Topic 5b: Behavioral Activation & Automatic Thoughts {by 10/1}

[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 10/1.  Have your two replies posted no later than 10/3.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

30 Comments (+add yours?)

  1. Allie Supernor
    Sep 26, 2020 @ 11:24:29

    Part One- MDD-8:
    Mark did a really great job completing his first Daily Activity Schedule! He discussed some of his strengths and pitfalls with Dr. V in session. Some additional questions I would like to explore would be: What activities that he planned for himself were not initiated/completed? Were there negative predictions that were disproven?
    Secondly, the automatic thoughts that warrant further attention moving forward are Mark’s thoughts of not worthy. These negative automatic thoughts first came up when he was discussing his friends. He questioned; do they even want to be friends with me? And do they value me and this friendship? Further, his thoughts of not being enough came up with his recruitment work. He personalized and internalized not hiring at work. He questioned, am I doing enough? Is this because of me? These negative automatic thoughts reflect the unlikeable/unlovable core belief! These cognitive distortions should most definitely be explored in further sessions.

    Part Two- Automatic Thoughts:
    It is not uncommon for clients to mistake emotions, like hurt or sadness, for thoughts. There are moments in therapy when clients will struggle to differentiate between thoughts and emotions, especially pertaining to an event. It is important to hold that some clients may conceptually understand the difference between thoughts and emotions when reviewing the CBT model but struggle with actual application when asked specific events. Dr. V says this confusion may be an indicator for some distress they are experiencing. I think clients can often confuse emotions for thoughts because emotions are much stronger! They may not pick up on a thought that pops in their mind, but they will feel an emotion. In CBT it is really important to know the difference between the two because it determines the outcome and treatment plan. Understanding the difference can determine whether or not you (as the therapist) need to implement more psychoeducation on the relationship between events and emotions or move forward with case formulation and cognitive techniques.

    Reply

    • Madi
      Sep 27, 2020 @ 18:06:18

      Hi Allie,
      I also thought that Mark did a great job at completing his Daily Activity Schedule. I completely agree with you that his feelings of worthlessness definitely need further exploration for I feel as though this is a common theme through out the session.
      I liked how you discussed how a client’s distress might be causing him or her to struggle to distinguish between emotions and thoughts. I didn’t think about that when I wrote my response. Very insightful!

      Reply

    • Francesca DePergola
      Sep 28, 2020 @ 16:03:37

      Hi Allie,
      I felt very similar to you with what additional information I would like to know about the daily activity schedule. I also noted the same automatic thought you did that would warrant further attention. I feel like this core belief of Mark’s stretches out to other areas of his life, not just with his friends. Considering your answer to the second part about automatic thoughts I like the little details you mentioned. For example, your comment about confusing emotions for thoughts because emotions are felt stronger. I think I can agree with that especially if events are distressing.

      Reply

  2. Madi
    Sep 27, 2020 @ 17:57:50

    1. The additional questions I would ask Mark are:
    a. I would inquire about why Mark jumped to feeling worthless when his friends bailed on him. What insecurity does this point towards for Mark? What core beliefs is this connected to?
    b. I would inquire about maybe creating a bedtime routine so that it is easier to fall asleep at night. Possibly trying melatonin.
    c. How did having a good breakfast impact his mood for the day?
    d. Does Mark think waking up early to make breaking be a daily thing he does?
    e. What other areas in his life does he self-blame?
    2. The automatic thoughts that I think warrant further attention are:
    a. Friends bailing triggered a worthlessness feeling.
    b. Perfectionism tendencies. Up pack this see where it originates and what areas in life that it impacts.
    c. Self-blaming. Self-blames for people not getting hired when he is posting the job offerings.
    d. Issues with ambiguity
    3. Some possible reason why it is difficult for some clients to differentiate thoughts from emotions is that for some people who have not sat down and thought about the differences between the two might view them as the same. Some thoughts are emotional so a person could think that they are the same. But it is crucial that a client understand the difference. Examples of emotions are sad, angry, anxious. The thought are the sentences or images that go through one’s head. The emotions can trigger a thought or the other way around.

