Topic 5: The Practice of CBT – Automatic Thoughts {by 3/1}

There are multiple readings due over the past two week (J. Beck – 4 Chapters; Wright et al. – 1 Chapter).  For this discussion, share at least two main thoughts: (1) Highlight some (not all) of the key components/strategies used to elicit and modify automatic thoughts. (2) What are some potential challenges you may encounter as a therapist when attempting to modify a client’s automatic thought? Your original post should be posted by the beginning of class 3/1. Have your two replies posted no later than 3/3.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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18 Comments (+add yours?)

  1. Tori Bryant
    Feb 27, 2018 @ 23:18:53

    1) Clients can have a difficulty deciphering their automatic thoughts because they are often more preoccupied with the emotional aftermath the automatic thought creates. In order for clients to understand that they have automatic thoughts, therapists may ask them, “What was going through your mind?” If a client struggles in answering this question, there are several strategies a therapist can use to help his or her client gain insight.
    Visualizing the distressing situation may be helpful to clients who are struggling to understand their automatic thoughts. The client will imagine that he or she is back in the distressing situation as if he or she was there presently. It is important for the client to speak and explain the situation as if it is occurring in the present so that the scene can feel emotionally real and relatively intense; without this intensity the automatic thought may not be detected or completely accurate. This is helpful because they are reflecting on what was going on cognitively before they emotionally reacted to the distressing situation so that they can gain insight into the automatic thought that was triggered.
    A successful and popular strategy used to modify automatic thoughts is Socratic questioning. When asking clients questions in this particular way, a therapist’s goal is to improve understanding of important cognitions and behaviors, promote the client’s active participation and engagement in therapy, enhance collaborative empiricism, and stimulate a sense of inquiry within the client. Socratic questions should break thought maladaptive and inflexible thought patterns, help clients see how adapting their cognitions can increase their ability to cope and reduce painful emotions, increase their curiosity about possible perspectives they could adopt, and think for themselves.

    2) There are many challenges therapists could face when attempting to modify their clients’ automatic thoughts. A major challenge could be difficulty in distinguishing automatic thoughts from emotions; thinking and feeling are connected but it is important clients understand the difference between the two to make long-lasting, adaptive changes. As a client and therapist, modifications to automatic thoughts cannot be made until they are properly understood as they actually are by both parties in the therapeutic relationship. Automatic thoughts should not be in the form of questions, as embedded expressions, or as interpretations; otherwise, changes cannot be made to the thought.
    Automatic thoughts often times have some validity to them and that can make it difficult for clients to see these thoughts as maladaptive, which makes it more challenging to convince them that the thoughts need modification. Essentially, in order to modify a client’s thoughts awareness of what the thoughts are, what context/situations they happen in, and distinguishing the thoughts from emotions is crucial. When a client is unable to do the former things listed, it will be incredibly difficult to even comprehend the concept of modifying automatic thoughts.

    Reply

    • Lexie Ford-Clottey
      Mar 03, 2018 @ 13:36:33

      Hey Tori,
      In describing effective ways to elicit automatic thoughts I like how you pointed out the relevance of visualizing the distressing situation. I agree that having individuals place themselves back in that moment of an event can provide a great opportunity to better understand what was going through their mind. Reflection allows for the individual to assess what they may have been thinking cognitively which facilitates the types of automatic thoughts experienced. I also think it was important to highlight how Socratic questioning aids in active participation and collaboration. When done correctly, these types of questions help clients get involved by working with therapists towards their own change. When clients are involved in this process it allows for elaboration and insight. Lastly, I like how you mention that in some cases automatic thoughts can be valid, often making it hard for therapists to modify such thinking. I think in these instances psychoeducation is crucial, in which clients should be given the knowledge and resources needed to better understand their automatic thoughts.

