Topic 6: The Practice of CBT – Automatic Thoughts {by 10/12}

There are multiple readings due this 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 10/12.  Have your two replies posted no later than 10/14.  *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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38 Comments (+add yours?)

  1. Liisa Biltcliffe
    Oct 11, 2017 @ 18:13:41

    The most basic way to elicit automatic thoughts is just to ask “What was going through your mind just then?” This is the simplest manner in which to have the client focus on his or her thoughts, especially when you notice a shift in the client’s affect or behavior/body language; however, this does not always work, so there are other methods to elicit automatic thoughts. One of these methods includes having the client use imagery to imagine being in that moment itself, or rather thinking of the particular triggering event. This could help the client be in the moment and hopefully trigger the automatic thoughts that go with it. One aspect to keep in mind is that some clients may have issues distinguishing between thoughts and emotions. It is important to validate their emotions, and at the same time work with them to examine their thoughts for validity. Helping clients to evaluate automatic thoughts is accomplished by asking more questions. There are a number of different questions a therapist could ask to help the client clarify about his or her automatic thoughts. Any number could or might be used in one session, including the “evidence questions” and the “decatastrophizing questions.” Evidence questions include looking for the grain of truth that usually is inherent in the automatic thought as well as helping the client look for evidence to the contrary. I like the decatastrophizing questions because these help the client look at a “worst-case scenario,” or a worst fear, and then helping that client think of a best outcome. It is so important for the therapist to try to elicit as many of the automatic thoughts as possible associated with a triggering event because the first thought may not be the most distressing one. At the same time, the therapist does not want to seem pushy or overbearing. Keeping good therapy notes is essential for clients. They can look at the notes in-between sessions and this will help them to modify their thoughts. Another method of modifying automatic thoughts is to utilize coping cards. These are helpful because the client can take a 3×5 card, write down a situation and then list coping strategies to keep in mind. I think that the hard part of this would be to remember to have the card handy for certain situations (for example, if it is a spontaneous situation).

    One challenge I think I would have with helping clients in modifying their automatic thoughts is that I do not want to sound too patronizing when talking to them. In other words, some of the examples in the textbooks sounded a bit patronizing, and I do not want to do that. I want to be able to decipher what a person can handle hearing and be able to educate them about CBT without sounding as if I am talking to someone younger than they are. Another challenge I think would be difficult is picking up on when a client has moved onto the next distressing thought/emotion. In other words, they have processed the one we are talking about and feel less distressed by it, but perhaps I miss that and keep badgering them about the current topic. I worry about that. I also feel like there is SO much to know about helping clients modify their thoughts and that keeping it all straight in my head is going to be a real challenge. Being able to come up with different ideas for each client’s issues could be difficult.

    Reply

    • Venessa Wiafe
      Oct 11, 2017 @ 22:46:48

      Hi Liisa,

      I definitely agree with your first statement made. There’s no easier way to elicit automatic thoughts from a client then to ask in the most simplest form that they can comprehend and respond to. Asking the client exactly what they had thought during a specific moment can help them pick up on their automatic thoughts because they were directed towards a specific situation to evaluate. I also agree with the fact that even thought that seems to be the simplest way to ask a client about their automatic thoughts, it can still cause an issue and not work. Clients may have a hard time gathering their thoughts especially when they are put on the spot. Automatic thoughts occur so rapidly and sudden, so they can be difficult to catch up on. I like how you stated that first and then went in to explain additional ways to elicit automatic thoughts. The simple route doesn’t always work for everyone and the aim is to help the client alter his thoughts. To be able to touch base with the thoughts, the client must disclose his thoughts and if they are elcicited in a suitable manner for him, that goal can be accomplished.

      Reply

    • Lindsey
      Oct 13, 2017 @ 14:19:29

      I think the challenges you wrote about are all valid for consideration, especially when having a client who topic hops or seems all over the place / overly eager. I also think it knowing when to interrupt a client to bring them back to what YOU as a therapist want to focus on poses a challenge because you don’t want to accidentally invalidate a client’s thoughts or participation. I suppose the balance comes with experience but I definitely agree with where you are coming from.

      Reply

  2. Matthew Collin
    Oct 11, 2017 @ 21:07:04

    (1)The most common modality to elicit an automatic thought is in the moment. When a client is discussing something, it may be beneficial for the practitioner to ask “what is going through your head right now?”. It appears to be a simple question, but it’s actually pretty difficult to accurately articulate how your feeling and what you’re thinking when asked on the spot. This line of questioning is to help the client not only understand his/her thoughts, but to also see how instantaneous the automatic thoughts can be. It is also good for the practitioner to be present when coaching a client through the process of identifying the thoughts. The practitioner can read verbal and affect cues of the client while he/she is describing his/her thoughts. The practitioner can pick up if what someone is saying is incongruent with how they’re physically presenting the thought – this could further help the client accurately articulate his/her thoughts.
    Other ways a practitioner can elicit automatic thoughts are eliciting a detailed description of a particularly distressful situation that his/her client went through, using role plays of distressful interpersonal relationships, using thought records as homework, and the practitioner can state thoughts that he/she knows is most likely opposite of the clients. This is to give the motivation to correct the practitioner with a more accurate thought or feeling.
    (2)The first issue that could arise when a practitioner is trying to modify automatic thoughts is that the client may not be able to identify them. There must be an agreed upon automatic thought (or themes of thought) in order to proceed with any sort of cognitive techniques in order to change them to more adaptive ones.
    Another major issue is that clients may have very accurate automatic thoughts that are still distressful to them. For instance, if someone has an automatic thought like “I’m terrible at speaking to others”, or “I’m very socially awkward” and he/she is actually really awkward, or actually really bad at public speaking, then the traditional CBT technique of proving those thoughts wrong would not be the correct treatment plan to take. In the case of being bad at public speaking, then the therapist could teach those skills, and ask the client to practice them – the client can only do better at public speaking if he/she practices it. In the case of the socially awkward person, a therapist could try to teach proper socialization skills, or teach the client skills on how to read social ques. Although automatic thoughts are a key component to CBT, they are not necessarily something that might be worth changing – especially if the thoughts are accurate and logical. If a therapist looks to change logical and true thoughts, than that potentially puts the client in a never ending cycle of failure, and could possibly create illogical thinking.

    Reply

    • Sarah Hine
      Oct 14, 2017 @ 10:30:26

      Matt,
      You raise an interesting and I think important point when it comes to accurate but negative automatic thoughts. Oftentimes we almost act on impulse to immediately deny someone’s negative comments about his or herself. In a therapeutic setting this is not helpful. The therapist has to take this thought and dig deeper, focusing on long term problem solving and stress reduction rather than in the moment feel good assurances. As you suggest with your example, it is better to focus on how the client faces and deals with the negative, but accurate, automatic thought rather than changing the content of the thought.