    Reply

    • Allie Supernor
      Sep 28, 2020 @ 14:37:55

      Hey Madi, great job picking up on Mark’s perfectionism tendencies. I heard him say it when I watched the video but forgot that could be tied to CBT and Case Formulation. I also liked that you picked up on issues with ambiguity. He does interpret things by internalizing them. He takes situations or people’s emotions and personalizes them.

      Reply

    • Francesca DePergola
      Sep 28, 2020 @ 16:17:46

      Madi,
      I really liked how your questions were so specific and geared toward the deeper meanings behind his behaviors. I especially like your question about making a bedtime routine as this was a thought of mine as well. I think if he were a little more organized he would have a better time falling asleep and waking up earlier. I think it was interesting that you noted his perfectionism because now that you mention it, I can see those themes with Mark. Especially if things do not go as planned, or slightly off-plan.

      Reply

  3. Francesca DePergola
    Sep 28, 2020 @ 14:44:53

    Behavioral Activation
    (1) So, the first thing that stuck out to me during this session was Mark’s ability to recognize that the mornings were slightly better. He mentioned he did not feel as rushed, was able to go on a longer walk with his dog, and prepared breakfast. I definitely would like to know if what he was expecting was different than what had happened, positive or negative, because maybe he expected it to go worse than it did, and maybe due to that he had lower negative automatic thoughts the following morning, week, etc. I think it was impressive that Mark was able to plan the date and follow-through, it was just too bad that his friends canceled at the last minute and was such a disappointing experience for him. I think his adaptive behaviors like planning and following through should be validated and reinforced. The focus on the negative automatic thought was good because it made Mark realize that this is a core belief of his and that he is personalizing this experience.
    (2) I think Mark’s negative automatic thoughts surrounding the idea that his friends do not like him or want to be his friend. The unlikability was something that Dr. V points out is something that is more of a core belief for Mark. I think it is worth it to pay close attention to the beliefs he has about his friends because I feel if these thoughts continue to persist in Mark he might damage his relationships with his friends. I think it would also be important that he had some negative automatic thoughts about his ability to wake up. I feel like since he was able to wake up a half-hour earlier this week it shows that he is able to do it contrary to what he believed.
    Automatic Thoughts
    Some clients find it hard to differentiate thoughts from emotions as it can be a common experience. They might find it hard because they have never thought of them as being different, maybe the client is too distressed to identify which is which, they might have a limited vocabulary or intellect to understand and explain emotions and their thinking, and more. It is important for the client to know the difference between thoughts and emotions because they both affect behavior. Thoughts and emotions also affect the outcome, the treatment plan, the number of skills used in a session, and so on. Overall, differentiating the two will be helpful for the client and counselor to not only build on the relationship but also be more accurate throughout sessions.

    Reply

    • Allie Supernor
      Sep 28, 2020 @ 16:57:59

      Francesca, I enjoyed the connection you made between Mark’s morning schedule and negative automatic thoughts. You mentioned that you think he has some maladaptive thinking and that’s why he cannot wake up on time. Almost like he doesn’t deserve it? Great observation!

      Reply

    • Madi
      Sep 28, 2020 @ 18:31:02

      Hi Francesca,
      I also agreed that his reaction to his friends bailing on him triggered his automatic thoughts about worthlessness. I would also add that this worthlessness spans through many areas of his life.

      Reply

    • Alison Kahn
      Sep 30, 2020 @ 21:24:21

      Francesca,

      I like how you mentioned that Mark’s negative automatic thoughts as it relates to his friends cancelling their plans could potentially impact his friendships. I think that’s definitely something to keep in mind as a counselor because in the event that it did happen, it would only reinforce Mark’s negative automatic thoughts and core beliefs that the is unlikable. I also discussed Mark’s morning routine as something I would want to gain additional information on for the next activity schedule. He definitely shared both positives and negatives about his mornings during the week, but overall sounded like he was more satisfied than in weeks prior!

