Topic 7: Automatic Thoughts & Core Beliefs {by 10/27}

[Automatic Thoughts] – Watch MDD-10: Automatic Thoughts – Eliciting, Identifying, and Evaluation.  Answer the following: (1) By evaluating this negative automatic thought, what else did you learn about the client’s thinking pattern? (2) What is significant about the event associated with the negative automatic thought? (3) Is there any other information about the negative automatic thought and/or event that you would like to know?

 

[Core Beliefs] – Watch MDD-15: Core Beliefs – Identifying – Downward-Arrow Technique. (1) How was the downward-arrow technique effective in leading to the client’s core belief based on his negative automatic thought and considering his background? (2) Based on the client’s core belief and what you know about his negative automatic thoughts, what modification technique(s) would be the most appropriate?

 

[Core Beliefs] – Complete the Downward-Arrow Technique on yourself (if you want, you can start with your negative automatic thought from your NATR).  Answer the following (you can be brief): (1) Even though you probably already knew what core belief you were working towards (admittedly, this can be an awkward technique to do on yourself), did you have any emotional or cognitive reaction afterwards? (2) Was there any particular question or approach that you found more helpful (or less helpful) than others?

 

Your original post should be posted by the beginning of class 10/27.  Have your two replies posted no later than 10/29.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

43 Comments (+add yours?)

  1. Tom Mandozzi
    Oct 23, 2022 @ 17:48:46

    I think after evaluating Mark’s automatic thought, the therapist can begin to identify a pattern of thinking and how it may impact behavior patterns. As Dr. V mentions to Mark, there is a pattern of cognitive distortion and personalization taking place for Mark based on automatic thoughts he has surrounding perceived rejection from others. By evaluating Mark’s thought patterns, Dr. V also identified Mark’s anticipatory thinking before asking Jeff to go out for lunch. Mark reported that he was anticipating rejection, while also assuming Jeff would say yes to going to lunch (which is a noteworthy discrepancy between these two countering thoughts/beliefs that Dr. V addressed). In this situation, highlighting this discrepancy may be helpful because how can Mark be satisfied if both conflicting beliefs exist? The client also identified feeling “unwanted” and it was important to evaluate how this may relate to the client’s core beliefs. I think through the therapeutic process, Mark had a lot of personal insight into his negative automatic thoughts and was even able to acknowledge and reflect upon some of his patterns of thinking. I also think Dr. V was able to implement validation and reflection techniques to reassure and empower the client to continue exploring his thoughts and associated emotions. The event associated with the negative automatic thought was significant because it was based on assumptions that Mark made regarding what Jeff was doing and what thoughts he may have had about going to lunch with Mark. These assumptions resulted in rumination and generalization and the client was able to acknowledge that when looking at the event more realistically and taking a step back from his automatic thoughts. I think in terms of treatment and continuing to support Mark, I would want to know how strong these negative automatic thoughts and the associated beliefs are and the degree to which they are impacting Mark’s level of functioning. I would want to further explore the thoughts and events that preceded this event. Are there previous events in which Mark felt similar? I think asking Mark to describe some of the positive interactions he had with Jeff might help to gain some insight into evidence that goes against some of these negative thoughts. How do these relate to Mark’s core beliefs and other aspects of his life? I also think having Mark reflect on his own behavior when it comes to interacting with Jeff (and others) would be helpful information (i.e. has he ever had to tell Jeff he was too busy to get lunch? How might Jeff have felt in that situation? etc.). I think getting more details about the event and Mark’s perspective is helpful in terms of implementing interventions to manage future negative automatic thoughts and modifying the resulting core beliefs.

    I think the downward arrow technique was effective in leading the client to their core belief, because it provides a sense of structure and direction for exploration of thoughts and their meaning. Without this technique, I think it may have been more challenging to connect the client’s automatic thoughts to their core beliefs and come to a deeper and more comprehensive understanding of how their core beliefs impact their own lives and functioning. I think it was also a helpful visual component to the process by looking at the downward arrow and developing connections and relationships between our thoughts and beliefs. I think also looking at the core belief and making it more measurable my ranking it from 1-10 in terms of believability can help the client and therapist in prioritizing and implementing interventions that can modify core beliefs. In the video it helped to evaluate how important it was to modify the core belief or whether the core belief does not really need changing. Dr. V and Mark were able to extrapolate the underlying core belief that was associated with the automatic thoughts and get to a place in which they could work toward modification of this belief. I think Dr. V did a great job of supporting Mark in identifying his core belief while also allowing him to discover this belief on his own and come to beliefs using his own words and conceptualization. I think some modification techniques that would help to address Mark’s negative thoughts are Socratic techniques such as examining the evidence and separating the self from the negative belief. These techniques can be used to help Mark modify the identified negative core beliefs and improve functioning.

    I think it was helpful to practice doing the downward arrow technique on my own automatic thoughts, because it allowed me to get a sense of how this technique would be helpful from the perspective of both the client and the therapist. As mentioned in the prompt, I think I had a good understanding of what core belief I was dealing with in this exercise, but I thought it was helpful to practice kind of further narrowing down what my core belief really was. Asking follow-up questions was helpful in determining a more specific idea of what my core beliefs were. I had an emotional and cognitive reaction to this exercise, because I was able to ask myself some of these questions as if someone else were asking me them. This was helpful for me to view my thoughts and beliefs from a different and more objective perspective, which was helpful in terms of being able to identify negative or maladaptive thought patterns. I felt sad for myself in a similar way that I would feel sadness for a close friend or family member if they had a similar negative thought or belief. At a cognitive level, I was able to notice what patterns of thinking were negative or maladaptive because this exercise allowed me to feel like I was separating myself from my thinking. In terms of approaches that I felt helpful, I thought it was most effective for me to ask follow-up questions that came up almost instantly in response to the previous questions. Instead of trying to edit or think too much about what questions to ask myself in order to arrive at the core belief, I chose ask myself the questions that came organically following my previous response. I think because I was doing this with myself, it was a little bit easier to take this approach. When working with a client, I think it would be more important to think about what questions are asked and at what time based on the individual client and the appropriate approach to take. This made me think about practicing this with a client (What if I can’t think of a relevant follow-up question? What if I ask a question that does not feel relevant to what automatic thoughts were identified and what problems are being addressed?) I think some of these worries are normal responses to learning something new as we continue to learn how to engage clients in these activities. I think after practicing this and working collaboratively with our clients, this intervention will be extremely helpful in clinical practice to help clients modify negative automatic thoughts and improve their lives.

    Reply

    • Bekah Riley
      Oct 26, 2022 @ 11:40:03

      Hi Tom,
      I really enjoyed reading your post this week! I thought you did a great job at highlighting how the client’s thought pattern leads to a pattern of behaviors! Particularly, this client ruminates on the idea of being rejected when trying to be social, whether it is anticipating the event or after the event itself, which may in turn effect his motivation to be social. I also like how you described the downward arrow technique as a sense of structure to allow the client to have a deeper understanding and interpretation of their thoughts and how they lead to certain core beliefs.
      Overall, great response!

      Reply

  2. Bekah Riley
    Oct 25, 2022 @ 13:23:33

    After evaluating this client’s automatic thought, I was able to notice a particular thought pattern. Specifically, this client asked a coworker to go out to lunch and described that the coworker brushed him off, not really looking up from his computer and turned down the offer. This client’s negative automatic thought was that his coworker did not want to spend time with him or be his friend. Upon diving deeper and evaluating the negative automatic thought, the client described that even prior to asking his coworker out to lunch, he was already experiencing negative thoughts and emotions about potentially being rejected. This created an unwanted validation of his negative automatic thoughts and experienced emotions when his coworker did turn down his offer to get lunch. In previous situations where the client puts himself out there by attempting to make plans with his friends, he feels the same negative thoughts and emotions around being rejected and unliked. This reoccurring pattern of negative automatic thoughts followed by negative emotions based on this client’s experiences with striving to be social may be significant because it has formed this core belief where the client views himself as unlikable and unwanted. In addition, in being rejected by both his coworker and friends outside of work, the client’s believability rating for his negative automatic thoughts as well as the intensity rating for his feelings are very high, which in turn contribute to him forming maladaptive core beliefs. In further accessing the client’s negative automatic thoughts, I would like to know how much of an impact they have in terms of contributing to his withdrawal from daily activities that he has described in previous sessions.