      Reply

  3. Luke Dery
    Oct 11, 2017 @ 21:11:47

    Identification of automatic thoughts can be accomplished through a few different strategies. One strategy is imagery, which involves having a client “go back in time” and think about a past situation that elicited certain thoughts and feelings. The therapist can ask a series of questions to help the client fully immerse him/herself in the moment and to create as realistic an image as possible. Questions are also used to elicit the automatic thoughts, such as “What were you saying to yourself in that moment?” Another strategy to identify automatic thoughts is by monitoring self-reported mood changes in clients and ask clients what they are thinking when they are in a specific mood. For example, if a client comes in for a session feeling anxious due to prior events, that would be an opportune time to probe for automatic thoughts happening in the moment or recently before the session. Thought recording is another method of identifying automatic thoughts. This involves having clients write down the situation and their thoughts and feelings, either in the therapy session or for a homework assignment. This can introduce clients to the process of identifying thoughts and also give them confidence in their ability to monitor their own thinking.
    Modification of automatic thoughts can be stimulated by many techniques. One method is examining the evidence. In this activity, the client identifies their automatic thought, then provides evidence supporting the thought and evidence against the thought. In this technique, the client can see both recognize the factual evidence that is possibly leading to their thought, but also can identify factual evidence that their thought may not be true. Another modification method is to develop rational alternative thoughts. This involves identifying other ways of thinking about or looking at a situation. Strategies in this method involve having the client try to think like they did before their current negative style of thought, such as at a time period before they were depressed. Clients can also think about what other people would say about their situation. Overall, brainstorming and creative thinking should be encouraged to help clients learn to think outside the box and find more logical ways of seeing certain events.
    One challenge I’ve encountered is lack of clarity of whether or not a client has actually changed their perspective after a thought modification intervention. Sometimes it’s easy to read their tone and body language and acknowledge they’ve had a moment of clarify, but sometimes it’s hard to tell if they’ve actually put any stock into the alternate thoughts we’ve brainstormed. Another challenge involves giving the client evidence that modifying thoughts actually will help change their emotional and, ideally, behavior. It’s easy to see on paper that a different way of thinking can lead to different emotions, but imaging these changes isn’t the same as actually experiencing them.

    Reply

    • Stephanie Welch
      Oct 14, 2017 @ 23:27:55

      Luke,
      I liked how you pointed out that it can be difficult to determine whether the client has changed his or her perspective after thought modification intervention. I have questioned whether some clients may be saying that they have changed in order to please the therapist ( or in my case, for evidence that they are in fact ready to be discharged from the program). It can be easy to tell with some clients through their actions and nonverbal cues, but other clients are more difficult to “read” and may have a history of “playing the system” that makes it difficult.

      Reply

  4. Olivia Grella
    Oct 11, 2017 @ 22:06:58

    The way that is most commonly used to elicit an automatic thought is to simply ask the client. The question can be phrased in multiple ways, but it comes down to asking the client what they were thinking at that exact moment. It is a direct approach to do so, but is the easiest way to understand what a client is thinking in that moment or in past experiences. There’s always the chance that they will give a response that is an emotion, but it can still be worked on right then (or another time if the therapist does not find it appropriate to correct them then) to get to what the automatic thought is. The readings also listed other methods to identify automatic thoughts. One is keeping a thought record. Thought records are helpful to the client to be able to start identifying automatic thoughts on their own and it also serves as a homework assignment to give to them. Thought records can also be used to help modify automatic thoughts. This is because the client is describing the situation in detail and explaining what evidence may or may not be behind the thought. Doing this can help the client see and understand through their own depiction, that the automatic thoughts they are having are not valid. Role playing can also be used to identify automatic thoughts. By acting out the situation again between the client and therapist, this can bring back those thoughts and allow them to evaluate the validity of them in the moment. Although it was noted that this method is not commonly used because it may pose an issue regarding boundaries. However, it can still help a client identify and modify automatic thoughts. Typically, testing to see the evidence behind the thoughts is the best method to go about modifying them.
    There can always be issues with attempting to modify a client’s automatic thoughts though. For one, the client may have difficulty being able to identify them. Although they can be taught what automatic thoughts are and how to do so, for some clients it just does not click with them right away. It just means that extra time will be needed to help them learn how to do so. The readings also mentioned that there is always the possibility that an automatic thought might be true. If this were the case and it was distressing to the client, that’s going to cause a problem for the client especially if the thought produces a lot of negative emotion. This time instead of modifying the thought, the therapist may have to help the client accept that these thoughts are true and teach them adaptive ways to cope with this.

    Reply

    • Venessa Wiafe
      Oct 11, 2017 @ 22:54:28

      Hi Olivia,

      I really liked how you did not just only point out the fact that a client can have a hard time identifying their own automatic thoughts, but also the fact that it can take time for them to be able to accomplish that. CBT was established so that a client’s automatic thoughts can be altered into thoughts that help him function in an adaptive and healthy manner. Even if it may take a longer duration of time for a client to be able to comprehend and disclose his true automatic thoughts, it is worth it. Without a disclosure of his automatic thoughts, therapy can’t be adequately performed and the client won’t be able to prosper towards a better life. The therapist should definitely work in collaboration with the client and work at the same pace with him. The therapist shouldn’t give up on helping the client identify his automatic thoughts and move on to another segment of therapy. It is vital for the therapist to take his time to make sure that the client does eventually understand automatic thoughts, its function, and identify his own.

      Reply

    • Lindsey
      Oct 13, 2017 @ 14:29:29

      Hi Olivia, I like that you mentioned some automatic thoughts are true and can be a tough pill to swallow for the client. Sometimes the best thing a therapist can do is just let the client feel the feels in those moments and assist by going over emotion-focused coping skills. As therapists, I can see where this part might be challenging to observe because certain situations/events cannot be changed and might take longer than situations that require utility evaluation and problem-focused coping skills. As much as I am a proponent of CBT, I also hold personal beliefs that ‘time can heal all wounds’ because the grieving process might last longer than the 12-16 sessions recommended in CBT…. particularly in situations when major losses occur.

      Reply

  5. Venessa Wiafe
    Oct 11, 2017 @ 22:39:34

    Cognitive Behavioral therapy is a very helpful way to assist clients that are troubled with negative thoughts. In order to omit these troubling thoughts from clients’ minds, they must be brought forth, identified,understood, and altered into positive thoughts and beliefs. Eliciting and modifying automatic thoughts that a client may have are vital in the process of changing the way he thinks so that he can function in a much more healthier, adaptive, and prospering manner. Some of the key strategies that are utilized in CBT by a therapist to elicit a client’s automatic thoughts are obtaining a detailed description, recreating an interpersonal situation through role play, and phrasing the question differently for the client. When a therapist elicits a detailed description from the client, the therapist can be able to get the client to bring forth what was going through the client’s mind when they were undergoing the negative experience. Not only will the therapist be able to get a better understanding of the client’s thoughts, but the client himself will be able to come into contact with how he was feeling. The client may have not realized his automatic thoughts when he was going through his experience(s) because they are so abrupt and rapid. This technique helps the client break down his thoughts and evaluate them so that he may be able to understand why he felt the way he did. When the client and therapist engage in role playing of the client’s situation, the client can see how his situation played out from a different lens. He can be able to see the situation he went through transpire in every aspect. Sometimes when a situation occurs, we don’t have the time to think it through, or at least think before we act, so we just let whatever happens, happen. It isn’t too late for a client to be able to see how his situation played out. When the situation is played out, the client can gain significant insight on the situation as well and learn how to deal with his experience differently the next time. The therapist can help the client with eliciting his automatic thoughts by rephrasing a question he asked. The first time a question is asked by the therapist to the client may not be understood by the client. The client may have a lot of information to disclose regarding his automatic thoughts and it is important to bring all of that forth. Taking another shot at asking the client a question in a way that will be better understood by him can definitely allow him to talk about his automatic thoughts. The first time a question is asked also may have been too hard for the client or too much for the client to answer. So, it is important to change the wording so that an opposite thought can be proposed such as a question related to a positive thought can be asked and then a the client’s true negative automatic thoughts can be elicited through it. Automatic thoughts can be modified through Socratic questioning, the utilization of self-disclosure, and the establishment of a cognitive continuum. Socratic questioning encourages the process of changing as well as challenging a client’s irrational thoughts into rational and healthier ones. Therapists probe their client’s with questions to get to the bottom of these negative thoughts so that they can come to the surface. This also gives the client a chance to assess their own thoughts and uncover the evidence that causes the client to have his negative thoughts. When the therapist self-discloses, the client is able to see that he is not alone. It also normalizes the situation he is going though. Being able to have someone else relate to him in a sense can really help him feel better about what he is facing. Self-disclosure can also help clients have a new and different view point on their situation as the therapist brings his perspective into place. The client may have been thinking about his situation in one fixed way without realizing that there can be other ways to handle and/or view it. This can help the client move from having a negative mindset on his situation to a much hopeful and positive one and the therapist is able to lead him into different ideas and various ways to go about it. A cognitive continuum can help stop a client from having an “all or nothing” approach to situations he is dealing with. Clients may see everything in being just black and white, but they need to be able to realize that there is a gray area. Instead of judging a situation as a final end to something or as the end of the world, the client should be able to realize that just because something negative occurs, doesn’t mean, for instance, that he is incompetent and can’t ever be successful. That isn’t the case because no one is perfect and everyone makes mistakes . A middle ground should be established because they should have “maybe ” or “what ifs” in mind and not think that just because a situation doesn’t favor them, doesn’t mean that the situation will never improve, because it can and it will.