      Reply

    • Christopher LePage
      Oct 01, 2020 @ 15:03:12

      Hi Francesca,
      I liked how you asked about Mark’s mindset about how his morning was going to go. I did not even think about how his mindset potentially influenced how his routine would have went, and this can be extremely influential. If the entire night Mark had ruminating thoughts about how his morning was going to be a disaster, by seeing it go smoothly could have made him think his routine was more successful than originally expected. By noting this difference, you have a better understanding on whether or not the schedule is actually helping him.

      Reply

    • Eileen Kinnane
      Oct 02, 2020 @ 21:11:48

      Hi Francesca,

      I really like your point about Mark’s feelings of worthlessness being tied to his friends cancelling plans. It’s very interesting how this seems to be a theme for Mark that is tied to multiple relationships and aspects of his life. I also really like the observation you made about Mark’s maladaptive thoughts on him not being able to wake up on time. This was a connection I hadn’t made and it was interesting to read your thoughts on it.

      Reply

  4. Alison Kahn
    Sep 30, 2020 @ 21:19:46

    (1) To assist me in moving forward with Mark’s daily activity schedule, I would ask him for additional information regarding his morning routines and breakfast. Mark reported that he was able to make breakfast during the week, and that he felt somewhat accomplished despite not having the time to eat the breakfast at home. I would want to discuss any barriers that Mark foresees as it relates to making breakfast and sitting down to eat in the morning in order to brainstorm future activities (i.e., did you find it difficult to wake up?). In his daily activity schedule, it is noted that Mark doesn’t elaborate much on the activities he engages in while at work. That said, I would want to inquire about work activities that Mark finds pleasurable (he talks a lot during the session about the tasks he does not enjoy or that cause him discomfort) and discuss what makes them pleasurable. I would also like more information as it relates to Mark’s breaks and lunch while at work.

    (2) Throughout his sessions with Dr. V, Mark reports feeling distressed when facing ambiguity, and when things are not clear or explained thoroughly. Mark reported experiencing negative automatic thoughts such as “they must not want to be my friend” and “they must not value me” when his friends cancelled dinner plans with him. He also voiced core beliefs of worthlessness and unlikability. When discussing his activity schedule, Mark noted that although he was able to make breakfast, he was unable to eat it at home and instead had to eat it in the car on the way to work. Mark reported that he was hard on himself for this and experienced negative automatic thoughts (“I didn’t do exactly what I had planned, therefore I failed”). I believe these negative automatic thoughts and core beliefs warrant further attention because they appear throughout Mark’s sessions with Dr. V and seem to directly contribute to his withdrawn behavior.

    (3) I believe that people have difficulty differentiating thoughts from emotions because they are so closely tied together. Much like the CBT model itself, thoughts and emotions have a reciprocal relationship and are constantly informing one another. That said, it is very easy to compound thoughts and emotions, especially when one is experiencing distress. As we have learned with negative automatic thoughts, it may be difficult for an individual to even consciously recognize thoughts when they occur because they happen so quickly. Despite not being aware of them, thoughts elicit emotions, which we tend to be much keener to. In that way, the thought and the emotion become tied, and the physical and psychological experience of the emotion is much more readily available to an individual than the initial thought. The emotion then likely elicits further thoughts, and so on. Finally, some clients may struggle to differentiate thoughts and emotions simply because they have difficulty labeling their emotions.
    It is important to know the difference between thoughts and emotions because of their impact on one another. In CBT the goal is to identify and modify automatic thoughts, therefore, emotions are not necessarily the aim of treatment right away. For this reason, being able to identify thoughts and understand how they are different from emotions is key for an individual to modify the thoughts, which in turn can lead to positive emotions. Where emotions are subjective, thoughts tend to be easier to dissect in terms of their validity/invalidity, rationality/irrationality, etc.