    The downward arrow technique was effective in leading to the client’s core beliefs based on the negative automatic thoughts he described. In this session, the client described that when asking his coworker to lunch, the coworker stated that he already had plans. However, the client later witnessed his coworker walking back into the office after going out to eat with other individuals who work in the same office. The client described experiencing the negative automatic thought that the people he worked with did not want him around. Dr. V then used the downward arrow technique by challenging the client’s negative automatic thought. Specifically, Dr. V asked if the thought was valid, why it matters and what kind of person it makes the client. This led the client to emphasize that he desires and really cares about being liked by others, and even described that his own wellbeing is tied into being included in things. The client then went on to say if his closest coworker Jeff does not like him, then who really does like him. The client describes having this reoccurring doubt that people do not like him. Dr. V then asked the client to say if he thinks people like him or not. The client then described that his feelings right now make him think that people don’t like him, but deep down he knows some people do. This helped to uncover the core belief that the client tends to feel unlikable. Based on the client’s negative automatic thoughts and core beliefs, a technique that may be particularly beneficial in modifying his thoughts and beliefs would be the Socratic questioning technique. Specifically, I would ask questions to examine the evidence of the client’s thoughts and core beliefs as well as ask what advice he would give to a close person in his life, such as his girlfriend, if this same situation were to happen to her and she had the same thoughts and beliefs.

    After completing the downward arrow technique on myself based on a negative automatic thought I experienced, I was able to really identify my core belief. Even though I had an idea of what core belief I had formed from my negative automatic thought as well as other similar negative automatic thoughts, I found it beneficial in conceptualizing the core belief. I had more of a cognitive reaction in the sense that I began to remember different instances where this core belief may have had an impact on my emotions and behaviors. More specifically, I tend to be very hard on myself, which prompts me to put more effort into certain relationships or tasks then I need to, causing me to feel emotionally exhausted at times. However, I found it to be very beneficial to process the core belief and how it has an effect on my daily life in the sense that it allowed me to examine the evidence behind it as well as the overall validity and believability. I think asking myself what evidence I had to support my automatic thoughts and core belief was the most beneficial technique for me personally.

    Reply

    • Tom Mandozzi
      Oct 26, 2022 @ 13:41:37

      Hi Bekah,

      Great post! I really related to what you said about thinking about your thoughts at more of a cognitive level. I also felt like the downward arrow technique was helpful for me to make connections between my own thoughts and how they relate to my emotions and behaviors. I think this was a great visual representation of not only our patterns on a cognitive level, but how we can relate out thoughts to our feelings and ultimately to our behaviors. This technique is such a great tool for developing a greater understanding of ourselves. I also resonated with what you said about being self-critical and hard on yourself, as I am the same way. Gaining more education and practical experience with how our cognitive processes impact our emotions and behaviors is so important when looking at the relationship between these interrelated processes. Great post this week!

      Reply

    • Ashley Torres
      Oct 26, 2022 @ 19:20:11

      Hi Bekah, it was very difficult to focus on my negative automatic thoughts and connect it to my core belief. I knew where my negative automatic thoughts were coming from but I still will ruminate if I don’t examine the validity of my thoughts. I also believe examining the core belief and its evidence is very beneficial. Before learning about core beliefs, I wouldn’t stop and ask myself why these thoughts are happening or if they are valid. Examining evidence has helped me explore my core beliefs and realize when I am being excessive.

      Reply

  3. Amanda Bara
    Oct 25, 2022 @ 15:03:27

    By evaluating this negative automatic thought, it is apparent that Mark’s thinking pattern involves a lot of rumination and anxious tendencies. Mark has adopted beliefs about himself due to this thinking pattern that make him view himself as unwanted and worthless. Mark tends to engage in negative thought patterns both before events happen (anticipatory) and after events happen (rumination). These negative thought patterns make him engage in self-isolating behaviors that he would otherwise not engage in if the event had gone according to the plan. What is significant about the event that is associated with the negative automatic thought is how the coworker responded to Mark’s invitation. Mark was noticeably hurt by how Jeff did not look up from his computer to talk to Mark and seemed like he was uninterested in having a conversation with him. These specific actions made Mark feel even more sad as he kept mentioning this portion of the event. It is important to note that Mark already had negative thoughts going into the event in which the actions of Jeff could have confirmed those thoughts. Some other information about the event that I would like to explore was how the rest of the work day went for Mark and what it was like going back to work that day. Since getting tasks done at work is an area of focus for Mark, this specific event could have affected the rest of his work day. I think it would also be important to know how likely Mark would be to ask Jeff to lunch again even after he declined this time.

    The downward-arrow technique was an effective technique for Mark based on his negative automatic thought because it challenged him to think more conceptually. Considering Mark’s background and his history of social engagements not going as well as he would want them to this technique helps to dig deep into the reality of the thought. Using challenging questions like Dr. V did pushed Mark to come to identity the belief and confirm it verbally. He did so by questioning the validity of the thought and what it meant in regards to Mark as a person. By challenging what the thought meant to Mark helped to subsequently identify why the thought mattered to him. Forcing Mark to see the worst parts of this thought and his view of himself brings out the inner beliefs he has of himself. Based on the client’s core belief and what is known about his negative automatic thoughts, the most effective technique in modifying the thought would be to examine the evidence. Examining how true the thought is can bring Mark to see that there is proof that people like him. There is evidence to show that other people enjoy spending time with him including his girlfriend and situations where he has gone out to lunch with his coworkers.

    While completing the downward-arrow technique on myself I concluded that there is much more to my core belief than I had originally thought. After writing down my answers to the challenging questions I felt sad and almost angry that I had felt that way about myself. Using the questions to define the meaning of my automatic thought helps me to pick out specific ideas I had that were harmful to my thinking patterns. I realized that these thoughts show up a lot more than I think they do therefore I tend to ruminate about them. One particular question that I found to be helpful was the question of, “If what you say is really bad, what is the worst part about it?” I think they can be so many aspects to why a thought is negative but defining the worst part can really dig into that core belief.

    Reply

    • Ashley Torres
      Oct 26, 2022 @ 19:48:12

      Hi Amanda, I also think it is a good idea to ask Mark how the rest of his day went. I agree with you, it would be helpful to talk about how long his rumination lasted and how he felt the rest of the day at work and when he went home. Another interesting question you shared is asking Mark how likely he is to ask Jeff to lunch again. I would like to bounce off that and ask him how many times he has gone out with Jeff and other coworkers. I think this will help Mark look at the evidence and notice how his negative thoughts can be misleading.

      Reply

    • Yoana Catano
      Oct 30, 2022 @ 23:57:27

      Hi Amanda,
      Your response shows a good understanding of the cognitive triad. Mark’s negative thought patterns maintain his depressive mood, not only by the anticipation of the event as you explained but also by the rumination that circles back the core belief.

      Reply

  4. NikkiAnn Ryan
    Oct 25, 2022 @ 21:44:42

    By evaluating the negative thought that his coworker did not want to spend time with him, we learned more about the client’s thinking pattern. First, he expressed that he had an “inkling” that Jeff might say know which demonstrates that he was slightly anticipating rejection before asking him to go to lunch. Also, evaluating this negative thought provided more insight into some of the client’s cognitive distortions including personalization and generalization. The client also “filled in the gaps” regarding why Jeff did not go to lunch with him, which he did while ruminating on it and eating lunch alone. Additionally, evaluating this negative thought contributed to a better understanding of the underlying core belief which is that he is unlikeable. This event was significant because the client was already feeling a bit overwhelmed by work and was trying to employ adaptive coping strategies and to follow through on a goal he has been working on which is engaging in more social activities/interactions. This is important to note because it may contribute to related negative automatic thoughts such as “why bother reaching out if I am just going to get rejected.” I think it would be helpful to explore some of the other resources and coping strategies that may be available to the client in the future if he is feeling overwhelmed at work and needs to take space but does not have someone, like Jeff, who can go out to lunch with him.