    A challenge that a therapist may run into when trying to modify a client’s automatic thoughts relates to when there is a discrepancy between a client’s thoughts and emotions. For instance, during a session, a client may speak on a situation and disclose that she feels just fine and her thoughts weren’t negative. However, when she was disclosing that she is fine and happy, she started to become teary-eyed, forcing herself to hold her tears back. It is clear that the client was sad, but at the same time, she was disclosing that she had thoughts that were positive and made her happy. When the client’s thoughts and emotions/behaviors don’t match, it is hard for the therapist to be able to change anything, because, it isn’t entirely clear if the client’s thoughts are true or not. It is important for the therapist to be able to assess true thoughts, so that CBT can modify them correctly. It is vital for the client to be able to link her emotions to the content of her automatic thoughts. Another potential challenge is when the client has a hard time differentiating her emotions from her automatic thoughts. The client can be confused when it comes to the two, leading the therapist to misconstrue and mislabel automatic thoughts as emotions and vice versa. It is normal for that kind of confusion to occur, because it can get tough when trying to set apart a thought from an emotion since they can occur simultaneously. It is salient to distinguish between the two, so that the actual thoughts can be assessed and altered.

    Reply

    • Alana Kearney
      Oct 14, 2017 @ 09:59:45

      Hey Venessa,
      I also think a particular challenge for the client to distinguish between emotions and automatic thoughts. As everyone has mentioned, automatic thoughts occur naturally and instinctively that it can be extremely hard to bypass them before an emotion is created within us. Especially at the beginning of therapy when a client is unfamiliar with this (and other) psychological phrase, this can be difficult to understand. I think that is why it is very important to always remember and repeat the question “what was going through your mind?” For a client to be able to initiate change, he/she must understand how to think about thinking. As the mind moves rapidly, and the body moves just as quickly behind the thoughts, a client must learn how to slow down the process by examining his/her thoughts. However, the difficulty for clients is to be able to think about the thoughts, while also trying to keep the instinctive emotions off to the side long enough to recognize the thoughts.

      Reply

    • Luke Dery
      Oct 14, 2017 @ 13:11:03

      Hi Venessa,

      That’s a good observation about clients who may be showing emotional responses via body language but try to deny it. I think that may give you a chance to identify discrepancy in their behavior and challenge them a bit as well. Maybe something like, “You say that you don’t have any negative thoughts/emotions right now, but you seem to be tearing up/getting irritated/etc.” This problem with identification could also come from misunderstanding of what a thought or emotion is, but probably also from situations where the client is unable to accept their emotional state or distress.

      Reply

  6. Julie Crantz
    Oct 11, 2017 @ 23:47:58

    1. When working with a client to identify automatic thoughts, some of the key strategies to evoke automatic thoughts include guided discovery, thought recording, imagery, and checklists for automatic thoughts. Guided discovery is a technique used frequently for pinpointing automatic thoughts. When using guided discovery, the therapist uses specific questions to identify the client’s thinking patterns. The questions stimulate emotion from the client with a focus on recent events and on one topic at a time. Another key component used to elicit automatic thoughts is the use of thought recording. The client writes down automatic thoughts on paper with the help of the therapist in session, and then continues the practice as a homework assignment in between sessions. Thought records may include a listing of events, automatic thoughts, and emotions. The therapist and client review the thought records together in session. Imagery is another means of invoking automatic thoughts. During imagery exercises, the therapist helps patients recall relevant events in their mind to experience the thoughts and emotions formerly encountered during the original event. The therapist uses cues to revive the client’s memories of the original event to bring up automatic thoughts. Another method for eliciting automatic thoughts is using checklists. Checklists contain common automatic thoughts and the client places a check mark next to each thought he or she has had in a set time period. This method can be helpful for clients who have trouble recognizing their automatic thoughts (Wright, Basco, & Thase, 2006).

    Some of the key strategies to modify automatic thoughts include Socratic questioning, using thought change records, identifying cognitive errors, and examining the evidence. Socratic questioning involves the therapist asking clients questions that inspire eagerness to learn more about themselves. Socratic questioning is vital to the process of learning about dysfunctional thinking. It also helps to support and strengthen the therapeutic relationship between the therapist and client. Another important method to help clients modify automatic thoughts is the use of thought change records. This approach involves self-monitoring by clients noting events, automatic thoughts, emotions, rational responses, and outcomes. Thought change records are practiced in session and then assigned as homework to clients for in between sessions. The therapist and client review the thought change records together. It is extremely beneficial for clients to see positive outcomes noted on the thought change records. In cases where a positive outcome is not noted, the therapist uses this as an opportunity to identify obstacles and formulate action plans to handle the obstacles. Identifying cognitive errors is another way for therapists to help clients modify automatic thoughts. The therapist provides psychoeducation to the client to define what cognitive errors are and the most common distorted thoughts. In addition to psychoeducation within sessions, the therapist encourages the client to read self-help books detailing cognitive errors or provides the client with handouts to explain cognitive errors. Therapists work with clients to identify cognitive errors through reviewing thought records to note the cognitive errors that have been present. With practice the client will be well versed at spotting cognitive errors and working to engage in more logical and adaptive thinking. Examining the evidence is another effective strategy for clients to modify automatic thoughts. Therapists help clients to note the evidence for and against the automatic thoughts. Then they examine the evidence and work on modifying the thoughts to be compatible with the newly discovered evidence. The exercise of examining the evidence is done in session and is also assigned as homework in between sessions (Wright, Basco, & Thase, 2006).