    Reply

    • Brigitte Manseau
      Oct 03, 2020 @ 23:54:58

      Hi Alison,
      I like that you would ask Mark about potential challenges he may have relating to him eating breakfast at home. Mark did a great job troubleshooting with Dr. V during the introduction of DAS. Therefore, this would provide another great opportunity for Mark to brainstorm and increase his chances of successfully completing an activity (e.g. sitting down and eating breakfast) on his DAS. Also, I like that you wanted to know more about what Mark does during his breaks at work. Discussing what Mark does during breaks and lunch will give you insight into what pleasurable or unpleasurable activities he partakes in. That may reveal another area that should be focused on in Mark’s DAS. Increasing pleasurable activities that Mark can engage in during his breaks may help improve his mood and his mindset at work.

      Reply

  5. Alison Kahn
    Sep 30, 2020 @ 21:27:16

    Madi,

    I really like how you inquired about in what other areas of Mark’s life he experiences self-blame. I think delving into this with him would be super helpful in terms of tying together common themes and getting at a deeper underlying core belief that may have been ingrained early on in his life. Understanding this on a deeper level would likely help Mark break the pattern of negative automatic thoughts and maladaptive behaviors.

    Reply

  6. Haley Scola
    Oct 01, 2020 @ 10:27:08

    1a. I thought it seemed that Mark put a lot of effort into his first DAS and did a thorough job at filling it out. Some further questions I have for Mark would be: How he thinks we could improve his sleep schedule/bedtime routine? He seems to have the core belief he is unlikeable and so I would like to ask other instances in his life that reinforced this belief? How did he feel the rest of the morning that he had a full breakfast? Any coping skills he thinks he could’ve used instead of initially withdrawing after his friends cancelled on date night?
    1b. The first core belief that stuck out to me was that he is unlikeable or worthless. Second was his automatic thoughts surrounding his friend cancelling that “maybe George doesn’t even want to be my friend” and “Does he even value this relationship?”. Then when discussing work he had additional automatic thoughts of worth such as feeling like he isn’t doing a good enough job and he must be doing something wrong. I think these cognitive distortions need to be explored more.
    2a. Difficulty in differentiating thoughts and emotions is very common for many clients. Like Dr. V’s lecture recording said this confusion between the two may be an indicator for some distress they are experiencing. In other words, emotions tend to be felt stronger than thoughts so they ‘stand out’ more and overshadow the thoughts. Many clients haven’t sat down and focused on what they may be thinking about an experience but rather it is very common to think about how they may be feeling. The importance of differentiating between emotions and thoughts is due to the effect they both have on behavior. For example, although the thought may be valid but the emotion may not be causing a reaction that is maladaptive. Knowing the difference between the two helps the client and counselor to understand themselves, automatic thoughts, core beliefs, and in turn cognitive distortions they may have.

    Reply

    • Christopher LePage
      Oct 01, 2020 @ 14:59:39

      Hi Haley,
      I like how one of your questions asks specifically about what coping skills could he have used when his friends had canceled on him. I think this is an excellent opportunity to show Mark what he can do in these scenarios, and he will have a better chance of reacting properly if he has a better understanding of the situation. I also liked how you mentioned how emotions can often overshadow your thoughts, as emotions have been known to be very influential on a person’s thoughts.

      Reply

    • Brigitte Manseau
      Oct 03, 2020 @ 23:40:18

      Hi Haley,
      I like that you would ask Mark for evidence regarding his belief of being unlikable. You would get a better understanding of how Mark’s mind works by knowing the previous experiences that have attributed to his belief. I, too, wanted to ask Mark about his night routine. Focusing on and improving his bedtime routine could help make it a bit easier for him to get up in the morning. I focused on what things he could do the night before work that may make it easier for him to get ready in the morning.

      Reply

  7. Selene Anaya
    Oct 01, 2020 @ 10:43:46

    Behavioral Activation –
    (1) Mark is doing really well with his Daily Activity Schedule. He says that he sees improvement and notices how good he feels when he does things that he plans, so that is a big step for him! Some additional questions I would like to ask Mark about pertain to his specific automatic thoughts that he notices may come up while he performs certain tasks. I would also like to ask him more about the actual experience of completing tasks and ask him to compare it to his predicted experience/pleasure. Talking about this out loud could help Mark identify the differences that exist between his perception and actual experience. I also wonder if exploring if his thoughts and feelings he has at work are being taken home with him which goes on to impact his relationship, night routine, and even morning in fear of having to do it all over again. Exploring the emotions, thoughts, and behaviors that Mark has at work can help them move forward.

