    Feb 26, 2021 @ 14:02:30

    When trying to get more information on Mark to figure out how to work on his negative automatic thoughts, I would really want to ask more about the specifics of his thoughts and emotions in different situations.
    “What do you do in the moment to cope with a bad situation?”
    “what’s the first thing that you thought you should do when your friend called to cancel?”
    “What thoughts are going through your head when something doesn’t go as planned?”
    “What activities bring you the most pleasure and why?”
    “What thoughts are you having when you planned to do somethings and you actually did it as planned?”
    Mark definitely likes to ruminate about things that don’t go as he wanted in life or “fill in the gaps”. When he gets any form of rejection, like when his friend cancelled on him for dinner, he immediately thinks that he is unwanted and worthless and withdraws frim his responsibilities as a way to cope. I would definitely want to challenge this more in Mark because he seems to personalize a lot of events and jump to conclusions when people don’t want to do stuff with him. Explain that there is no way you could know what the other person has going on in their life and filling in the holes like Dr V said can give you infinite possibilities the more Mark ruminates about something.
    Automatic Thoughts: It can be difficult for many clients to differentiate between thoughts and emotions. Thoughts are quick an happen immediately and usually cause the later emotions to occur and usually the emotions felt in a situation are more impactful on the person and they remember more how an event made them feel instead of what they were thinking after it. Mark is definitely remembering how situations make him feel but has trouble separating that from what he was thinking when it happened. It might be important to focus on these with Mark so we can emphasize those negative automatic thoughts he has when he is feeling rejection and try to change them because that seems to be one of his biggest presenting problems right now.

    Reply

    • Cassandra Miller
      Feb 27, 2021 @ 10:00:38

      Hi Connor,

      I really like how you mentioned Mark “filling in the gaps” during the video. It does seem as though the problem stems less from the provoking event and more from his rumination about why afterwards. If he is not given a clear-cut answer, he would rather think worst case scenario and self-reflect about it being his own characteristics that is the reason for the occurrence of the negative situation. I like how you mentioned his withdrawal as being a coping mechanism because he really does seem to rely on this to protect himself from further events that he has the potential to perceive as negative.

      Reply

    • Tim Cody
      Feb 28, 2021 @ 00:32:01

      Hi Connor,
      The questions you raise offer Mark a chance to cope with his harsh situations and combat his mental health. I think these are great questions to raise as they hone in on his depressive symptoms specifically, and even allow him to ruminate on his strengths as well. One question you asked was “What activities bring you the most pleasure and why?” and I think this is important for him to think about. When he experiencing withdrawal, he can look toward these pleasurable experiences and activities and focus on raising his morale.

      Reply

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Adam M. Volungis, PhD, LMHC

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