Thought Challenging
A Self-Help Guide
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Mental Health Access Team, Barnsley
South West Yorkshire Partnership NHS Foundation Trust
Thought Challenging - Part One
When people are depressed or anxious they tend to have many
unhelpful thoughts. Their negative thoughts tend to be driven by
opinions which are influenced by their emotions and are often not
factual but are instead overly negative and unrealistic, making them
feel worse. Thoughts can occur in different forms:
 Words/sentences that we say in our heads e.g. “I got that all
wrong”;
 Images of things that might happen e.g. imagining being
shouted at by your boss;
 Memories e.g. remembering things that have gone wrong in
the past.
Each of these types of thoughts can be unhelpful if they make us
feel worse. These negative unhelpful thoughts:
 Are automatic – they occur without you being aware of
them;
 Seem believable and plausible at the time (although in fact
they are often unreasonable and distorted);
 Are the kinds of thoughts that most people would be upset by
if they believed them.
Challenging unhelpful thinking helps you to look at your thoughts
in a different way. When your thoughts are more balanced and
realistic, your depression or anxiety will reduce.
Thinking Errors
Some common thinking errors are shown below. Tick the ones you
do regularly when you are feeling depressed or anxious.
□ All or nothing thinking: Seeing things as ‘black or white’ with
nothing in between, with no shades of grey. Thinking that if
things aren’t perfect then they are worthless.
e.g. “I’ve made two mistakes in that letter – it was a total
failure”.
“I didn’t get all the shopping I wanted – it was a waste of
time”.
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□ Mental Filter: In a situation, singling out negative details and
dwelling on them, ignoring any positive or mitigating factors.
e.g. you made a nice dinner but you over-cooked one
vegetable and conclude that the whole dinner was awful.
□ Overgeneralization: Having singled out one or more of the
negative aspects of a situation, seeing them as a general
pattern of disaster.
e.g. “I’ve made a mistake - I can never do anything right”.
“This argument proves nobody likes me”.
□ Labelling: Calling yourself unpleasant names, which you think
seem to sum you up. These names are based on one or two
negative occurrences. They ignore everything else about you
and imply many faults that you don’t have.
e.g. “I’m a failure” or “I’m a wimp”.
□ Disqualifying the positive: Even if you do become aware of
positive facts, finding a way to discount them.
e.g. “I did manage in that situation, but anyone would have
done”.
“I enjoyed going out, but I still felt depressed afterwards”.
□ Catastrophising: Predicting that things that happen will be
catastrophes, i.e. disastrous or dangerous, rather than merely
unpleasant or upsetting.
e.g. noticing your heart beating fast and predicting you will
have a heart attack and die;
e.g. “If I make a mistake at work, I’ll lose my job. I’ll lose my
house and end up living on the streets.”
□ Jumping to Conclusions: Seeing things as being negative
whether or not you have any facts. Assuming special powers
to tell how badly people are thinking of you (mind reading)
or what is going to go wrong in the future (crystal ball gazing
/ fortune telling).
e.g. “They think I look stupid”.
“I’m going to be sacked”.
□ Personalisation: If something bad happens, assuming it’s your
fault; ignoring any other possible causes.
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e.g. “the kids were behaving badly today – I must be a bad
mother”.
“It was my fault that mum was upset”.
□ Should Statements: Having strict, unrealistic rules for yourself,
which you have little chance of keeping especially when you
are feeling low or anxious, which causes further guilt and
anger. These often reflect high standards for yourself, which
you would not expect of others – a double standard.
e.g. “I ought to have achieved more than this”.
“I should not upset people”.
“I shouldn’t be feeling like this, I should be able to cope”.
□ Emotional Reasoning: Because you feel bad, assuming that
things are really bad; confusing your thoughts with facts.
e.g. “I feel guilty so I must have done something wrong”.
“I feel anxious, so something dangerous is about to
happen”
It can be very helpful to notice when you are using these thinking
errors, as they make you feel worse. You can then take a step back
from thinking this way and start to question your thoughts.