    (2) I definitely think that Mark’s automatic thoughts of being unworthy or possible core belief of being unlikable warrant further attention moving forward with more cognitive techniques. In the videos, Dr. V challenged Mark and tried to get him to gain insight into how he was thinking and the reality of the situation by bringing in how Mark thinks his wife thought about the situation. Mark understood, but the conversation just moved on from there. I think spending time uncovering these feelings and where they stem from could be helpful with moving forward. Not only to address the thoughts Mark has towards situations in his life right now, but working on the core belief that Mark may have of being unlikeable can prevent these thoughts from happening towards other situations later on in his life. Mark also puts a lot of pressure on himself, he personalizes a lot of things especially at work and I think attention should be put towards that to see if the pressure is valid or warranted regarding each individual situation.

    [Automatic Thoughts] –
    Differentiating thoughts from emotions can be difficult for many clients. From what we know about automatic thoughts, thoughts often elicit emotions. This is one possible reason why it is difficult for some clients to differentiate thoughts from emotions. Many individuals view them as the same because they often happen at the same time. Emotions also tend to be a lot stronger, so some individuals may not even know that thoughts are separate from the emotion because they feel combined. Different emotions elicit different thoughts about situations. For example, a person who is angry will think about a situation differently than an individual who feels sad about the same situation. Thoughts can elicit emotion or even be there after an emotion is felt to explain the emotion. Therefore, the perception of our environment affects how we feel, and how we feel impacts our thoughts about the environment or situation. Being able to learn how to differentiate the two will be helpful in therapy because each has different elements that can be worked on to improve functioning.

    Reply

    • Eileen Kinnane
      Oct 02, 2020 @ 21:17:34

      Hi Selene,

      I think you made a lot of really interesting points in your response. Something that stuck out to me was your point on how talking out loud could help Mark differentiate his perceptions and his actual experiences. This could be crucial for Mark as he filters through the truth of the situation and the thoughts he ruminates about afterwards.

      Reply

    • Haley Scola
      Oct 03, 2020 @ 14:24:27

      Hi Selene,
      I think you did a really nice job of focusing on Marks progress and pointing out that there should be a focus around the experience of tasks for him. I also thought your question of if exploring his thoughts and feelings has any negative implications on his home life. I completely agree that Mark is displaying evidence of a worthlessness core belief, as well as the amount of pressure he puts on himself to feel “successful”. Finally, you did a really great job at differentiating between thoughts and emotions and explaining the importance.

      Reply

    • Trey Powers
      Oct 03, 2020 @ 15:24:21

      Hi Selene!

      I think that you are correct about how important it is to address Mark’s feelings about himself and his worth when it comes to his job. It seems as though he is in a tough position given his depression, as his job is largely left up to chance. The job market is a complicated and ever-changing thing, and such ambiguity as to what the reason is behind people not accepting job offers or sending in applications appears to be taking a toll on Mark, who automatically begins to think that it is due to his performance rather than outside variables that are out of his control. The added pressure that he expressed facing from his superiors is also not helping this issue. I think addressing these thoughts that he is having, and helping him to more objectively evaluate his performance would help with these feelings of inadequacy.