    The downward-arrow technique provided an opportunity for the client to dig deeper into uncovering his negative core belief. Although he had discussed the concepts of core beliefs and even a little bit about unlikability/unlovability in previous sessions, going through the steps of the downward-arrow technique forced the client to feel it more than just knowing it intellectually. This brought up some new thoughts and beliefs regarding doubt about who does like him. This technique was also particularly useful given the fact that negative automatic thoughts related to people not wanting to spend time with him had come up several times in sessions. The client has expressed a pretty good understanding of the examining the evidence technique including which situations indicate a need to examine the evidence so I think it would be an appropriate modification technique. Additionally, I think it may also be useful to use the technique of listing the advantages and disadvantages of the core belief. This may help the client gain a deeper understanding of the disadvantages that emanate from his core belief, and it may be useful to know what advantages are associated with the negative core belief so that the client and therapist can work together to determine more adaptive ways to meet his needs.

    Intellectually, I knew what core belief my negative automatic thought was related to, however, going through the downward-arrow technique made me feel the core belief emotionally. This reminded me of the way the client had an understanding of core beliefs, but actually going through the technique of digging deeper made him feel it more and understand the significance of the core belief. Also, going through the steps of the downward-arrow technique prompted related thoughts/memories of times I felt this way which I think will be helpful for catching some of these thoughts in the future. The question “what is so bad about…?” was the most helpful in uncovering the negative core belief and helped me understand why the negative automatic thought made me feel the way that it did.

    Reply

    • Yoana Catano
      Oct 31, 2022 @ 00:03:41

      Hi NikkiAnn,
      I like the way you highlight how Mark is gaining insight into his cognitive distortions, and how they lead Mark to withdraw from social activities. Cognitive distortions affect the way we behave and Mark has demonstrated clearly how this core belief has been perpetuated over the years. I also appreciate your idea of providing Mark with some coping strategies, not only as behavioral activation but to start modifying his cognitive distortions.

      Reply

  5. Tuyen Phung
    Oct 26, 2022 @ 08:23:22

    Automatic thoughts

    By evaluating the client’s negative automatic thoughts, I can see that the client tended to validate his emotion as sad at the event in which Jeff did not want to spend time with him. Mark internalized the event and had intense arousal after the event. Dr. V posed a remarkable question when he asked Mark about his emotion before the event asking Jeff to go out with him. Mark said that his morning was not bad until he invited Jeff for lunch and received his answer. Therefore, Mark tended to focus on his negative thinking and generalize him as unwanted and unlikeable. Therefore, he had a strong belief in his thoughts, leading to his intense negative emotion.
    Mark was likely to be consistent with his negative thought when he confirmed several perspectives around the event. First, he noticed Jeff’s behavior, including not looking at him, not having eye contact, and focusing on his computer. Also, Jeff had not been doing anything before Mark walked into his room to invite him for lunch, but he said he did not have time. Therefore, the associated events lead to his conclusion that he was unwanted. For him, this automatic thought seemed valid when there was evidence associated with the event.
    In terms of negative automatic thoughts and events in the case of Mark, I would like to know more about Jeff’s specific job. I would ask Mark if he could describe specifically Jeff’s task that morning. Jeff may be appointed a job that required a lot of concentration and Mark did not notice it. Also, I would like to ask whether other surrounding people could access and talk to Jeff as usual. Mark may take Jeff’s behavior insight too much that he did not see his behavior from other people around him. Finally, I would ask Mark whether he had ever invited any of his colleagues for lunch like this and whether he had this negative automatic thought when he was refused as was the case with Jeff.

    Core beliefs

    After watching the video, I understood more about how the Downward-Arrow Technique work in this case. Dr. V was successful in helping connect Mark’s automatic thoughts to discover Mark’s core beliefs. He let Mark express all his thoughts while he could conclude that he was unwanted, invaluable, and worthless. From this point, Mark came to the conclusion that he was not a good person. By challenging Mark, the therapist could help him verbally state his core beliefs as an unwanted person with the question on background that Jeff did not like him, other people did not like him, so who can like him? Even though Mark found his core beliefs as partly valid with various pieces of evidence, he could still find something invalid in there so that he could recognize its negative consequences in his life and admit to change. As a result, the therapist helped him become more aware of his core beliefs by asking him about his believability in his core beliefs. In connection with his emotion, Mark became more aware of the connection between his core beliefs and his distressing condition. With this core belief, I can use the Socratic technique of separating himself from the negative core belief in which he could assume that Melisa, his girlfriend, has the same core belief as an unlovable person, what Mark could tell her in this case. When Mark could confirm that his core beliefs cause more harm to him in an objective way.

    Core beliefs

    Actually, I have not paid attention much to my automatic thoughts until I learned about the factor and their influences on emotions and behaviors. I have recently recognized my negative automatic thoughts after I saw them as invalid, its evidence against the thoughts, and their negative consequences. When I have negative automatic thoughts, I recognize how they originate from my core beliefs. As a result, intense emotions and negative behaviors are significantly drawn from the core beliefs. Most emotions following after the negative core beliefs are negatively harmful and draw me back from implementing positive actions. From my recognition of negative core beliefs, I like to use the way to look into the negative consequences of core beliefs. I ask myself what are consequences if I continue to keep my core beliefs. When I am more aware of the negative consequences or disadvantages of my core beliefs, I try to think in a positive but appropriate way.

    Reply

    • Bekah Riley
      Oct 26, 2022 @ 11:47:39

      Hi Tuyen,
      I thought you had an amazing post this week! I liked how you emphasized that the client’s negative automatic thoughts felt very valid to him and created an intense feeling of sadness. In addition, I thought you did a nice job of explaining how the client’s negative thoughts and emotions led him to generalize himself as being unlikable or unwanted. When you were describing your specific negative automatic thoughts and how those tie into core beliefs, I thought your question of “what are the consequences if I continue to keep my core beliefs” was very powerful. As seen with the client, there are a number of negative consequences that he has to struggle with upon having the core belief that he is not likeable by others.
      Overall, great response!

      Reply

    • Tom Mandozzi
      Oct 26, 2022 @ 13:27:21

      Hi Tuyen,

      I really related to what you said about how learning about and practicing some of these skills has allowed you to pay more attention to your own thought and behavior patterns. I like that you mentioned that you hadn’t paid much attention to your automatic thoughts until you learned about their influences on emotions and behaviors. I have also been able to better recognize my own negative automatic thoughts after being more aware of them and tracking them. I have been better able to recognize evidence against these thoughts and the negative consequences and patterns associated with them. I think this practice is so helpful in thinking about how much these interventions can impact our clients in the future. Great post!

      Reply

    • Sarah Kendrick
      Oct 27, 2022 @ 21:51:52

      Hi Tuyen! I too found your observation of asking yourself about the consequences of continuing to keep your core beliefs very powerful! I think a lot of people struggle with the anxiety of what if they do truly believe this, what if this doesn’t go away, and what does this mean for me now/how do I move on knowing I believe this, whether or not I always think it’s true. I also agree that learning more about Mark’s place of work could help validate the likelihood that Jeff was indeed busy in that moment, and I also liked your inclusion of if Mark experiences this with other colleagues as well.

      Reply

    • Tayler Shea
      Oct 30, 2022 @ 13:29:18

      Hi Tuyen,

      Great post. I completely agree with you about not noticing automatic thoughts or our own core beliefs before using the downward arrow technique. I like your observation about how when you are noticing that you are experiencing negative automatic thoughts you ask yourself what the consequence of those thoughts are. It is so hard not to get wrapped up in the feelings that core beliefs and negative automatic thoughts trigger. I am glad you found the downward arrow chart helpful – I did too!

      Reply

  6. Ashley Torres
    Oct 26, 2022 @ 19:12:35

    In the video the client explains how he tried to invite a coworker to eat lunch. The client has negative automatic thoughts about his friend not liking him because he declined the offer. The client mentioned that his coworker wouldn’t even look at him which did not help his negative automatic thoughts. He felt like he was not important because he denied his request even though he did not seem busy. I learned that the client does not deal with rejection lightly and it brings distorted thinking and negative automatic thoughts. It is important to note that the client had already feared rejection before he asked his friend to lunch but still went for it because he hoped he would say yes. His core belief of not being unlikeable distorted his automatic thoughts because he believed his friend just didn’t want to spend time with him. The client began to ruminate on the encounter and made himself feel bad. The client proceeded to get lunch but went to a “dirty” fast food restaurant instead of a sub shop due to not being happy at the time. I would like to know how many other times they have been able to meet? How did the lunch break go and what was he feeling during the social hour. The client did say that his coworker suggested meeting another time so it would be helpful to know if that ever happened.