    2. A therapist may encounter some potential challenges when attempting to modify a client’s automatic thoughts. It is not easy for clients to make changes to thinking, especially when they are habitually having the same negative thought patterns for many years. A client may lack motivation to change and may not engage in doing homework assignments. Homework is a critical piece for CBT therapy and changing distorted thinking. Another issue a therapist may face is clients may understand the automatic thoughts they are having are cognitive distortions, however, they may still have strong emotions associated with the automatic thoughts and the clients still believes the thoughts. This will interfere with the process of modifying the automatic thoughts as the clients may discount the adaptive responses to the automatic thoughts. This may be due to an unidentified core belief that supports the automatic thoughts. The therapist and client will need to further explore and evaluate the underlying core belief behind the automatic thoughts (Beck, 2011). Another difficulty with modifying automatic thoughts is an automatic thought that is causing a client distress may actually be true. The therapist will need to work with the client to ensure the proper conclusions have been drawn about the thought. If the automatic thought is indeed truth, the therapist will need to work with the client on problem solving and acceptance. Sometimes clients may have unrealistic expectations and acceptance issues when therapists work with them on modifying automatic thoughts. Therapists will need to work with the clients on focusing on gratitude for the fulfilling aspects of their life, gratitude, and find new ways to enhance the quality of their experiences (Beck, 2011).

    Reply

    • Sarah Hine
      Oct 14, 2017 @ 10:51:13

      Julie,
      You provided some great examples of difficulties that may come up when attempting to modify automatic thoughts. Habits, strong emotional responses, lack of engagement, etc. are all potential roadblocks our clients may encounter throughout therapy. While the list of interventions (some of which you highlight in your post) was extensive, I think the fact that CBT provides so many different methods for working with automatic thoughts will be helpful in tackling these obstacles. When one method fails, there is flexibility to alter it or try something different, meeting the client’s individual challenges and embracing individual strengths. It is inevitable that our future clients will have difficulties modifying automatic thoughts, but it is reassuring to know that there are many different methods that will help address these challenging situations.

      Reply

    • Matthew Collin
      Oct 14, 2017 @ 13:07:01

      Hi Julie,
      I enjoy how you mentioned Judy Beck, and her explanation of what a therapist needs to do in difficult situations – especially if the automatic thought is a valid and logical one. I also really want to highlight the last sentence in your response. Am I the only one who gets frustrated when reading passages like this? Judy Beck really doesn’t give a great description of “different ways” on enhancing client experience if his/her negative automatic thought is an empirically supported one. In CBT, it seems that distressful, negative, and illogical automatic thoughts are a key component in the therapeutic formula. I feel like a lot of the emotional coping skills set forth by Wright, et.al., and Beck are simply lack luster, and I can see them being lack luster for the client.

      Reply

  7. Sarah Hine
    Oct 12, 2017 @ 07:21:03

    1. There are several methods used to elicit and modify automatic thoughts. Beck offers several questions that are useful in identifying automatic thoughts. This process of guided discovery seeks to clarify what the client was thinking when they elicit a certain emotion or when they share a certain situation in therapy. The therapist can follow up to the information the client provided by questioning what was going on in their mind. If the patient follows with an emotion, interpretation, or other thoughts rather than the automatic thought, the therapist can continue to guide the conversation in order to help the client discover the automatic thought behind the situation/behavior/emotion. The therapist could also use visual imagery to help the client imagine a situation and uncover automatic thoughts. Role playing, visualizing a scene, or describing a scene in detail can all elicit emotions and automatic thoughts the client may be experiencing. Clients can also record thoughts using thought records and automatic thought checklists, both of which are tangible examples the client can see of negative automatic thoughts they may be experiencing.

    Socratic questioning was one method listed that can also aid in modifying automatic thoughts. This method allows the therapist and client to explore potential negative automatic thoughts and evaluate their validity. Questioning the client’s evidence for their thoughts, creating alternative explanations, and using problem solving based questions can help a client look critically at their own thinking and think about what would be different if their thoughts were different. Solutions that a person comes to on their own often seem to be some of the most meaningful, and this process provides clients an opportunity to just that. A technique that is helpful for thinking beyond current thoughts to brainstorm other potential thoughts is called generating rational alternatives. Another technique, examining the evidence, involves the client coming up with evidence for and evidence against their automatic thoughts and comparing the two. Other methods to modify automatic thoughts involve specific techniques such as therapeutic notes and thought records. By reading and applying notes taken during therapy while automatic thoughts are occurring, the client can reinforce therapy and work on changing his or her thoughts rather than just identifying them. Thought records not only identify automatic thoughts, but they also give the client an opportunity to identify the specific situations they occur in and the emotions, actions, and thoughts they elicit. These seek to evaluate thoughts in the moment and help the therapist and client have specific examples to work through in therapy. Use of coping cards is also a practical, hands on way for a client to determine strategies for potentially problematic situations and use them to apply in real life situations. The process of creating coping cards not only helps the client practice problem solving, but can help a client be mindful of significant automatic thoughts in the moment and take care to practice acting or thinking differently. It is important to have several options for identifying and modifying thoughts, because clients will differ in what approach (or approaches) will be effective.

    2. Modifying thoughts may come with some amount of difficulty, especially if a client is having difficult identifying or acknowledging the existence of such thoughts. Automatic thoughts may not be obvious to the client and the client may mistake emotions or other thoughts as automatic thoughts. Conflicts in perspectives between the client and the therapist will also make this process difficult. What the therapist thinks is going on may not be accurate or may not be important for the client, or the client may not recognize that the automatic thoughts the therapist identifies exist or are significant. The client may also have difficulty in accepting the need to modify these thoughts. These thoughts are tied to core beliefs, truths that the client has held on to and based many decisions and thoughts on throughout their life. It will be difficult for a client to recognize that these thoughts may not be true. If these thoughts have been consistent guides for years, it will also take considerable work for a client to change the habit of thinking in certain ways. Even if a client is not resistance to changing, it may take many a trial and error for a client to begin to change their thoughts, especially if those thoughts are self-defeating and make it difficult for the client to believe they are able to change.

    Reply

    • Julie Crantz
      Oct 13, 2017 @ 12:51:31

      Hi Sarah,
      Modifying automatic thoughts is certainly a challenging aspect of CBT. If a client is resistant to changing thoughts or doesn’t want to acknowledge the thoughts exist, the therapist is going to have to work very hard with the client to educate the client that there are more adaptive means of thinking. It is hard to change thoughts that have been with a person for all of his/her life. Many automatic thoughts develop in the earlier years of someone’s life and can be a comfort, even if they are maladaptive. You make an important point that it will take trial and error to help a client begin to change his or her thoughts. Patience will be key in this process, for both the therapist and the client.

      Reply

    • Chiara Nottie
      Oct 13, 2017 @ 12:53:33

      Hi Sarah!
      I think everyone can agree that recognizing and identifying automatic thoughts can definitely be new and tricky to a person. Even people who are not currently experiencing mental illness probably have trouble being aware that thoughts can trigger feelings and behaviors. I think the Beck book laid out a lot of different ways to explain what automatic thoughts are and how to help clients identify them. I think people will differ between how skilled they are at identifying automatic thoughts vs how skilled they are at modifying them. Having the beck books will be helpful to look up the different methods of identifying automatic thoughts, and how to help clients differentiate between thoughts and feelings. I can see clients being challenged by knowing how to recognize a thought compared to a feeling, even if it may seem simple to do.

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    • Luke Dery
      Oct 14, 2017 @ 13:18:13

      Hi Sarah,

      I think your comment at the end about how modification of thoughts can take a while is really spot on. I think we as therapists have to realize that our client have possibly been thinking a certain way for years, if not their entire life. I think this means we have to emphasize practice with them and also help them create habits that they can continue after therapy. They may gain insight in 16 weeks of therapy, but changes are they haven’t permanently changed their way of thinking in that short period of time. We also have to find ways to assure them that things WILL change, but not overnight.