      Reply

    • Allexys Burbo
      Mar 03, 2018 @ 19:48:05

      Hey Tori,

      You offer a great perspective in acknowledging that clients may very well overlook their automatic thinking because they have become more preoccupied with the emotions that follow their emergence. In order for a client to change any maladaptive behavior, it is important that they first become aware of its existence. Automatic thoughts fall within this same realm; if a client is to change their reoccurring, intrusive, and negative thought process, they must first recognize its presence. It is the clinician’s job to initiate the process of identifying this automatic thinking. Change, in this instance, can only occur if the clinician is able to aid his/her client in both identifying and evaluating automatic thoughts and their function. With the strategies you have described, in combination with psychoeducation, clinicians are able to help clients challenge their automatic thinking with the goal of movement towards positive change.

      Reply

  2. Teresa DiTommaso
    Feb 28, 2018 @ 17:19:00

    1. According to Beck and Wright, there are many different strategies that a clinician can use in order to elicit and modify automatic thoughts. Before modification can begin, the therapist must first identify the automatic thoughts and make the client aware of the maladaptive thoughts as well. One strategy that can be used to elicit automatic thoughts is to recognize when the client has had a dramatic mood shift or intense emotional response. These times usually indicate that an automatic thought has just occurred. The therapist needs to be able to step in at this time and ask the client, “What was going on in your mind?.” One other important tool used to elicit and identify automatic thoughts is through guided discovery. This involves targeting a specific situation, question the client in order to engage those strong emotional responses, focus on the current situation, and to ask questions that formulate a deeper and clearer understanding of the situation that is causing such emotional distress.
    Once automatic thoughts have been identified, then modification can occur. It is important to note that modification of automatic thoughts is never met first with a direct challenge. This is because the therapist does not know how much of the automatic thought is true, does not want to make the client feel invalidated, and it would violate collaborative empiricism (Beck, 2011). Main modification of automatic thoughts is through Socratic questioning. Socratic questioning does many different things to elicit modification. Through this type of questioning, clinicians should ask questions that reveal opportunities for change, ask questions that get results, ask questions that get patients involved, avoid leading questions, and always ask such questions so that they will be beneficial to the client (Wright, 2006).
    2. Conceptualization and modification of an automatic thoughts is difficult to do and obstacles are common. One of the more common obstacles if an evaluation of an automatic thought was ineffective is if there are more central automatic thoughts, rather than the one that was evaluated, that have not been identified and perhaps overshadow the progress made in modifying a lesser automatic thoughts (Beck, 2011). Additionally, the evaluation of the automatic thought may have been insufficient or implausible. A third obstacle is that the automatic thought being evaluated is also a core belief. If this is the case, different approaches need to be taken in order to modify the thought that is also a belief.

    Reply

    • Sarah Mombourquette
      Mar 02, 2018 @ 13:57:39

      Hi Teresa, I like that you emphasized the importance of mood shifts in relation to automatic thoughts. Emotions, particularly emotions that occur quickly as in a mood shift, can be directly related to automatic thoughts or even be caused directly by the automatic thoughts. Going further, guided discovery allows the clinician to engage the emotions in order to understand why the emotions caused by the automatic thought are so salient. I also like that you mentioned how important it is for a clinician to approach the automatic thought somewhat tentatively rather than a direct challenge. By asking questions about the automatic thought, the clinician can gain a better understanding of it before challenging or modifying it. Lastly, your point about automatic thoughts overshadowing the progress of the modification of another automatic thought is important because it indicates the importance of clinical judgment. Ultimately, the clinician will need to recognize which automatic thoughts are worth spending time by the degree to which it will help the client.