    The downward arrow technique was effective in leading the client’s core belief because it challenged the clients thought pattern. The technique gave the client an opportunity to explore his thoughts and question the validity of them. The client believed Jeff didn’t like him therefore no one else did. Here the client was forced to dig deep and acknowledge the possible explanations of the rejection and his reality. I think what helped a lot was when the therapist asked the client if overall, did people like him? He was hesitant because he believes his coworker doesn’t like him but then he named a few individuals that did like him. The technique was a great visual tool to reach their core belief and show them what stems from it. The client seemed very comfortable discovering the belief and coming up with his own reasoning which comes from the technique guiding the client. I think a technique that can continue to be used is examining the evidence. Like I said before, the client realized people did like him when the therapist asked if he is likable in a black and white answer. Even though he still had negative feelings associated with this thought it helped him dig deeper and he even mentioned the people that did like him.

    While working with the downward arrow technique I notice how quickly people can slip into negative automatic thoughts. After completing the technique I realized I had both emotional and cognitive reactions. While thinking about the thoughts I felt sad because I cave into my negative automatic thoughts but I knew it was exaggerated thinking. I felt like I knew which questions to ask because I knew what my core belief was. I knew it was not true but I still felt sad because there is a part of me that wants to believe it. I did feel a lot better once I answered my own questions because I realized it is not as bad as I make it to be. Using this exercise was very helpful because I understand how difficult it can be for clients to step out of their own thoughts and make sense of their reality.

    Reply

    • Tuyen Phung
      Oct 28, 2022 @ 21:07:45

      Hi Ashley,
      It was interesting for me when I read your discussion on how Mark had had the core belief before he asked Jeff to go out for lunch. You paid good attention to the detail that Mark’s core beliefs of unlikeable lead to his distorted thinking. I haven’t thought about it. I also think Mark was very sensitive to any detail or reaction confirming his core beliefs. As a result, the negative thought was triggered. Jeff’s refusal to go for lunch with Mark partly confirmed his core beliefs, leading to his negative reaction to sitting alone at the park for lunch. When Mark mentioned the detail in which Jeff went out for lunch with him again. He did not consider it as appropriate evidence against his thought, but he still got stuck with the thinking of being “unlikeable.” This can be a general tendency of people with psychological distress and the main change should be from his core belief.

      Reply

    • Rylee L Ferguson
      Oct 30, 2022 @ 18:14:22

      Hi Ashley, I agree that the downward arrow technique was especially helpful as a visual technique. When working with difficult subjects, if they are confusing or just hard to talk about,I think having some sort of visual aid can make things easier. It can help clients literally confront their feelings as they are face to face with them.

      Reply

  7. Patricia Ortiz
    Oct 26, 2022 @ 20:08:48

    Automatic Thoughts] – Watch MDD-10: Automatic Thoughts – Eliciting, Identifying, and Evaluation. Answer the following:
    (1) By evaluating this negative automatic thought, what else did you learn about the client’s thinking pattern?

    By evaluating the client’s negative automatic thoughts, I see that he has a ruminating thinking pattern. His focus of attention remains anchored in a real or imagined element that causes him discomfort, stress, and anxiety. In this case, the element that causes his discomfort and anxiety is the thought that his friend does not want to spend time with him. This negative automatic thought makes him feel worthless, hurt and rejected. Consequently, he ruminates about all of that and continues as a cycle that does not end. This makes him feel unwanted and definitely makes him feel anxious, and as he said in the video that “something bad is going to happen” every time he thinks about asking his friend Jeff to spend time with him. His believability at the moment of the incident is an eight or a nine, which is a high level of believability, so this automatic thought really interferes with his thinking. Also, I feel like he anticipates a lot; anticipatory emotions include fear, anxiety, hope, and trust. When the anticipated event fails to happen, it results in disappointment (if positive event) or relief (if adverse event). As he is mentally preparing for and expecting a specific outcome or result (that Jeff says yes), when this does not happen, it leaves him feeling the worst, and then is when the automatic thoughts kick in. It is safe to say that this mental dynamic is destructive for any person because anxiety and stress increase due to rumination and general discomfort.

    (2) What is significant about the event associated with the negative automatic thought?
    The fact that his friend Jeff told him “no” without any other explanation or talking to him made the client feel unwanted and hurt. He felt rejected and worthless. In terms of thoughts, he thought that he did not want to be with him.

    (3) Is there any other information about the negative automatic thought and/or event that you would like to know?
    This client internalizes his feelings; he might have difficulty coping with negative emotions or stressful situations, so he directs his feelings inside. I would like to know if he has tried to talk directly or communicate his feelings with his friend Jeff. Also, I would like to know if he examined the evidence of his negative automatic thoughts, as mentioned in the video and what supports the thinking to then move forward and see the thought from another perspective.

    [Core Beliefs] – Watch MDD-15: Core Beliefs – Identifying – Downward-Arrow Technique.
    (1) How was the downward-arrow technique effective in leading to the client’s core belief based on his negative automatic thought and considering his background?

    I think that this technique was effective in identifying his core belief. First, Dr. V helped him identify a relevant negative automatic thought related to his core belief. As seen in the video, when he identified that he felt that no one wanted to be with him, he felt hurt and “not wanted” and told Dr. V that he felt those emotions like a seven or eight. Then he asked the client the meaning of the negative automatic thought; for instance, he made questions like “If that is true about you, so what?” “If what you say is true, what does that mean about you?” “What is so bad about ..,”. And the client stated that he understands that the negative automatic thought might be wrong, but a part of him still believes in it. Also, Dr. V always showed empathy and support to him, and this is critical in the process because when the client faces the negative core belief, they could feel sad, hurt, or even frustrated. It is important to note that at the end of the exercise, he said that after doing the exercise, he felt like he was processing things more and that, looking at the evidence, he thinks there are people that actually do like him.
    (2) Based on the client’s core belief and what you know about his negative automatic thoughts, what modification technique(s) would be the most appropriate?
    I think a great technique to use with this client would be behavioral experiments to test his old core beliefs and apply new core beliefs. With the downward-arrow technique, I could see that he improved a lot in identifying and understanding that his negative automatic thoughts were not so rational, and he understood that even if he thought that his thoughts were in part true, a part of him also believed that they were wrong. So, with this technique, we could reinforce a new core belief, for instance, “I am likable.”

    [Core Beliefs] – Complete the Downward-Arrow Technique on yourself (if you want, you can start with your negative automatic thought from your NATR). Answer the following (you can be brief):

    (1) Even though you probably already knew what core belief you were working towards (admittedly, this can be an awkward technique to do on yourself), did you have any emotional or cognitive reaction afterwards?
    While doing the Downward-Arrow technique, I felt good because I could see that sometimes we need to slow down and examine ourselves. It is good to apply those techniques from time to time and see where we need to work on and what we need to improve to be the best we can be for our clients.
    (2) Was there any particular question or approach that you found more helpful (or less helpful) than others?
    I like the “if that’s true, so what?” question. In the beginning, it sounds a little shocking and makes you think a lot of things, and it seems challenging. But it is powerful because it makes you realize that even if you think your thoughts are 100% true, you will be capable of overcoming whatever it is you think and that you will have the skills and abilities to cope with the situation. So, I think that question by itself is very therapeutic and can change anyone’s perspective of their negative automatic thoughts and core beliefs a lot. After thinking about it, an individual can feel a sense of relief and security and less anxiety.