      Reply

  8. Stephanie Welch
    Oct 12, 2017 @ 10:31:49

    1) Some of the key components or strategies used to elicit and modify automatic thoughts are recording automatic thoughts and imagery. Judy Beck suggests the use of a Thought Record for identifying and modifying automatic thoughts. The Thought Record allows the client and therapist to examine the strength of the client’s automatic thoughts. The therapist can ask the client about specific situations where the client may have had difficulty identifying automatic thoughts and question the the client about “what were you thinking at this point”. The Thought Record also allows for the client to practice identifying his or her automatic thoughts outside of the therapy sessions.
    Wright et al also mentions imagery as a form for changing automatic thoughts. The client is instructed to think about a specific situation. The client is then asked about the thoughts and feelings in the situation. The therapist gives verbal cues to the client regarding the situation and his or her automatic thoughts. The therapist can ask the client “What were you thinking?” at specific moments that the client is imagining. This allows the client to focus on his or her thoughts during a particular moment. If the client describes a feeling, then the therapist can direct the client to describe thoughts and put his or her thoughts into words. The therapist may also make subtle suggestions to the client such as “thinking this” in order to help the client verbalize his or her thoughts and also for the therapist to understand the thought process of the client.
    2) Some potential challenges that I may encounter as a therapist when attempting to modify a client’s automatic thought are the client labeling a feeling as a thought. Because automatic thoughts are brief, a challenge may arise in identifying the automatic thoughts. Beck points out that clients are more likely to recognize their feelings than their automatic thoughts. Furthermore, The patient may have a visual thought vesus a verbal thought. This can make it difficult to determine the automatic thought.
    Another challenge could be when the client has multiple automatic thoughts. It could be difficult to determine which one of the client’s automatic thoughts is the most important thought to focus on in the therapy session. Judy Beck points that it may be difficult to determine when the client is the most distressed. The client may feel distressed before, during, and after a situation. The therapist may have difficulty determining at what precise point the client was the most distressed. The automatic thoughts may actually be valid. In this case, it would be difficult to change automatic thoughts that are true.

    Reply

    • Olivia Grella
      Oct 12, 2017 @ 21:52:17

      Hi Stephanie, I like how you brought up how clients can have multiple automatic thoughts and determining which to focus on can be difficult. We mentioned in class today how sometimes one automatic thought can lead to others as an individual ruminates over these thoughts. I think this is relevant to what you are discussing because also in these situations, multiple thoughts are coming through and figuring out which is the most distressing to the client at that moment can be a challenge.

      Reply

  9. shay
    Oct 12, 2017 @ 11:22:11

    One potential strategy used to modify automatic thoughts Is socratic thinking/ questioning. This allows thinking to be structured. Socratic thinking is basically a dialectical discussion. Usually therapists will question the evidence one has to support the accuracy of an automatic thought. Next comes an alternative explanation question. Here basically the patient is probed and engaged in a discussion of alternative explanations of what happened. Afterwards, the client is asked a decatastrophizing question such as “what is the worst that could have happened?” or the therapist could ask the client about their worst fear if their automatic thought does not contain a catastrophe. This gets at having patients realize their worst case scenario is often unrealistic. The goal is to help them think of more realistic and less extreme possibilities. Next you will want to address the impact of the automatic thought, or the possible implications of responding and not responding to the distorted thinking. Distancing is another possible target. Distancing involves asking the client to remove themselves. What would they tell a friend or family member in the same predicament? At the end, there is the now what question. After all has been said, what does this information mean and what can you do with it to help change distorted automatic thoughts. Beck mentions that all these questions may not be necessary or relevant for every client. It is up to the therapist to choose the best questions to ask. It also may be too time consuming to use all forms. It may be helpful to bring up a few at a time.
    Another technique used to modify automatic thoughts is generating rational alternatives. It is not helpful for clients to turn negative automatic thoughts into unrealistic positives ones. Instead clients should work to view circumstances in the most rational way possible and find more adaptive ways to cope, obviously with the therapist’s expertise and help. There are ways and methods used to help clients. One being that the therapist can suggest the clients open their mind to possibilities. Ask them to think like a scientist, FBI agent, lawyer, psychologist or a detective. These professionals don’t jump to conclusions right away before examining all the evidence. Another method is having patients get in touch with their old self. This may involve remembering how they thought before they were anxious or depressed. Thinking of old achievements and past success can help illuminate old thought patterns that were lost.
    Thought recording is another helpful technique in which clients will write down their automatic thoughts on a piece of paper. The recording process pushes clients to pay attention to cognitions, and stimulate a sense of inquiry about the validity of the thought patterns. Seeing thoughts on a paper is sometimes motivation enough to want to correct and change the misaligned thoughts. It may also be an easy pre-step to a thought change record. Thought change records may be saved for later on in therapy once clients have a better understanding of automatic thoughts and are in a better place to change them. Thought recording records may be useful in identifying cognitive errors as well.

    2)There are some potential problems that might arise when trying to modify automatic thoughts. The first one being the validity of automatic thoughts. Usually automatic thoughts contain a least a grain of truth. Some automatic thoughts can be true, but the evaluation is poor. As a clinician it may be potentially more difficult to challenge an automatic thought that is rooted in some truth. Sometimes clients often struggle to elicit automatic thoughts or cannot recall a specific event that was emotional. Struggling with this beginning part, may make the modifying process more difficult. Also some clients may struggle to parse apart a thought from an emotion. I would think that someone who has very deeply entrenched core beliefs that impact their automatic thoughts may have more difficulty modifying their thoughts as well.
    Another potential problem is working with clients who are very moody. Emotion can be very helpful in identifying the importance of an automatic thought. Automatic thoughts often produce an intense emotional response. Often displays of emotion can be sign that an important automatic thought occurred. Having clients that are very emotional or moody can be make identifying and modifying automatic thoughts more tricky.
    Another potential difficulty for clients is that they may struggle to spot cognitive errors. Clients may be focus on their ability to spot which cognitive error is at play (whether its overgeneralizing or ignoring the evidence) etc, when truthfully it is important that they are spotting that an error is even present.

    Reply

    • Luke Gustavson
      Oct 12, 2017 @ 15:41:42

      Hello, Shay:

      I have been under the impression that many automatic thoughts are false, but some can certainly be true. Similarly, are we not supposed to leave true automatic thoughts alone except when the reaction is distressing? This brings me to what you said about an automatic thought that is rooted in some truth. If an automatic thought is only partially true, what are we supposed to do with it? Is that even possible?

      AT: My friends hate me. (Partially true.)
      Reality: Some of my friends hate me. (Accurate.)

      I assume that particular AT would be handled slightly differently when considering the evidence. Perhaps it would be approached from the idea that if a friend hates you, are they really your friend? Or would we explore *why* these friends hate you?

      While I’m at it, here’s a Chiara-esque question: If someone has a false automatic thought but it doesn’t bother them (that is, it doesn’t lead to a negative emotional or behavioral response), what would we do with it? Would we correct it for the sake of being rational or would we leave it alone because it’s not dysfunctional? What if it’s false but there’s a positive emotional response? Not on a delusional level but harmless enough so as to not be capable of harming the self if it turns out to be false.