      Reply

  3. Stephanie Mourad
    Feb 28, 2018 @ 20:34:34

    (1) Highlight some (not all) of the key components/strategies used to elicit and modify automatic thoughts.
    To elicit automatic thoughts, the key components consist of guided discovery, guided imagery, role-playing, differentiating thoughts from emotions, and tracking automatic thoughts. Guided discovery is using emotions to elicit automatic thoughts. Guided imagery is using images to elicit automatic thoughts. Role-playing is recreating interactions to elicit automatic thoughts. Differentiating thoughts from emotions is using sentence/phrasing for thoughts and single words for emotions. Tracking automatic thoughts is including thoughts with emotions and events.
    Evaluating and modifying automatic thoughts is also a strategy. Before modifying, client will need to first evaluate the thoughts to see if they have practical/therapeutic relevance and appropriate for modification. Evaluation is emotion and thought assessment and modification is emotion and thought intervention. Another technique is Socratic techniques. Socratic questioning is a common term used in CBT that refers to asking clients direct questions about their negative automatic thoughts to help them “get to the truth” on their own. This technique depends on the content for each thought. Decatastrophize perceived negatives outcomes is a technique whose primary goal is to assist clients in their ability to consider more realistic outcomes.
    (2) What are some potential challenges you may encounter as a therapist when attempting to modify a client’s automatic thought?
    Some challenges include believing these thoughts to be valid and they are persistent and self-perpetuating, Contradictory evidence is overlooked, but emotions can be intense and very real. It is hard to stop and change these thoughts and it can stimulate other automatic thoughts that are part of a larger them such as core beliefs. Cognitive distortions can become a challenge because it would be difficult for the client to modify. There are different types of cognitive distortions. One type is dichotomous thinking which is when you view you self, others, events in two categories. Another one is personalization, which is the perception that other’s negative experiences or negative external events are because of you with little or no evidence, alternative explanations are not considered. Magnification/minimizing is when you view your self, others, or events by either magnifying the negative or minimizing the positive. One last type is mind reading, which is assuming what other people are thing about you with minimal to no evidence while not considering other information and possibilities. Changing someone’s automatic thoughts is challenging, especially those with negative thoughts and distortions because usually they have it set that their thought is valid and can be unchangeable.

    Reply

  4. Aleksa Golloshi
    Mar 01, 2018 @ 00:39:28

    1. Pre-surface thinking is referred to as automatic thoughts. Everyone experiences automatic thoughts but we often lack awareness of these thoughts. People don’t think of these thoughts until they become negative and start to add stress and disturb daily functioning. An important strategy that is used to elicit automatic thoughts is guided discovery. This method involves specifically using emotions to elicit automatic thoughts. The therapist may ask a question such as, “What is going through your mind in this instance?” By answering this question the client can evaluate what thoughts are wandering around in their head, which may contribute to their behaviors or feelings. Another important strategy that can be used to elicit automatic thoughts is guided imagery. Guided imagery involves using images to elicit automatic thoughts. This method involves using all the senses and really aids in connecting the client with his/her core feelings and beliefs. This is helpful to use for clients who are mainly reporting images and need help with clearly describing what is occurring when the automatic thoughts roll into their mind. Role-playing is also known to elicit automatic thoughts. When a client partakes in role-playing they recreate the interaction that created the automatic thought. The therapist and client can than work together to decide what safe and adaptive ways the client may engage in so that negative automatic thoughts do not occur.
    Modifying automatic thoughts involves using Socratic questioning. This occurs when the counselor asks the client direct questions about how they’re experiencing their negative automatic thoughts. By asking these thoughtful questions, the therapist will be able to help the client talk through their maladaptive negative automatic thoughts so that they can reach the truth about the feeling on their own. When using Socratic techniques, the therapist must first decide if there really are negative automatic thoughts that are occurring in their client. The therapist might then explore the possibility of alternative explanations, as well as assess how much of an impact the negative automatic thought has on the client’s personal beliefs. The therapist must help the client understand that they, as a person, are an individual and are separate from the negative automatic thought that they are experiencing. This method can help the client become more hopeful and motivated to get to the root of their negative automatic thoughts. If they can reach this and alter it, they will lead an adaptive life.

    2. One potential challenge a therapist might encounter when attempting to modify a client’s automatic thinking is cognitive distortions. Clients might catastrophize and think about the worst-case scenario when they have little or no evidence to think this way, while they simultaneously ignoring more realistic outcomes. Another potential challenge involved in cognitive distortions is overgeneralizing. The client could make a conclusion about a single event that they then extend to multiple events, even when the events are not related at all. The client might also lack motivation to modify their automatic thoughts, or they don’t have social supports in their life to encourage them and help them maintain these modifications. The client may also have a mental or medical disorder that stops them from engaging in modifying their automatic thinking.