    Reply

    • Tuyen Phung
      Oct 28, 2022 @ 21:39:27

      Hi Patricia,
      You found an effective way of how the Downward-Arrow Technique is helpful in the conversation between Mark and Dr. V. It is also interesting that you found it more interesting than other approaches. The question “If that’s true, so what?” sounds like a way of challenging clients for me. I think the question is more helpful when the therapeutic relationship is strong. If not, clients may feel shocked when they are challenged with the question. However, this is a very beneficial question that helps clients gain awareness of their automatic thoughts. It makes clients ask themselves that if their thoughts are true, what will happen? If they go deeper into the internal dialogue, they only find negative consequences in their emotions and behaviors. As a result, changing their beliefs is a good way so that they can find the light at the end of the dark road.

      Reply

  8. Rachel Marsh
    Oct 26, 2022 @ 22:24:13

    Automatic Thoughts-MDD-10

    Question 1

    ​Through the evaluation of Mark’s automatic thought, I noticed the pattern of emotions that Mark has preceding his automatic thought. After having the thought that Jeff did not want to spend time with him, Mark mentioned that he feels unwanted, rejected, and hurt. In other videos we have watched with Mark through the semester, I notice that Mark has these feelings each time he thinks that someone does not want to be around him.
    ​Something else that stood out to me regarding Mark’s thinking pattern was the negative anticipatory thought Mark had before the event. Before he approached Jeff about going out for lunch, Mark thought that Jeff would not want to spend time with him. Because Jeff’s reaction was consistent with Mark’s anticipatory thought, this magnified his negative automatic thought about the event.

    Question 2

    ​Something about the event associated with Mark’s belief that I found interesting was that Mark perceived the outcome of the event to be worse in the moment than it was in retrospect. For example, when Dr. V asked Mark to rate the thought, he rated it as a 6 retrospectively, but in the moment would have rated it as an 8 or 9. This made me think that in the moment Mark was unable to think clearly and ruminated about the event. After the event, Mark was able to acknowledge that the event resulted in negative emotions while also acknowledging that his distorted perception of the event made it seem more negative than it was.
    ​Another thing I found significant about the event was that Mark stated that he didn’t have all the information about the event but acknowledged that he jumps to negative conclusions. Because of Mark’s distorted thinking, he was unable to take a step back from the event and come up with an alternative explanation for why Jeff reacted in the way that he did. Due to his distorted thinking, Mark tends to ruminate about the event after.

    Question 3

    ​Something else that I would want to know about the event and automatic thought is if these patterns are present with other individuals in Mark’s life. As highlighted earlier, Mark tends to have emotions of sadness, rejection, and unlikability that precede similar thoughts. I would want to gain more insight into this to explore these automatic thoughts and their relation to Mark’s core beliefs. Something that I remember reading about pertaining to core beliefs is the presence of themes in automatic thoughts that can indicate core beliefs. For example, Mark frequently has the thought that people don’t want to spend time with him or be around him. This stems from his core belief that he is unlikable. This is something that I would want to explore with Mark further.

    Core Beliefs-MDD-15

    Question 1

    ​The downward arrow technique was beneficial for Mark for several reasons. Firstly, this technique helped Mark identify his emotions and reflect on what this thought might say about him as a person. By asking Mark what it would mean if the belief was true, Mark was able to acknowledge the emotions he was feeling about the event. Next, by asking Mark what this indicated about him as a person, Mark was able to articulate that to him, it suggests that he is unlikable and a bad person. With this understanding, Dr. V was able to acquire insight into Mark’s self-perception stemming from the event.
    ​Moreover, this technique was also able to help Mark consider his core belief from a more logical standpoint. For example, when Dr. V asked Mark to identify the worst part about the event, he responded by stating if Jeff doesn’t like him then, nobody would. After some reflection, Mark was able to say that there would be some people who like him. Though Mark still has the conviction that people dislike him, Dr. V was able to work with his admission that some people do like him to further challenge his negative automatic thoughts and maladaptive core beliefs.

    Question 2

    ​Two other techniques that I believe might help Mark are reframing and behavioral experiments. Reframing involves changing the meaning of the event. For example, with Mark, he attributed Jeff’s rejection of his invitation to go out for lunch as an indicator of his unlikability. By reframing the event, Mark could explain the event as “Jeff is too busy for lunch” or “Jeff is just having a bad day” rather than blaming himself for Jeff’s rejection.
    Behavioral Experiments involve conducting tests to assess the validity of a belief. Specific to Mark, this might involve identifying other people who he could ask to go out for lunch with him to change his belief that he is unlikable. Additionally, this could involve having Mark identify other times where Jeff has gone out for lunch with him or asking Jeff on a day where he seems less busy to see what he would say.

    Core Beliefs

    When I did the downward arrow technique, I used an automatic negative thought that I had about a big life change I experienced recently. After going through the downward arrow technique, it made me understand my automatic negative thought and the core belief that it stemmed from on a deeper level. It just goes to show that some of the techniques we use on our clients can also benefit us in some ways.

    In the video with Mark, one question that I found to be the most thought provoking was “If this belief is true, what does that say about you as a person?”
    When using the downward arrow technique, I asked myself this same question. It made me realize that even if my automatic thought were true, it doesn’t necessarily indicate anything negative about me as a person.

    Reply

    • Rylee L Ferguson
      Oct 30, 2022 @ 18:18:21

      Rachel, I noticed you brought up how it was interesting that Mark had rated his feelings about the negative event differently, worse in the moment and less so in the therapy session. I wonder if this has anything to do with how he has progressed in therapy. Perhaps he has already begun to question some of his automatic thoughts due to previous conversations in therapy. Either way I think it is clear that Mark is very committed to putting in the work to change his thinking and better himself.

      Reply

    • NikkiAnn Ryan
      Oct 30, 2022 @ 23:22:36

      Hi Rachel,

      I liked your discussion about using the downward arrow technique. I agree that the techniques that we use with clients can help us gain insight into our own thoughts, feelings, and behaviors. I found this technique to be a great way to understand the process of “digging deeper” to get to a core belief. Additionally, practicing the techniques that we use with clients is a good way to help us empathize with our clients when they practice the techniques because we will be able to reflect on what we liked versus disliked and what was easier versus harder. Overall, I enjoyed reading your post!

      Reply

  9. Yoana Catano
    Oct 27, 2022 @ 00:38:24

    [Automatic Thoughts] 1. The client has identified his negative automatic thought, but also a thinking pattern of rejection, he perceives himself as unwanted and worthless. These are Mark’s most central dysfunctional beliefs about himself that are showing a core belief underneath. Also, his negative automatic thought is part of cognitive distortions such as personalization or mind reading.
    2. The event itself might have been similar to other moments in his life, and the event itself doesn’t produce emotions, but it is significant that at this moment, Mark has anticipated his emotional response to it, the negative automatic thoughts have set the arousal for a response, which is anxiety, but also the interpretation of the event/outcome has provided more evidence to Mark that people don’t want to be with him, thus more believability.
    3. I would like to know if other similar situations have brought the same thoughts and emotions for him. What other thoughts have been derived from this event? What thoughts came during his lunch alone that he believes are true? If something has changed in his relationship with Jeff. If other people overheard what happened. If other people would think the same.

    [Core Beliefs] 1. Dr. V prepared the client to ask challenging questions, the form was presented, and openly explained how he would benefit from filling out the form. With the questions, Mark effectively uncovered his core belief, but also he was able to find opposite evidence. When Mark was brought to the extreme in what could be the worst, he didn’t have any other option that to return back to the middle. This is effective in the way that Mark can learn how to identify the cognitive aspect of his distress, shape or tweak the core belief, and apply the technique to other events in his life. The main goal of the therapy is to provide him with the ability to cope with stressful situations, and once he has learned a way to identify what core belief is bringing those negative thoughts and thus emotions, he will be able to manage better stressful situations
    2. It seems like challenging the evidence has already worked with Mark, and this is a term that he has been internalizing. Mark seems to be very insightful, so I think he would understand how the believability of a thought is based on evidence.