      Reply

  8. Christopher LePage
    Oct 01, 2020 @ 14:55:38

    1.a) While Mark is doing a great job thus far with his Daily Activity Schedule, and has seen many improvements, there are some additional questions that I would like to pose to further benefit him. One of these questions, would be to ask why did he have such a negative reaction when his friends had canceled the plans they had set. I think this question would be important to unpack as it most likely leads to these negative automatic thoughts and core beliefs. I would also like to ask him more about the positive aspects of his job, since he seems to have many negative thoughts surrounding his work placement. I would also like to know more about the social aspect of his job, and his relationships with his coworkers as this may impact how he views his job.
    b.) I think the biggest negative thought or core belief that I would focus upon is his feeling of worthlessness. This seems to be a major negative component in his life, and seems to be really impacting not only his personal life, but also his work life as well. I think cognitive techniques would be beneficial in this scenario, as they will be a great coping mechanism to calm himself down and be able to rationalize with himself.
    2. I think the reason that many people confuse thoughts and emotions, is because emotions often times cause thoughts and vice versa. For instance, if you are in a bad mood and see your partner, you may begin to be angry towards them even without them doing anything to cause this. With this mentality, some people may view thoughts and emotions as being interrelated. It is important to notice the difference between these two concepts, as they have different coping styles to them. It is also important to notice the difference between these two as understanding them leads you to knowing more about their relationship with one another, and how they influence each other.

    Reply

    • Selene Anaya
      Oct 03, 2020 @ 13:00:27

      Hi Chris!
      I thought you made a good point when you said you would like to ask Mark about why he thinks he had such a negative reaction when his friends canceled their plans. This would give the counselor insight into why Mark believes he has these feelings as well as give insight to Mark himself. I also kind of hinted towards wanting to know more about the positive aspects of work that he enjoys. This would be helpful for Mark to realize the good and remind himself that there are some pleasurable activities that are around in his day that he clearly tends to look over as his negative thoughts seem to take over!

      Reply

  9. Eileen Kinnane
    Oct 01, 2020 @ 15:37:36

    1a)The first thing I would like to know more is regarding Mark’s overall thoughts and feelings on the DAS. I would ask him if he enjoyed it, if it went better or worse than expected, and have him expand on that a little bit more. I would also like to know if there were any negative predictions Mark had that were disproved. Since he was really upset about his friend cancelling dinner plans, I would also want to help mark focus on some things he may have performed better than he expected on.

    1b)Moving forward, the automatic thoughts I think warrant further attention pertain to Mark’s friend cancelling dinner plans. Marks thoughts of “Do they value me and our friendship” and “Do they even want to be friends” lead Mark to jumping to negative conclusions about his relationship with his friends. I would want to explore his discomfort in ambiguity and work with Mark on the automatic thoughts that develop when he jumps to conclusions.

    2a) It is possible that it is difficult for clients to jump to differentiate thoughts and emotions because sometimes, thoughts are filled with emotions. This can lead the individual to blend the two together and think they are one in the same if they do not reflect on how they might be different. It is important for a client to know the difference is essential in being able to modify thoughts. It is also important in treatment planning to be able to differentiate the two when setting goals for the clients.

    Reply

    • Haley Scola
      Oct 03, 2020 @ 14:29:20

      Hi Eileen,

      I thought it was really insightful how you wanted to focus on Marks achievements (tasks he performed better on than anticipated) since he was upset about his friend canceling dinner plans. Although, I do think it was very important to explore those automatic thoughts and further implications that occurred after his friend cancelled. I think you did a good job at explaining the importance of differentiating between thoughts and emotions. Specifically, when you referred to clients “blending the two together” and not accessing their capacity to differentiate.

      Reply

  10. Brigitte Manseau
    Oct 01, 2020 @ 15:59:07

    1. Moving forward I would want to ask Mark about his morning routine and what aspects of his morning made him still feel a bit rushed. Also, I would want to know a bit more about his night routine. I would ask Mark if there was anything he could do the night before to cut down time getting ready in the morning. We know he struggles a bit to initiate activities so prepping for his morning the night before may reduce feeling stressed, feeling rushed, and may give him more time in the morning to eat breakfast at home.
    2. Mark’s negative automatic thoughts regarding his friends not valuing him and possibly not wanting to be friends warrant further attention. These thoughts seem to be connected to core beliefs of worthlessness and unlikability. Also, I would want to explore his automatic thoughts regarding him not being good enough at his job. Those thoughts seem to be connected with his core belief of worthlessness as well.
    3. Many clients find it difficult to differentiate their thoughts from their emotions. Thoughts and emotions are intertwined which can make it confusing to understand their differences. Some clients may assume that the two are the same because they haven’t actually thought deeply about the differences between the two. Other clients may find it hard to differentiate the two because they are struggling to process the source of their distress. It is important to know the difference because thoughts are what is targeted and modified in CBT, not emotions. Clients may express how they want to change their emotions regarding particular situations. They may be focused on emotions because that is what often sticks with clients rather than their automatic thoughts. It’s important that clients know they will experience less distressing emotions once their thoughts are modified.