    Reply

    • Stephanie Mourad
      Mar 03, 2018 @ 11:49:37

      Hi Aleksa,
      I like that clients get to evaluate their thoughts that are wandering around in their head. Therapists using strategies like asking questions can help elicit thoughts that contribute to behavior or feelings. Guided imagery is also a good strategy. This does help clients with reporting images and need help describing their thoughts clearly. Role-playing is also a good strategy. I have done this in therapy and I could say that it has worked for me when separating positive and negative automatic thoughts. Socratic questioning is also a good technique. It is also important to separate negative automatic thoughts to help client become more hopeful and motivated to get to the root of their negative thoughts.

      Reply

    • Lexie Ford-Clottey
      Mar 03, 2018 @ 12:09:07

      Hey Aleksa,
      I think it was important in your post to mention that automatic thoughts are something all individuals experience, indicating such thoughts are not solely displayed in people who may suffer from mental illness. Since automatic thoughts often go unnoticed and seem to only be recognized when they appear to cause significant distress, people assume that these thoughts are the root of abnormality. Through psychoeducation, clients are provided the opportunity to learn more about their automatic thoughts and how they may impact their lives in both positive and negative ways. As a way to elicit automatic thoughts I like how you pointed out the benefits of the client and therapist interacting in a role-play. By acting out a particular event, the therapist and client can work together in recreating the moment that ultimately answers “What was going through your mind,” indicating that context matters. Lastly, I agree that helping a client separate themselves from their thoughts is important, in which these thoughts do not define them and that they can be changed or altered.

      Reply

    • Allexys Burbo
      Mar 03, 2018 @ 21:07:30

      Hey Aleksa,

      Describing the challenges that may arise as a result of cognitive distortions is an important element to consider. Cognitive distortions, specific patterns of automatic thinking, are often so dysfunctional that they overpower the client’s rational thought process. Both catastrophic and overgeneralized thinking present a challenge for the clinician whose ultimate goal is to encourage the client that this way of thinking is indeed harmful and disruptive. The client who is particularly unmotivated to change might additionally make the process difficult. Given the assumption that an individual’s pattern of thinking (i.e., catastrophizing) is integral to their very identity, a client might regard challenging automatic thoughts as an unnecessary and unfavorable step. A lack of motivation on the client’s part makes the collaborative process difficult. In this instance, although the individual may have the supports necessary for change to occur, lack of determination will inhibit the intention.

      Reply

  5. Lexie Ford-Clottey
    Mar 01, 2018 @ 07:09:20

    1. With CBT primarily based on helping clients modify maladaptive patterns of thinking, clinicians often utilize many different strategies to elicit and reframe the automatic thoughts of individuals. In order to engage in effective change, clinicians help clients understand the source of their maladaptive thoughts by facilitating awareness through the identification of automatic thoughts. One strategy that can be used to elicit automatic thoughts is recognizing mood shifts. While in session, it is quite common for a client to experience a burst of automatic thoughts, often resulting in noticeable mood shifts or intense emotional responses. When such things occur, clinicians should take advantage of this in the moment feeling/thinking by directly asking the client “What was going through your mind?” Recognizing mood shifts offer rich opportunities for clinicians to draw out some of the client’s most important automatic thoughts and schemas. Following the identification of a mood shift, another effective technique is the importance of psychoeducation. Through psychoeducation clients are provided with the knowledge, resources, and tools to understanding and modifying presenting problems/issues. The more informed a client is about his/her automatic thoughts the more skilled they become at identifying, monitoring, and tracking these thoughts. When clients understand the concept of automatic thoughts they are able to apply meaning to what they have experienced. One of the most frequently used tools for identifying automatic thoughts is guided discovery. Through guided discovery clinicians question clients on specific situations, focus on relevant events, and dig deeper in order to channel the perceived emotional distress. When engaging in guided discovery, clinicians should focus on open-ended questions in order to facilitate elaboration and gain more detail.
    Once clients have become conscious of their automatic thoughts the clinician can focus on ways to modify such patterns of thinking. The main way to modify automatic thoughts is through Socratic questioning. Socratic questioning, often considered the cornerstone to changing dysfunctional thinking, involves asking clients direct questions regarding their negative automatic thoughts. This form of questioning allows clinicians to focus on questions that reveal opportunities for change, get results, and aid in active participation. When done effectively, Socratic questioning is shown to enhance the therapeutic relationship while also improving a client’s level of understanding concerning his/her automatic thoughts. Another way to modify automatic thoughts is by generating rational alternatives. This strategy is helpful in fostering options among clients, in which stepping outside their current framework of thinking is emphasized. The goal here is to help clients open their minds to other possibilities by considering viewpoints that are more rational and adaptive. In order to assist clients in coming up with ideas brainstorming is often used.