    [Core Beliefs] 1. I completed the Downward-Arrow Technique and it was interesting how it helps to find out a core belief, sometimes it seems like they overlap, but these questions help to clarify where is the thought coming from. Honestly, it didn’t bring many emotions because I probably don’t want to get too much into it, especially because the NAT was related to an event that I didn’t ruminate about. I am sure that some other events could bring more NAT, and probably a clearer view of the core belief. But I can see how finding out that I am unlovable, worthless, or helpless will bring a deep feeling of sadness.
    2. I really liked the question “If what you say is true, what does that mean about you?”, because I tend to blame others, but that question brought everything to me, which is actually something that I can control and change. I think it is really useful question to identify categories of Helplessness, worthlessness, and unlovability with NAT. I didn’t find helpful the question “If that’s true, so what?”, it sounds harsh towards the validity of the emotion, and I think it should be helpful to use it when the client has been validated emotionally and fully understand the challenging questions about the thoughts.

    Reply

    • Rachel Marsh
      Oct 29, 2022 @ 18:19:06

      Hello Yoana,

      I loved reading your post! Firstly, I like how you talked about Mark and the anticipation of his emotional response. In the video, we saw how Mark anticipated a negative outcome before asking Jeff out for lunch. When Jeff rejected Mark’s invitation, Mark used this as evidence to support his anticipation, thus magnifying his automatic thoughts regarding his unlikability. In addition, it would be beneficial to see if similar situations elicit similar emotional reactions, as you mentioned. In other videos we have seen with Mark throughout the semester, he tends to hold the belief that people do not like him or want to spend time with him. It would be beneficial to see if Mark generally has these anticipatory negative thoughts before interacting with others, resulting in a self-fulfilling prophecy that perpetuates his maladaptive thoughts and core beliefs.
      I also appreciate what you shared in your experience with the downward arrow technique. I completely agree with what you said about the downward arrow technique. You bring up a great point when you describe the “if that’s true, so what?” question as harsh. While it is helpful to ask a question like this, wording it in a way that validates the individual’s emotions might be more useful.
      Overall, great post!

      Reply

    • Teresia Maina
      Oct 29, 2022 @ 21:05:13

      Hi Yoana,

      Nice post! You had some fantastic questions you would like answered about Mark’s negative automatic thoughts. I especially liked the question about if other people overheard the conversation between the two…. I wrote something similar about the question “if that’s true, so what,” being a little harsh. I personally liked that question, but I can see how others would have a negative reaction toward it. With this question, tone of voice is very important so that it does not come off as offensive. Overall outstanding post. I enjoyed reading it.

      Reply

  10. Rylee L Ferguson
    Oct 27, 2022 @ 11:54:52

    We learned that the client begins this pattern of thinking negatively even before a negative event occurs. He is suspicious that others do not want to spend time with him and apprehensive that something bad is going to happen when he reaches out, such as rejection. These initial feelings are then intensified when the client’s social venture does not work out and it seems like his concerns about being disliked are validated. It is also made clear that this is a pattern of thinking and does not just apply to the situation with the coworker, but also other friends and family. This suggests that the automatic thoughts are indicative of an underlying core belief the client has internalized. The event was significant because the client thought he could rely on the coworker’s response to be yes but in reality he was met with rejection. Additionally, the client was trying to make positive strides socially which was a therapeutic goal. He felt like he was trying to do the right thing and instead of making progress the situation fit with his preconceived ideas about others dislike for him. I think it would be helpful to know how the event affected the rest of the client’s day. We know he isolated in response when he went on lunch and ruminated about the experience which led to him generalizing and feeling worse. Once the client got back to work did these feelings follow him and impact the rest of his day or was he able to shake them off and move on? This information could help inform how powerful negative social interactions are for the client.

    The downward-arrow technique was effective because it began with a powerful and recurring automatic thought and then provided questions that moved even deeper. The questions made the client really reflect on the underlying implications of the automatic thought and how it relates to how he sees himself overall. The technique encouraged the client to confront the strong emotions associated with the thought and evaluate how it played a role in his self-image. It also helps specify and pair down the range of automatic thoughts into a concise representation of the client’s thinking. Based on the client’s success in the past with examining the evidence, I think it could be a good way to try and modify his core beliefs as well. He is able to recognize that sometimes even though his feelings are very powerful and pointing towards one conclusion, he knows cognitively that there is reason to believe otherwise. The client has also shared about positive social interactions so the therapist can be confident that there is evidence to challenge the belief with. It is clear that the thought is worth modifying as it is not valid and helpful to the client. Another potentially helpful modification would be behavioral experiments. These would allow the client to engage in situations that would further a more healthy core belief and give him evidence against the negative core beliefs.

    While I suspected the core belief I would uncover, I didn’t realize the extent to which I believed the core belief until I completed the downward arrow technique. It also made me think that maybe it would be worth considering ways to modify it moving forward. I was able to see how my automatic thoughts devolved into the core belief and how extreme a conclusion I was drawing from normal circumstances. It helped me see I need to be less harsh on myself. I think asking myself all the questions and seeing where it took me was a helpful approach. Being able to write down my thoughts and reflect was also helpful as it was not just an amorphous idea floating around in my head any more. Tracking the progression highlights how intense the feelings can become based on just a few negative automatic thoughts. I think what was most helpful was asking to consider if the core belief was true because it highlights the conflicting feelings that support it and the logic that argues against it.

    Reply

    • Patricia Ortiz
      Oct 28, 2022 @ 15:23:50

      Hi Riley!,
      I like how you mentioned that doing the downward-arrow technique helped you see you need to be less harsh on yourself. I felt the same way with this exercise, and I think I tend to do it because being a counselor brings a sense of responsibility, and I want to be the “best” I can be so I can bring the best of myself to the clients. But what you say is true; we should always write down our thoughts, reflect on them, and understand that we are also human. Great post!

      Reply

  11. Tayler Shea
    Oct 27, 2022 @ 12:39:20

    After evaluating Mark’s situation with his co-worker not being able to go out for lunch with him, we learned the client has a negative automatic thought that he is worthless to his friend and unwanted. The client feels hurt and rejected by his friend. I noticed that the client anticipates being let down by his friends and these thoughts occur many times during the day. This is important because now we know that Mark is approaching situations with the anticipation that something bad is going to happen. This helps us understand that the client has a lot of negative core beliefs surrounding his worth and rejection. The client believes these negative automatic thoughts, which makes it hard for him to experience situations of rejection without experiencing negative emotions. The believability of his negative automatic thoughts reinforces his maladaptive core beliefs which elicit his negative emotions. This also contributes to the client avoiding social interactions with friends due to the fear of rejection. I think that it is significant that Mark was already having a bad day at the time that he asked Jeff to hang out. I also think that it is significant that Jeff was genuinely busy at the time that Mark asked him to hang out. Mark describes the situation as Jeff being very busy at the moment that he had asked him to go out for lunch. I also think that it is significant that Mark and Jeff had gone out to lunch in the past and that Jeff offered to spend time with him at a different time. I would like to know what Mark’s thoughts are when his friends do spend time with him. I wonder if he assumes that they are only spending time with him because “they have no one else” or “no better options”. I also would like to know if Mark feels like his feelings of anticipation towards something bad happening contribute to him avoiding spending time with friends.

    The downward arrow technique is used to understand the client’s core beliefs on a deeper level. The technique begins by starting with a negative automatic thought and asking the client strategic questions until you reach a core belief. This technique is used to help the client discover their core belief, rather than the therapist explaining it to them. The therapist is using these questions to challenge the client and where their thoughts are coming from. This technique was helpful for the client identifying that he has a core belief that people do not like him. The client knows that he has evidence that people do like him, but he has a belief that he is unlikable and unwanted. Many of these thoughts as a result of past experiences that Mark has encountered with friends. Mark began to notice that his core beliefs feed into his automatic thoughts. He also had a breakthrough during the downward arrow technique, and he noticed that when he is feeling emotionally upset as a result of his automatic thought that he needs to take a second to think about the evidence that he has that contradicts his automatic thought. I think the best technique to help mark overcome these negative thoughts and core beliefs would be to evaluate the evidence in support of the core beliefs and then make a list weighing the pros and cons of believing those negative thoughts and beliefs.

    When conducting a downward arrow technique on myself, I already knew the core belief that I was examining. I actually think that although this was kind of awkward and I knew what I was working on, asking myself the question “So what if they do….” Or “what is the worst that happens if this is true” was very eye-opening to me. I did not have a super emotional response, but I did feel a sense of relief when I realized that the worst thing that could happen wasn’t all that bad. Since then, I experienced one situation where my automatic thoughts were triggered. I noticed that during that situation I reminded myself that it is a core belief that may or may not be true. I then evaluated that even if the core belief were true, the result of the belief isn’t that bad.