      Reply

      • shay
        Oct 14, 2017 @ 14:10:30

        Luke
        In terms of true automatic thoughts, that are not distressing I would probably leave it alone. If the thought is accurate and is not causing the client a lot of emotional distress then I probably wouldn’t bother that specific thought, especially if there are more harmful, central or emotionally provoking automatic thoughts. I would argue that addressing them depends on the pervasiveness of the thought. I would argue that something that is not distressing isn’t necessarily a good thought that you would want the client to have. So for example thoughts that have some truth, probably also have some level of falsehood in the evaluation. A lot of clients will focus on the part that supports their belief, and not the part that discredits it. It would definitely depend on the specific client, the actual automatic thought and other situational factors. About your example, I think this example is tricky only because if friends truly hate you, you wonder if they really deserve the friend label. Arguably they don’t. In that regard maybe some of your acquaintances or coworkers don’t like you and this is true, but the evaluation is where some things become invalid/ distorted. Maybe a new staff member comes on board, and doesn’t speak right away. A person with the automatic thought mentioned above, may have another automatic thought that the new staff member also hates them which is untrue.
        If someone has a false automatic thought that does not bother them, I would again juxtapose that AT against other ones the client may have. I think it’s about prioritizing. If there are more important issues at hand I’d fix those before fixing an automatic thought that is not interfering too much with the client. However, I would also consider that teaching the client to think rationally is a good skill-set to have. So I may address the irrational automatic thought with means to teach more rational thinking. I would also consider that the false automatic thought might be influencing or impacting other/ more automatic thoughts.

        Reply

    • Olivia Grella
      Oct 12, 2017 @ 21:55:29

      Hi Shay, I also agree that Socratic questioning is an important way to elicit automatic thoughts. You mentioned how doing this can provide structure, which is important especially during the earlier sessions with a client. Due to the reflexive nature of automatic thoughts, having structure can be a challenge because what thought the client has can change and certain situations cause different thoughts. Having a structure to how to approach them can lead to some consistency when identifying and eliciting them.

      Reply

  10. Chiara Nottie
    Oct 12, 2017 @ 12:37:50

    Automatic Thoughts
    The cognitive model states that the interpretation of a situation, rather than the situation itself, often expressed in automatic thoughts, influences subsequent emotion, behavior, and physiological responses (Beck, 2011). This makes automatic thoughts crucial to address during therapy. There are many ways to elicit and modify automatic thoughts with the use of CBT. A favorable way to explain automatic thoughts to clients, in order to identify and modify automatic thoughts they (clients) have, is to use an example of an automatic thought a client has (Beck, 2011). This is a great strategy because only clients have full access to their minds. If clients understand what automatic thoughts are, they can be more helpful in therapy sessions, in identifying their automatic thoughts, in order to use modifying techniques. This isn’t an easy feat however, so another way to elicit automatic thoughts is by asking investigative questions such as “what was going through your mind?” (Beck, 2011). Sometimes clients pay more attention to other things, such as feeling and outcomes than they do to their initial thoughts in a situation. Helpful questions to elicit automatic thoughts can be: ask how they were feeling, ask how their body experienced emotion, elicit detailed description of the problematic situation, request a visualization of the distressing situation, or roleplay the specific interaction the client had (Beck, 2011). Utilizing these strategies can help a client gain necessary insight into their thoughts by working their way backwards in a sense. Another way to elicit automatic thoughts is by learning what triggers them. Clients can learn during therapy sessions what problematic situations typically lead to certain thoughts. Recognizing situations that evoke automatic thoughts can help clients more easily and quickly identify new automatic thoughts they have, and possibly better reflect on past experiences of a similar nature. It is not uncommon for clients to have difficulties differentiating between thoughts and emotions. It is a useful strategy to work on identifying emotions so thoughts can be better recognized as well (Beck, 2011). Addressing emotions can be more challenging for clients than addressing thoughts. CBT theorizes that changing behaviors and emotions can subsequently change thoughts. This suggests that working with emotions can help clients understand the thoughts they have, and whether those thoughts are valid or invalid. One invalid thoughts are identified therapeutic techniques can challenge them until they no longer hold truth to the client. Besides working with emotions clients and therapists can work with thoughts directly by selecting important automatic thoughts instead of trying to work on all automatic thoughts. Working with a small portion is easier than working with a large portion, no matter what the subject is, automatic thoughts, cooking, construction, spring cleaning, etc.. Selecting a handful of automatic thoughts is useful primarily because there is no way to tell in the beginning how distorted an automatic thought is (Beck, 2011). Once a selection of automatic thoughts is made a client and therapist (together) can: examine the thought’s validity, explore the possibility of alternative interpretations, decatastrophize the problematic situation, recognize the thought’s impact, gain distance from the thought, and problem solve (Beck, 2011). As mentioned earlier with challenging validity of emotions, challenging the validity of a thought can help a client agree that there are possible alternative interpretations they can make towards a situation. These alternative interpretations can help lessen the degree of doom the client feels situations can evoke. Doing all of this can help a client feel safer and closer to baseline which clears up thinking and allows objective evaluations of situations. Recognizing the impact, a thought has can importantly motivate a client to try modifying techniques. A lot of times we become familiar and comfortable with the thoughts we have even if they are distressing, because they are all we know, or because unknown options are too terrifying to consider. Motivation really helps clients take a chance to abandon old habits and ways of thinking. Distancing one’s self from an automatic thought is helpful because it gives the thought less power, and makes it seem less real, and lessens the amount one considers an automatic thought a part of their identity. Problem solving is a great modifying strategy to use after some of these previous strategies have been implemented. The previous strategies in loosening the foundation while problem solving get the ball rolling towards the end goal of a modified thought.
    Challenges
    Modifying automatic thoughts may seem easy on paper but in practice modifying automatic thoughts can come with plenty of challenges. One challenge could be a client’s ability of insight. Due to innate cognitive delays, injury, or illness, some clients may not be able to recognize the meaning of an automatic thought, or be able to identify automatic thoughts. In this case working with emotions and behaviors may be the only way to modify automatic thoughts. A related challenge to this, is accurately identifying automatic thoughts. It is easy for clients to misidentify what is their automatic thinking in a situation. Therapists have enough skill to help clients differentiate between emotions and thoughts, but they cannot read clients’ minds, so they are limited to a degree in identifying automatic thoughts. Another challenge comes with risking a power struggle with a client. An appealing quality of CBT is the equality of the relationship between therapists and clients. When addressing automatic thoughts clients may feel less empowered during therapy sessions, and also like the therapist thinks they are wrong about situations, or incapable individuals (Beck, 2011). Re-affirming the teamwork of therapy can help alleviate this issue. As well as careful approaches towards challenging validity of thoughts and emotions. As stated early automatic thoughts may be so familiar to a client that they all seem valid. Challenging validity can make a client feel misunderstood, or that a therapist is not helpful. Using techniques such as recognizing the impact a thought may carry, and distancing might be ways to warm a client towards considering automatic thoughts may be invalid. This relates to motivation. A lot of clients with anxiety and depression may struggle feeling motivated to confront and modify stressful, scary, or sorrowful thoughts that have negatively affected them in the past. Encouragement, genuineness, and optimism can help ease therapy towards readiness to change.

    Reply

    • shay
      Oct 14, 2017 @ 14:11:15

      Chiara,
      I think you made a lot of interesting points. I liked how you spoke about therapists being limited in a sense. The client does hold a lot of responsibility regarding modifying and identifying their automatic thoughts. Therapist cannot in fact read clients minds. I think this goes back to the basics, and speaks to the importance of really establishing rapport so that the client will open up. I think establishing this foundational relationship will also help take care of the power-struggle you mentioned. Validating the client, and letting them know that you believe they are capable may help them to feel more at ease, and that they are not being judged for irrationality. I also think good psychoeducation may play a role, and help validate that these concepts and terms exist because we all have cognitions and subject to thinking more dysfunctionality.
      Finally I liked that you mentioned the familiarity of automatic thoughts, may make them seem more valid to the clients. Generally the more “supporting evidence” you have, the more likely you are to believe in it. I think challenging the validity can be done in a more sensitive way, where the patient understands the therapist is not attacking them persay or not misunderstanding. Again validating throughout this process may ease the risk of clients becoming upset. Also the psychoeducation or using a worksheet to help aid may make clients feel more normalized, like they are not the only ones who have maladaptive automatic thoughts.