    2. When attempting to modify the automatic thoughts of clients, it is not uncommon for clinicians to face obstacles. One potential challenge for clinicians involves automatic thoughts that happen to be attached to core beliefs. Since core beliefs are often characterized as beliefs that people may hold about the self, others, and the world, they appear harder to break away from. With much of these beliefs developing at an early age, clients may become resistant or unwilling to adopt new ways if this all they have known. In these situations, clinicians need to use many techniques over time in order to alter this belief. Another potential obstacle involves clients understanding intellectually that the automatic thought is distorted, but may not believe it on an emotional level. When clients experience discrepancies between distinguishing their thoughts from their feelings it becomes increasingly hard to modify behaviors effectively. When automatic thoughts contain some validity to them, they may not be viewed as maladaptive according to the client, indicating no real reason to explore that thought.

    Reply

    • Stephanie Mourad
      Mar 03, 2018 @ 11:35:02

      Hi Lexie,
      I like that you said that a potential challenge for automatic thoughts could be that the client is attached to core beliefs. I is hard to break away from them because they have been ingrained in the person for most of their life. It is true that clients can be resistant from changing or modifying these core beliefs and it is a challenge for therapists. If clients have maladaptive thoughts they may have a hard time changing the thought because to them it is valid and real although that is not the case.

      Reply

  6. Abbey Lake
    Mar 01, 2018 @ 09:04:37

    1.)The readings from Beck and Write discuss the multiple components/strategies used to elicit and modify automatic thoughts. Before an individual is able to modify their automatic thoughts he/she must first become aware of these thoughts. The clinician may help the client to gain self-awareness and identify automatic thoughts that may be maladaptive. One way to elicit automatic thoughts is to focus on emotions and to pay attention to any signs of a shift in negative emotion and intensity. Although it is important for clinicians to validate emotions, it is helpful to challenge a client’s thoughts by bringing awareness to particular cognitions that may be causing the client distress. Another way to elicit automatic thoughts is to observe and respond to mood shifts. Attention to both verbal and nonverbal cues and specific attention to detail can aid in this process. One of the strategies to modify automatic thoughts, that I found to be quite interesting, is Socratic questioning. This strategy refers to helping clients to get to see the falsity in their automatic thoughts themselves rather than the clinician explicitly telling them what to think. Another strategy to modify automatic thoughts is to decatastrophize perceived negative outcomes. The purpose of this is to help clients to think about more realistic outcomes for scenarios related to their automatic thoughts, because clients often associate worst possible scenarios with their automatic thoughts.

    2.) One potential challenge that I may encounter as a therapist when attempting to modify a client’s automatic thought is helping a client to understand the difference between thoughts and emotions. This may be challenging because the client may struggle to recognize that a thought is more elaborate than an emotion. This may be easier for clients to recognize after the event, but in the moment this may be more challenging to identify. One way to overcome this challenge could be to explain the difference to clients in a way that is simplistic, such as explaining to the client that thoughts are more elaborate than emotions because emotions are the reactions to thoughts. Another potential challenge that I may encounter as a therapist when attempting to modify a client’s automatic thought is identifying relevant negative automatic thoughts. This may be challenging because the client may be experiencing a multitude of negative automatic thoughts, which may make it hard to decipher which thoughts are causing the client the most distress and should be priority for modification. Tracking automatic thoughts may be a way to overcome this challenge because it will help identify which automatic thoughts are most consistent and/or distressing for the individual.