    Reply

    • Sarah Kendrick
      Oct 27, 2022 @ 21:42:07

      Hi Tayler! I like your inquiry about if Mark thinks his friends only spend time with him because “they have no one else” or have “no better options.” – this may be good for further insight as well as would be very helpful to reality test with. I also liked your identification that the downward-arrow technique requires the therapist to challenge the individual – this technique may reveal some things the client didn’t even expect and can really give them a chance to explore their thoughts and emotions if they are indeed up for the challenge!

      Reply

    • Sam Keller
      Oct 29, 2022 @ 09:55:39

      Hi Taylor!

      I liked how you mentioned that Mark has issues with rejection. This is definitely a part of his negative belief structure and likely generalizes to other aspects of his life. You also did a good job summarizing the negative thoughts he had of “they have no one else” or “no better options”, as they are central concepts to what was upsetting Mark. The downward arrow technique definitely works better when the therapist is leading the client to discover for themselves what their negative core beliefs are instead of just being told. Good answer!

      Reply

    • Teresia Maina
      Oct 29, 2022 @ 20:49:37

      Hi Tayler,
      I enjoyed reading your post! You did a great job explaining the purpose of the downward arrow technique. The technique is helpful so that clients can figure out their core beliefs for themselves. I feel as if therapists told clients what their core beliefs were, they would be less inclined to make a change. If clients experience an emotional or cognitive reaction can act as a motivator. Great post!

      Reply

  12. Sam Keller
    Oct 27, 2022 @ 14:05:50

    Automatic Thoughts – Watch MDD-10 1) By evaluating this negative thought we can learn how this client perceives sei-neutral stimuli. After some thought and evaluation he was able to accept that there may be some alternative explanations to why his coworker was so abrupt with him and did not want to go out for lunch but he immediately jumped to the worst conclusion that it was something about him that was the primary reason the coworker declined going out to lunch. He then took this assumption and generalized it so that it meant that he was unlikable. 2) What is significant about his coworker not wanting to go to lunch with him was that for Mark it was evidence towards his belief that this person did not want to be friends with him and that he is generally unlikable. It was also significant because he had observed that his coworker had gone out to lunch with others before. I am not sure if this is the same incident with the coworker not wanting to go to lunch with him but if it is the second time then this is starting to become a pattern. There may be some validity to this thought if this is the second time this person has done this. 3) I would like to know more about Mark’s relationship with his coworker. Has the coworker been a consistent friend? How close are they? How frequently do they get lunch together? It also sounds like Mark might have withdrawn a bit first because of his depression so I would want to get more information about that. I would also want to see how core beliefs of being unwanted or unlikable might be affecting other aspects of his life.

    Core Belief – MDD-15 1) The downward arrow technique seemed to be pretty helpful to Mark. We went from not wanted to not valued to not being a good person to not being a likable person. He also emphasized that he valued being viewed as a likable person and that his well being was tied into being included. This emphasizes how important this is to Mark which shows that we are getting down to core beliefs. He also generalizes that if one person doesn’t like him then does anybody like him? He was definitely feeling strong emotions which shows that we are getting into those hot cognitions. 2) I would do some reality testing with Mark about ‘so if these beliefs are true, how far can we realistically generalize this?’. I would also do some rationalization of how much this is actually true and then ask him how much he believed this on a scale of 0-100. I would use that logic testing to try and chip that believability from a 100 to like a 50. I would go for a combo of trying to ask how much of this he believes and how much this would affect him if people actually didn’t like him.

    [Core Beliefs] – Complete the Downward-Arrow Technique 1) I definitely had to take a look at how strongly I believed these things even though after the technique I realized that there were plenty of logical gaps in those beliefs. It also brought up more emotion than I expected considering there wasn’t a recent inciting incident that I could incorporate into strengthening these incorrect beliefs. 2) I found that asking myself if these things were realistic to believe was very helpful in modifying the strength of those beliefs or how strongly I felt about them.

    Reply

    • Rachel Marsh
      Oct 29, 2022 @ 18:29:06

      Hello Sam,

      I enjoyed reading your post! Specifically, I appreciate your insights about the techniques that may help Mark further address his core beliefs. First, as you mentioned, Mark tends to generalize his negative experience to all his relationships. If one person does not want to be around him, then Mark believes that everybody else he interacts with would feel the same. With that, empathically challenging the generalizability of Mark’s core beliefs may benefit him by helping him realize that there are people in his life who like him. For example, when Dr. V was challenging Mark’s core beliefs, Mark did admit at one point that he knew that other people like him, but his experiences made him believe otherwise. The tactic you described would be great with Mark’s insight.
      Moreover, I like how you talked about using a continuum to rate the believability of Mark’s belief. This would be useful for Mark to work with him to decrease the believability of the idea. Asking him how much this would affect him if the belief were true would be a great way to achieve this.
      Overall, great post!

      Reply

  13. Kristin Blair
    Oct 27, 2022 @ 15:35:02

    We learn that Mark often has these thoughts when interacting with others and often. He will often anticipate rejection from the individual. However, in the case with his colleague Jeff, he reveals that he also assumed he would say yes to his request to go out to lunch with him. This is an interesting discrepancy, while at the same time, I also feel like this sounds like a somewhat common thought process for many people. These thoughts would definitely be something to address with Mark as it could be really helpful for him to be more cognizant of his thoughts and how they can impact his emotional and physical state. I think it would be helpful to look deeper into Mark’s feelings of being unwanted, or his presence not being of value to his friends to see if there are any connections with a core belief that he may have.
    The event that occurred was significant because it was completely formed by Mark’s assumptions as to the why that Jeff could not do lunch with him that day. These assumptions caused Mark to endure lots of negative feelings of being unwanted by his friend. It also caused him to leave work and choose a quick and unhealthy lunch option that he ate alone in his car.
    I also think the event is significant here because this is someone that Mark interacts with daily. Due to this, it may make it easier to identify faulty thinking patterns because there are many other interactions to compare it with. Additionally, Mark has a positive rapport with Jeff. This helps identify more appropriate and rational thinking regarding Jeff’s seemingly short and discarding answer to Mark.
    For moving forward on this topic with Mark, I would want to explore other instances and interactions in which he feels similar feelings. I would also want to know the severity and the number of times he feels these thoughts enter his mind. Mark does a great job in session with Dr. V at quickly being able to see other perspectives and potential flaws in his thinking as he walks back through the interaction with Dr. V. Having mark reflect on his own behavior and maybe asking some challenge questions to help him hone in on the validity of his thoughts. Once he starts to see and consider other reasons why Jeff responded/reacted to him the way he did, it becomes easier to introduce and see how his actions are directly influenced by irrational thoughts. Once we know more about these thinking patterns with Mark, it will help to curate future interventions that will be most helpful in managing Mark’s negative automatic thoughts.

    The downward arrow technique seems to help the client be challenged and really get to the heart of his negative automatic thoughts. Mark gets the opportunity to look as likability on a grander scale and examine other relationships in his life that are necessarily in question in the present moment. This technique offers the structure that can often be necessary for firmly connecting an automatic thought back to a core belief. Secondly, I personally am a visual person, so I really appreciate actively writing things down and seeing it in front of me to really make connections, so I think that piece is really helpful. I also think that this technique can really help the client discover their own core belief, which can be very helpful in creating change in this department.
    Moving forward, I think that using the Socratic questioning technique would be a significant step in order to dig deeper into these thoughts and beliefs. By probing Mark with appropriate, yet challenging questions that correlate with the negative thoughts and core beliefs, the validity of those thoughts should then be more mailable and able to change.

    I enjoyed using the downward arrow technique on myself; even though I pretty much knew my core belief, it still overall helped me with asking myself additional questions regarding my thoughts. I experienced cognitive and emotional reactions. Some of the questions sort of further validated my negative automatic thought, which felt counterproductive but was somewhat validating at the same time. Two helpful thoughts for me was, asking if other people may have similar interpretations of the same situation. And “Could my thought be an exaggeration of what is true?” These questions stand out to me because one of them validated my negative thought, and one of them went against it. I found this to be interesting. It also led me to think about that happening with a client in session and how I would navigate that response from someone.