    Reply

    • Selene Anaya
      Oct 03, 2020 @ 13:04:23

      Hi Brigitte!
      I thought it was insightful how you would like to ask Mark about his nighttime routine to try and alleviate some of the stress that he would feel the next morning. I do this in my routine and always notice the difference between when I prep and when I do not prep the night before. This definitely has the potential to help Mark. I also like how you mentioned that it is possible that thoughts and emotions are hard for clients to differentiate because they are struggling to process the source of their distress. Oftentimes, emotions take over and it is hard to think about what exactly elicited the feeling. It is definitely important to be able to differentiate the two!

      Reply

    • Trey Powers
      Oct 03, 2020 @ 15:17:41

      Hi Brigitte!

      You have a number of good suggestions for how Mark could potentially make his morning routine easier for himself. I think that getting him to consider ways in which he can prepare in advance for waking up earlier would likely encourage him, and provide him with more confidence that he will be successful in achieving all that he would like to plan for his mornings. A good start to the day, as we saw, gives Mark a sense of accomplishment right off the bat, setting him up for the day far better than how he was feeling before when he was rushed because of waking up later. If waking up earlier and successfully completing all of his planned activities can be made into a routine, he will likely continue to feel better about his days, which may improve his overall condition.

      Reply

  11. Trey Powers
    Oct 03, 2020 @ 15:12:01

    Behavioral Activation
    1
    It appears as though the behavioral activation homework that Mark engaged in over the week prior to his session went well overall. He planned a number of activities, and many of them he was able to complete as intended, and with some amount of pleasure and sense of accomplishment. That being said, he did hit a few snags along the way as well, which resulted in some negative automatic thoughts. I would like to explore his thoughts and feelings that occurred in the moment in more depth to gain a better understanding of exactly what he is experiencing, which would likely help to generate some hypotheses about how to address these thoughts and feelings so that he is not as affected by occasional upsets, such as his dinner plans being suddenly canceled. I would also like to gather more information on why he seemingly always has a tendency to blame himself for things not going as planned, even when they do not appear to have anything to do with him. Identifying these patterns in his logic will inform future plans to address negative core beliefs. Finally, I would like to know what his thoughts and feelings are when something does not go as planned, but is also not experienced as being negative, such as not making it to the dog park, but still going on a long walk. Does the fact that he did something differently and/or close to his plan still cause him distress or lead to self-criticism, or does it give him a sense of accomplishment regardless.
    2.
    I think that the automatic thoughts that should be addressed further moving forward are those related to Mark perceiving rejection by others as being due to him and his likability rather than things that are happening in others’ lives, and those related to his placing blame on himself for things that are outside of his control. Both of these thoughts are affecting his happiness, his self-efficacy, and his self-worth, and are therefore creating a cycle of attempting activities, experiencing difficulty or setbacks, and then confirming his previously-held beliefs. Breaking this cycle will be important for him to begin feeling better about himself, and appraise situations accurately.

    Automatic Thoughts
    Thoughts and emotions are often confused, or believed to be relatively synonymous, because of their closely related nature. Thoughts can elicit emotions, and the experience of an emotion can lead to more thoughts. Because emotions are generally more powerful, they often become the dominant force that people tend to focus on. Emotion also tends to lead to more impulsivity, both of thought and behavior. CBT recognizes that however powerful and significant emotion may seem, it is also important to focus on the thoughts that an individual experiences as well. Emotion occurs as a result of how we interpret a given situation, which therefore makes thought of utmost importance when it comes to adjusting emotional response. Identifying errors in thinking and encouraging accurate evaluation of a given scenario are ultimately how the emotional response is adjusted.

    Reply

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Adam M. Volungis, PhD, LMHC

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