      Reply

  11. Luke Gustavson
    Oct 12, 2017 @ 12:44:46

    The key strategy for eliciting automatic thoughts is the question “what was going through your mind?” It is used to have clients identify what they were thinking about either in the present or when recounting an event that has already happened. This is probably going to be the most commonly used strategy for eliciting and identifying automatic thoughts, but there will always be situations where it is less useful. For instance, a client may have difficulty grasping what they were thinking at a particular moment, or become stuck on an emotion. This I can see being more problematic earlier in psychotherapy, when knowledge of automatic thoughts is still relatively new and clients are learning to tease thought away from emotion.
    Another technique I find intriguing is to heighten the emotional or physiological response. This technique essentially uses the client’s memory of the feelings they had at a particular moment to help tease out their associated automatic thoughts. By eliciting at least the memory of the emotion and presenting the situation where that anxiety could be felt, the psychotherapist is able to elicit an automatic thought. I think what I really like about this technique is that it taps into the reciprocally deterministic nature of cognitions, physiology (behavior), and affect. Elicit the emotions and physiological response and you can approximate the associated cognitions that may have been encountered within the moment.
    Similar to the above technique is eliciting a detailed description. Through the process of detailing a specific event, a psychotherapist is able to bring the client back to the mindset of that moment, at least for a brief moment. Through the recreation of the time, the place, and the activity, it is possible for a client to consider what they would be thinking at such a point.
    The key strategy for evaluating or modifying an automatic thought is likely the evidence question, wherein the psychotherapist asks the client what evidence they have that something is true or false. Particularly when it pertains to actions or involves others, the evidence question can morph to fit the situation. If the client is concerned about what could happen in a situation or whether a particular individual would react in a certain way, the psychotherapist can question the evidence for the best, worst, and most realistic outcomes. The point is to have the client logically go through the evidence in order to arrive at the most logical conclusion.
    The other strategy is actually one I learned in undergrad as a way of getting interviewees to answer difficult, emotionally charged questions. This is the distancing technique, wherein the psychotherapist asks the client what they would suggest a friend or colleague do in a situation similar to theirs. By putting the focus on other people, the client is able to gain psychological distance from the situation, effectively allowing them to have a little room to think.
    In terms of challenges when it comes to modifying thoughts, some clients may not fully examine the evidence associated with a thought. Such a problem might mean the client is holding back or has not completely expressed their associated thoughts and emotions. It might also mean the psychotherapist has not adequately probed for automatic thoughts and the associated evidence. Similarly, the automatic thought that has been expressed could also be a core belief, meaning modification becomes much more difficult. At such a point it may be more useful to probe a different but related automatic thought in order to best attack that core belief.
    The last challenge I can particularly see happening is that after work has been done to get a client to see something in a rational, logical manner and heaps of evidence have surfaced, the client will still believe the thought at an emotional level. This is the “I know, but…” reaction, I imagine. While the logical response has been presented, there’s still a belief in the way, preventing the client from truly believing the modified thought. Essentially, the client has not been truly convinced; the logic is there but the heart is not. Statements such as “This doesn’t change the fact that I am a horrible person” likely back schisms between being convinced in thought and being convinced in emotion.

    Reply

    • Alana Kearney
      Oct 14, 2017 @ 09:46:04

      Hi Luke,
      I also envision client’s using the line “I know, but…” a lot throughout, but especially at the beginning, of the behavioral change process. I think this is a common, instinctive reaction for humans, which is why we are so familiar and prepared for it. I know I have heard this reaction from many friends, but I wonder if, as a therapist, we will hear it more or less often. On one hand, the clients are human and as I mentioned, this is a typical human reaction. However, when we are in the roles of counselor, I wonder if the clients will be more or less likely to believe and trust in what we have to say. It is hard to watch someone disbelieve logical thoughts, so I think counselors should always be prepared to encourage and emphasize the client’s abilities.

      Reply

  12. Alana Kearney
    Oct 12, 2017 @ 13:30:22

    A therapist should be aware of shifts in negative affect or a client mentioning specific problematic situations that have occurred since the previous session. When a therapist wants to address the client’s automatic thoughts during these situations, the first question should be is “what was going through your mind?” This question aims the conversation towards exploring the thoughts that are elicited after certain situations. The therapist wants to search for a reason as to why the client reacts to the situation in the way he does, which is why it is important to understand the thoughts that lead to the action. Sometimes it can be difficult for the client to identify these thoughts immediately, so the therapist should be prepared to help them elicit the thoughts. Some popular techniques to elicit these thoughts are asking the client how he/she feels during the situation, asking for a detailed description of the situation, asking the client to visualize the situation, attempt to role play the situation, or even just rephrasing this question. These techniques are meant to focus the client’s thoughts on exactly what happens within his/her mind during these situations. If a client can describe how he/she feels during the situation, he/she might be able to identify why he/she starts feeling that way. If I client can visualize or remember details of the situation, he/she can pinpoint the moment he/she began to feel distressed in the situation and what thoughts may have initiated the feelings and behaviors. The goal of identifying automatic thoughts is to eventually show the clients how their thoughts are influencing their behaviors and also how the thoughts may not be completely accurate or appropriate for the situation.
    Wright offers various strategies to modify a client’s automatic thoughts. This book emphasizes the effectiveness of the Socratic method of questioning. The authors believe this technique can reveal opportunities for change, involve the clients in the learning process, and enhance their ability to think about how they think. Thought records are also useful tools in the cognitive change process. They teach a client to identify automatic thoughts, rationalize and identify cognitive errors in order to manipulate the negative thoughts, and act as evidence to see how their behaviors change as a result of modifying these thoughts. A third strategy that is important for the client is learning how to identify any cognitive errors in order to be able to make any cognitive changes by challenging these errors with rational thoughts. These, and other, techniques are very important for a client to learn and master in order to properly and effectively modify any automatic thoughts that may occur outside of the therapy session.
    Since automatic thoughts are almost instinctual and natural for the client, it can be difficult to break the chain that causes these thoughts. At first it may be difficult for the clients to identify the automatic thoughts. They may address the emotions that they feel in a situation instead of the thoughts that activate these feelings. Then once they’ve identified the thoughts, they may find it difficult to create rational alternatives and hold onto their automatic thoughts despite understanding that they are irrational. Even if they are able to challenge their irrational thoughts in session, they may find it hard to implement these skills outside of therapy with no one to point out the discrepancies to them. Automatic thoughts stem from our core beliefs, which makes it especially difficult to challenge or change these thoughts into something rational.

    Reply

    • Stephanie Welch
      Oct 14, 2017 @ 23:12:26

      Alana,
      I liked how you began with the changes in a client’s thoughts from the previous session. I think that it is a point that can be missed. Since automatic thoughts are so brief, the changes in automatic thoughts may not be recognized by the client and the therapist. I think that the statement of asking the client about his or her thoughts is the most agreed upon way to elicit automatic thoughts. However, I liked how you mentioned the technique of visualization because automatic thoughts can be difficult to put into words and may sometimes present themselves as an image rather than a word.