    Reply

    • Sam Keller
      Oct 29, 2022 @ 10:00:06

      Hi Kristen!

      I think you are correct in saying that Mark makes a lot of assumptions about people’s motivations. He seems to think that any rejections means that he is unlikable in general or that it says something about him as a person that he views as very important. I do think that while there might be alternate explanation for his coworker’s behavior we might be beginning to see a pattern as far as this specific coworker flaking out on lunch engagements. I also think it is important to recognize that Mark admits to having withdrawn somewhat since the depression started becoming bad. This might give us some insight as to why this might be occurring. Good response!

      Reply

    • NikkiAnn Ryan
      Oct 30, 2022 @ 23:13:03

      Hi Kristin,

      I agree with your thoughts about gathering more information regarding the intensity and severity of Mark’s negative thoughts in order to better determine future interventions that will be most suited for him. I am looking forward to using some of the different techniques for modifying negative automatic thoughts and core beliefs, however, I wonder what it is going to be like to try to figure out which techniques will be best for different clients. I think building rapport and gathering a lot of information about the client’s thoughts will be helpful for this task. Nice post!

      Reply

  14. Teresia Maina
    Oct 27, 2022 @ 15:42:22

    [Automatic Thoughts] After evaluating Mark’s negative automatic thoughts, we learn he had feelings of worthlessness and feeling unwanted. Before asking Jeff for lunch, Mark had negative thoughts about being rejected even after the event. There is a pattern of cognitive distortion, and Mark tends to internalize what is going on based on his thoughts. From his automatic thought pattern, we get a look into Mark’s core beliefs. Based on what Mark noticed in Jeff’s environment/action, it was significantly easy to find evidence that supported his negative automatic thoughts. Jeff was not doing anything when Mark invited him and would also not make eye contact. These actions support his thoughts that his friends don’t want to be around him. I would like to know how many times they have met for lunch. I would like to know if Mark has ever canceled/not accepted a lunch invitation.

    [Core Beliefs: MDD-15] The downward-arrow technique led the client to their core belief through visual guidance. The technique has a clear structure that helps clients explore their thoughts. This technique leads the client to their core belief based on automatic thought. Dr.V was able to push Mark by using challenging questions like would it matter if the belief is true? Pressuring Mark to explore the worst of his thoughts and the believability of this belief. Based on Mark’s core belief and what we know about his negative automatic thoughts, the most appropriate technique to modify his thoughts would be examining the evidence. Examining the evidence can show Mark some people like him, like Melissa, and people do enjoy spending time with him.

    [Core Belief] It was an awkward technique to do myself, although it allowed me to experience how it could be difficult for clients to explore the believability of their thoughts. It also showed me how helpful this technique could be for clients. I did have a cognitive and emotional reaction. While admittedly, it is harsh, and in the beginning, I did not like the questions. After thinking about it, I would say that the question I found most helpful was, “If that’s true, so what?”. I feel like this question got straight to the point and didn’t sugarcoat things. It made me realize that it doesn’t matter if my thought was true.

    Reply

    • Patricia Ortiz
      Oct 28, 2022 @ 15:10:25

      Hi Teresia,
      I had the same reaction as you to the downward-arrow technique question “If that’s true, so what?”. I agree with you that this question got straight to the point and made me realize that it doesn’t matter if my thought was true. I thought that this question makes you feel uncomfortable at the beginning, but then when you start analyzing it, it makes you see things from another perspective, a more “realistic and optimistic” perspective. If that were true, I would have the skills and capabilities it takes to cope with it, and if I do not have them, then it is totally ok, and I will work towards overcoming it.

      Reply

    • Amanda Bara
      Oct 29, 2022 @ 10:59:56

      Hi Teresia! I enjoyed reading your post and thought you did a really nice job in identifying the patterns of thinking for Mark specifically, in relation to his cognitive distortions. I like your honest response to the downward arrow technique. I also thought it was a little awkward to do on myself as these challenging questions are not always ones you want to be asking yourself. I also had an emotional reaction to these questions that made me realize how much of an impact these thoughts can have on my emotions. Nice post!

      Reply

  15. Sarah Kendrick
    Oct 27, 2022 @ 21:32:05

    By evaluating the client’s negative automatic thought, quite a bit is learned about the client’s thinking pattern. The client asked a coworker/friend out to lunch but the coworker stated no, leading the client to think that this individual did not want to be with them or spend time with them. We learn that this client tends to personalize and mind read as they identified that they thought that their coworker did not want to spend time specifically with them. They also anticipated the situation, while thinking it would be a “sure bet,” they still were concerned and afraid of the possibility of rejection. In anticipating that they would be rejected and unfortunately having been “rejected,” the client’s fear was validated and they continued to ruminate about this situation, leading them to identify feeling unwanted and questioning if people even like them as they “filled in the holes” with information that supported these negative thoughts. Having previously experienced this anticipation associated with negative thoughts and emotions with other friends, this pattern has led the client to form a negative core belief that he is unlikable. In regards to other information, I would like to know just how big of an impact this core belief has on the client’s life (ex. Daily activities, other relationships) as well as where this belief started (was there a specific event/relationship etc. that really solidified this).

    The downward-arrow technique was effective in leading to the client’s core belief based on his negative automatic thought and his background. In evaluating the meaning of the negative automatic thought, Mark identified that if true, he still would feel hurt and unwanted, not valued, or not included and that these would be painful. This would mean that he is a bad person and the worst part about it is that he would truly question who, if anyone, does like him. Mark’s pain was visible in the session, even despite him identifying the emotion as well as the physical feeling of it in his chest. Mark was also able to identify that seeing his coworker have lunch with others made him think that they simply didn’t want him specifically around. Overall, this technique helped to truly identify Mark’s negative core belief (that he is unlikable), generally providing more insight as to how this belief manifested in at least a more recent event, as well as provided insight on how this is impacting Mark in the moment. As for modification techniques, evaluating the evidence and separating self from the negative core belief may be effective. While there may indeed be some validity in Mark’s core belief due to previous experiences, this does not define his relationships and generalizes his experience. Perhaps in evaluating the evidence, Mark will at least see that he is likable and wanted by some people and that it is not always or absolutely true that he is unlikeable. Similarly with automatic thoughts, it may be beneficial for Mark to step outside his perspective and ask himself how he would approach this with a friend or family member. He is unlikely to agree with them that they are unlikable and may come up with more adaptive answers as to why his coworker declined to have lunch with him. When applied back to his situation, he may be less harsh and rigid in his beliefs.

    In completing the downward-arrow technique on myself, I did notice an emotional and cognitive reaction afterwards. Every now and again I tend to have an epiphany about my life and things just sort of “click” in my head so this was similar to those moments! There’s a sort of mild relief to have a general statement identified (the “aha” moment), but then I can also relate to Mark’s identification of the chest heaviness feeling (not so “aha,” more so “oh…”) and overall anxiety of what to do about it now and if I reallyyy think it’s true or not. I think the more helpful question was what it says about you if it’s true or what is the worst part about it, I feel like these really dig deep as to the true beliefs and surrounding thoughts and I also think these are what bring up the emotional responses.

    Reply

    • Amanda Bara
      Oct 29, 2022 @ 10:57:03

      Hi Sarah! Your response was thought out and easy to understand. I like how you summarized the information about Mark’s thoughts and how that lead to him developing the core belief. I also think that it would be important to look at other events where this core belief has stemmed from in order to replace the belief. I also resonate with you on having those “epiphany” moments in life. It also happens a lot for me and I think it comes from how I manage to look at situations in different ways. Nice post I enjoyed reading it.

      Reply

    • Tayler Shea
      Oct 30, 2022 @ 13:35:54

      Hi Sarah! I like your post this week! I like the way that you explained that there is an emotional and cognitive reaction to negative automatic thoughts. I like how you described the “aha” feeling when you begin noticing the automatic thought. I agree with you that when dealing with automatic negative thought, you have to analyze what the worst part about the thought is and if it being true really does make a big difference.

      Reply

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Adam M. Volungis, PhD, LMHC

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