    Reply

    • Sarah Mombourquette
      Mar 02, 2018 @ 13:56:35

      Hi Abby, I like that you pointed out that as clinicians, we should be aware of both verbal and nonverbal cues when trying to identify automatic thoughts. Recognizing nonverbal cues such as body language or face affect in relation to specific subjects can be an indicator that an automatic thought has just occurred. If this happens, the clinician can take the opportunity to ask the client what he or she was thinking at the time of the nonverbal cue. I also like that you emphasized the importance of not have a clinician tell the client what to think. Rather, the clinician and the client will work together to modify the negative automatic thought. If the clinician were to be telling the client what to think, he or she would not learn how to modify the thought without the help of the clinician. Lastly, I agree that it might be difficult to help the client differentiate between thoughts and emotions. If the client has a difficult time identifying emotions, the client and clinician could work together to develop this skill.

      Reply

  7. Sarah Mombourquette
    Mar 01, 2018 @ 09:45:59

    1) There are multiple strategies that clinicians can use to elicit and identify automatic thoughts. These include recognizing mood shifts and guided discovery. Mood shifts are a good opportunity to recognize an automatic thought because the thoughts that are sparked from emotions are emotionally charged, immediate, and highly relevant to the individual. Because mood shifts are linked to emotion, some of the client’s most important automatic thoughts can be identified by observing the abrupt change in mood due to a specific event. Similarly, emotional charging has the ability to affect memory recall, making it easier for the individual to understand what automatic thoughts are in the first place. A second strategy for identifying automatic thoughts is guided discovery. As previously mentioned, automatic thoughts are often linked to emotion. Therefore, the clinician should focus on questions that will stimulate emotions. Because automatic thoughts are specific to an event, the questions that the clinician asks should also be specific. Similarly, recent events should be focused on rather than past events because it will be easier to modify a thought that the individual can still recall. A clinician should also focus on one line of questioning. Jumping around from various topics of automatic thoughts will make the process of changing the thought more difficult compared to focusing on one thought at a time. Lastly, the clinician should try to have the client expand on automatic thoughts by asking additional questions.
    The first strategy used to modify automatic thoughts is Socratic questioning. Socratic question can enhance the therapeutic relationship, engage the client in a sense of inquiry, improve how the client understands important cognitions and behaviors, and promote the client’s involvement in therapy sessions. In Socratic questions, the clinician makes sure that the topics of the questions reveal opportunities in which the individual can change. Similarly, the questions asked by the clinician are the questions that will get results. The client should also be involved in the learning process, so the clinician’s questions should also find ways to get the client involved. Questions should also revolve around what will be productive for the client based on his or her cognitive functioning, symptomatic distress, and abilities in concentrating. The client is the expert on himself or herself. Therefore, the clinician should not ask leading questions. Lastly, the questions being asked should be open-ended so that the client is not limited in how he or she can respond. A second strategy used to modify automatic thoughts is thought change records. With these records, the individual will learn to recognize automatic thoughts through the documentation of these thoughts. Similarly, the client will learn to identify cognitive errors, examine the evidence surrounding the thoughts, and create rational alternatives to the thoughts. Thought records also allow the individual to observe the positive outcomes that occur when he or she works to modify his or her thinking. Thought change records are usually assigned for homework and discussed at the following session.

    2) There are multiple challenges that can occur when a therapist is attempting to modify a client’s automatic thought. One challenge can occur if the automatic thought is true. If this occurs, it can be difficult for the clinician to help modify the automatic thought because the evidence surrounding the thought is valid. In this instance, however, the clinician should try to focus on problem solving. Similarly, the clinician can determine that the client has drawn invalid conclusions based on the automatic thought and will therefore focus on modifying the conclusion. If an automatic thought is true, the clinician could also try to help the client to come to a place of acceptance. A challenge related to this could be when clients have automatic thoughts that relate to a worse-case scenario. Once this catastrophizing idea is present to the client, it can be very difficult for the clinician to help the client to see other possible outcomes. Therefore, the clinician should work with the client to examine the evidence for why this conclusion has been reached. In examining the evidence, it is likely that the clinician and the client can work together toward decatasrophizing the event.