      Reply

  13. Noella Teylan-Cashman
    Oct 12, 2017 @ 14:51:55

    The simplest and most direct way to get clients to begin thinking about automatic thoughts is the question, “What is going through your mind right now?” As discussed in class, it is common for clients to initially respond by describing their feelings, instead of their thoughts. It is possible for the clinician to work through the process of deciphering between the two in this moment, though other methods of questioning may need to be implemented. Professionals may first try rephrasing the question in a way that helps clients become more aware of their thought processes, or they may try other techniques such as role playing, imagery, or thought records. Through these methods, the clinician can help the client track his/her pattern of thinking until he/she can pinpoint the troubling automatic thought.

    Socratic questioning is one of the main methods used to challenge negative automatic thoughts. During this process, the clinician and client challenge the validity of the client’s thinking and aim to debunk any irrational beliefs. The therapist will help the client identify disconfirming evidence for their core beliefs and automatic thoughts, in efforts to cognitively restructure the presenting problem. Ultimately, Socratic questioning is used as a mean to promote rational thinking.

    As a therapist, I imagine it is difficult to modify a client’s automatic thoughts, regardless of the circumstances. Because automatic thoughts are fleeting and reflexive, individuals often have a hard time identifying them. Then, once they are identified, individuals normally have difficulty recognizing their maladaptive nature. It may also be challenging for individuals to fully acknowledge the content of their automatic thoughts because they are often associated with strong emotions. These strong emotions may elicit negative responses from clients. While emotional distress is natural in the therapeutic process, it can also pose a barrier for treatment if individuals become more irrational during heightened emotional states.

    Reply

    • Luke Gustavson
      Oct 12, 2017 @ 15:29:10

      Hello Noella:

      I have also considered automatic thoughts to be at least somewhat difficult to modify given their nature. I suppose this is one reason why there are a myriad of techniques and strategies available to CBT practitioners, with a lot of them seemingly focused on recreating the event or situation (at least through imagination or role-play) in order to give the client another chance at catching the thought.

      Emotional distress is also something that I have noticed could get in the way. If a person is in extreme emotional distress either during treatment or was during the event, I think they might be more likely to focus on the emotion and not attempt to discern what precipitated that emotion. However, could this be something more likely to occur earlier in treatment when clients have yet to be taught how to take notice of automatic thoughts?

      Irrational emotional states are most certainly a barrier to modification of automatic thoughts, but I imagine it would be relatively simple to wait for the period to pass before attempting to engage on a cognitive level. Perhaps once the emotional state has calmed down the individual would gain a better grasp on their mental state during that period, though I can certainly see a problem occurring where the individual simply looks at the emotion and says “well, there’s nothing here.”

      I’ve been curious about what might happen if someone rejects part of the cognitive model. For instance, a person experiencing strong emotions might not believe there is a thought precipitating those emotions. How, then, would we work to change their mind about this, particularly considering how fleeting and reflexive automatic thoughts are? I have yet to come up with a decent answer.

      Reply

    • Matthew Collin
      Oct 14, 2017 @ 13:23:48

      Hi Noella,
      I like how you mentioned how difficult it is for clients to grasp what his/her automatic thought is, especially in the emotionally aroused states. I can only imagine someone being exceptionally, physiologically anxious during a homework assignment, and then trying to figure out what was their automatic thought that came just before the terrible physiological experience. It will probably be tough for the client to figure out his/her thoughts during those situations; however, it’s important that those thoughts be evaluated and corrected (if they’re negative and illogical), because these are the ones that cause them the most emotional suffering.

      Reply

  14. Lindsey
    Oct 12, 2017 @ 15:50:28

    Eliciting automatic thoughts can be as deceivingly simple as asking the client, “What is/was going through your mind?” Verbal and nonverbal cues can help a therapist pick up on clients’ hot cognitions but sometimes clients require a little more guidance to understand what is causing a particular emotional reaction. Wright did a great job outlining how to elicit and modify automatic thoughts: she highlighted the importance of discussing mood shifts, psychoeducation, guided discovery, thought records, exercises that involve imagery and role play, and the use of checklists with clients. These methods help elicit automatic thoughts through the facilitation of awareness. Most people have a tendency to describe emotions or physiological arousal symptoms when asked to describe their thoughts. Though emotions are logically connected to automatic thoughts, the cognitive behavioral model provides clients with opportunities to bring thoughts to the forefront of consciousness so-to-speak. Rephrasing the questions at times (i.e. What did this situation mean to you?) can also be helpful [see Figure 9.3, pg. 156]. The utility of the automatic thought is just as important as the validity because not all automatic thoughts are invalid so it is imperative that therapists discover personal meanings linked to the thinking patterns. When asking the client to discuss what they are thinking in the moment, therapists are able to collaborate with the client to test and respond to the thought immediately as a team. This experiential learning technique will ideally translate outside of therapy in the client’s personal life. Modifying automatic thoughts can take place through various techniques:
    – Socratic questioning
    – Thought change records
    – Discussing rational alternatives
    – Identifying cognitive errors
    – Examining the evidence (Collaborative empiricism)
    – Decatastrophizing
    – Reattribution
    – Cognitive rehearsal
    – Coping cards
    Though all of these techniques are useful and help in their own right I, personally, think coping cards are underutilized in therapy and should be used more often. It is a helpful way to encourage the client to maintain awareness between sessions when the therapist is not at their side to walk through the process. It might sound cheesy but asking the client to read through their coping cards each morning or 3x a day or when feeling sad/anxious/etc. enhances autonomy and serves as helpful reminders that they are in control of their thinking and emoting. During session, patients might want to share an important automatic thought that the therapist chooses not to focus on and this in itself can pose potential challenges for both the therapist and the client. If a therapist feels a particular thought will put the patient at risk of feeling invalidated and thus, ruin the therapeutic relationship, they might delay to discuss that particular thought until later stages of therapy or when there is more time in the next session to prioritize that particular thought. During the early stages of therapy, the client is still learning about automatic thoughts and how to identify them. The clients believed them to be true and the modification process might trigger high levels of distress that are inappropriate to activate. A new therapist might accidentally challenge an automatic thought which can pose a number of challenges, especially because the level of cognitive distortion about the thought may remain unknown and can trigger a chain reaction. Overall, collaborative empiricism is the optimal approach to minimize the risk of challenges during the modification process.

    Reply

    • Julie Crantz
      Oct 13, 2017 @ 13:02:38

      Hi Lindsey,
      I think you make an important point regarding the use of coping cards in therapy. It is very helpful for clients to have a visual reminder and strategy for dealing with difficult automatic thoughts. Assigning homework to the client that includes reading his/her coping cards at specific times throughout the day can really drive home that importance of modifying negative automatic thoughts into more adaptive thinking. The more clients read their coping cards, the more the positive thoughts will replace the negative thoughts. Coping cards are a great tool to use in CBT!

      Reply

  15. Chiara Nottie
    Oct 13, 2017 @ 12:45:33

    Hey Lindsey!
    I like that you suggested using coping cards. I agree that clients will probably need a lot of help out of session to work with their automatic thoughts. I think that’s understandable since it’s not typical to be overly analytical or conscious of our automatic thoughts, since they come and go so quickly. For individuals with depressive and anxious symptoms have an easy tool such as a coping card can be really useful for them to practice working on identifying and modifying their automatic thoughts. I think cards are good to because they are easily portable for most people. I wonder if teenagers would also benefit from coping cards. Adolescence is a particularly vulnerable age period where constant mental exercises can really help out a struggling teen.

    Reply

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Adam M. Volungis, PhD, LMHC

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