    Reply

    • Abbey Lake
      Mar 03, 2018 @ 10:01:12

      Hi Sarah,
      I like that you pointed out how some of a client’s most important automatic thoughts can be identified by observing the abrupt changes in mood. I think that when doing this it is important for the clinician to pay attention to both verbal and nonverbal clues. I also like your point about how it is important for the clinician to not ask leading questions, especially when using the method of Socratic questioning because the importance of this method is that the client comes to a realization without being explicitly told. Lastly, I think it is important that you mentioned catastrophizing because I feel as though this challenge may be especially hard for us as beginning clinicians, as it may initially be somewhat overwhelming. However, I agree that examining the evidence with a client is an excellent way to overcome this challenge and work together with the client to see things in a realistic manner.

      Reply

  8. Allexys Burbo
    Mar 01, 2018 @ 14:37:12

    (1) Automatic thoughts – the fast and fleeting thoughts that occur at the preconscious level of awareness – frequently go undetected and are often the source of conflict for the maladaptively functioning individual. Generally not disruptive to the everyday experience of the individual, negative automatic thoughts may result in distress and affect the daily functioning of the individual. From a cognitive-behavioral perspective, awareness of such thoughts is integral to the therapeutic process as insight offers the opportunity for change and growth to occur. Through CBT practices, the therapist attempts to bring these thoughts to the surface (conscious awareness) for the purpose of promoting positive change. Guided discovery, guided-imagery, and role-play are commonly used models utilized during the therapeutic process that aid in eliciting and identifying the type of automatic thinking that inhibits adaptive functioning. Guided discovery, which places focus on using client emotions to help elicit automatic thinking, may be an especially useful strategy for this purpose. A therapist might integrate guided discovery as a means of uncovering the types of negative thought patterns inherent to the automatic thought process by validating emotions and responding to covert shifts in mood. In this instance, emotion is regarded as central to the process and is used as leverage for identifying these thoughts. Another strategy, guided imagery, encourages the client to use images as a means of eliciting these automatic thoughts. Especially helpful for the client who primarily uses images to reflect his/her thoughts, this technique assists the individual in generating the emotions and thoughts associated with the event of interest. Role-play, another commonly used technique in CBT, is an exercise which helps the client identify automatic thinking by asking him/her to recreate specific interactions. In reenacting an instance where this type of negative thinking might present itself, the client is able to observe the maladaptive process more concretely.

    (2) Although modification of automatic thoughts is essential to the therapeutic process, it could present some challenges for the therapist. As a client’s automatic thinking is intrinsic to the individual, the very idea that such thoughts may present issues in their daily life may prove especially distressing. A client might feel so attached to their automatic thoughts – the belief that these thoughts are fundamental to their very being – that the very idea of modifying them might leave the individual feeling vulnerable and overwhelmed. Additionally, challenging automatic thoughts may evoke a negative emotional response. As a result, the client may be left feeling threatened, potentially inflicting tension and harm on the condition of therapeutic relationship. Furthermore, attempts to modify a client’s automatic thoughts could be met with resistance making change difficult. As cooperation and collaboration are regarded as especially fundamental to CBT, threats to this type of relationship may prove deleterious to the therapeutic process and, in turn, the chance for positive outcomes and long-term change harder to attain.

    Reply

    • Abbey Lake
      Mar 03, 2018 @ 10:12:44

      Hi Allexys,
      I like that you pointed out how automatic thoughts frequently go undetected and are often the source of conflict for a maladaptively functioning individual. I think that for this reason it may be very helpful for clients to separate themselves from their negative automatic thought(s). I also like that you discussed guided imagery, because I agree that this may be helpful for clients who primarily use images to reflect thoughts. I know many people who often rely on images to reflect thoughts so I feel as though as clinicians this could be a common technique to use. The point of this technique is to help the individual generate the emotions and thoughts associated with the event of interest. As we discussed in class it is important to recognize that the way to get to your client’s thoughts is through their emotions.

      Reply

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Adam M. Volungis, PhD, LMHC

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