Use the form on the next two pages to start recording your
thoughts when you notice that you are feeling anxious or
depressed. Two examples are given to help you. In your next
appointment, you and your Psychological Wellbeing Practitioner
(PWP) will discuss what you have written and how to start
changing these thoughts.
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Situation
What was happening? Where
were you? What were you
doing? Who were you with?
Emotion(s)
How did you feel
emotionally? How
strong was the
feeling from
0-100%?
Negative automatic thoughts
(words/images/memories)
What was going through your mind just
before you felt the strong emotion?
What were you afraid might happen?
What would it say about you/others/the
situation/the future?
Called in sick from work. Depressed 80%
Sitting at home, thinking
about problems, alone.
I should have gone to work. I’m a
burden to others. I’m letting people
down.
Went for a meal out
with family, in a pub.
Standing at the bar,
waiting for a table. Pub
was crowded.
It’s too hot in here. There are too
many people. I need to get out. I’m
going to faint. Imagined myself
falling to the floor in the middle of
the room.
Anxious 70%
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Situation
What was happening? Where
were you? What were you
doing? Who were you with?
Emotion(s)
How did you feel
emotionally? How
strong was the
feeling from
0-100%?
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Negative automatic thoughts
(words/images/memories)
What was going through your mind just
before you felt the strong emotion?
What were you afraid might happen?
What would it say about you/others/the
situation/the future?
Thought Challenging - Part Two
Now that you have started to notice your unhelpful thoughts, you
can begin to use a specific technique to challenge them and help
you feel better.
Case Example
Ian is a 52-year-old man who has been depressed and anxious after
taking early retirement 6 months ago. He has become increasingly
depressed and feels that he is no good to anybody. His wife has
continued to work and he feels he is no good in the house and has
lost his role as a worker. Since retiring he has not taken on any
new activities and spends most of his day reading the paper and
cat-napping. He feels depressed and is often tearful. As he is
sleeping a lot in the day he is finding it difficult to sleep at night. He
has lost his confidence and now finds that he is anxious in situations
that he used to cope with previously such as going out, meeting
friends and family.
Ian then completed the thought diary:
Situation
Emotion(s) Negative automatic thoughts
Rate how
bad it was
(0 – 100%)
Rate how much you believe this thought (0 –
100%)
Sitting at home
Sadness
(80%)
I am no good to anybody. (80%)
Letter from
work colleague
wishing me
well and
asking to visit
me
Sadness
(90%)
Fear
(90%)
My life has absolutely no purpose.
(90%)
I won’t have anything to say. (90%)
Broke the
vacuum
Angry
(95%)
Everything I touch or do goes wrong.
I am hopeless. (100%)
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On a separate piece of paper Ian challenged one of these thoughts
(the first one) by looking at the evidence for and against his chosen
thought. When he was collecting evidence for and against his
thought he focused only upon facts which have evidence to support
they are true, are undisputable and driven by rational thought. He
did not include opinions which are based upon a belief or personal
view and are arguable.
My thought
My percentage belief
I am no good to anybody
80%
Evidence for
Evidence against
I do little with my day, I just
sit and read the paper and do
a few chores.
Last week my daughter said I
was simply wonderful when I
looked after (Jack) my grandson
when he had a stomach bug and
she had to go to a really
important meeting.
I was an active working man
and was contributing
something to society and now
I am not contributing.
Jean my neighbour was very
grateful when I gave her a lift to
the hospital for an appointment.
Brenda (my wife) said how good
it was to see more of me and
that we spend more time
together.
A work colleague asked me if I
would be interested in teaching
carpentry to youngsters at the
local college.
My wife, children, and
grandchildren tell me they love
me dearly.
When Ian looked at this, he saw that he had been somewhat
mistaken in his belief that he was no good to anybody. Next, he
wrote a revised thought in light of this evidence and rated his belief
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in his new thought. He then re-rated the emotion he initially felt in
the situation. This can be found in next box:
Revised thought
Emotion(s)
There are many people
around me who I am
important to (95%)
Sadness (20%)
Rate how much you believe this
thought (0 – 100%)
Re-rate the emotion you felt initially
(0 – 100%)
As can be seen, Ian’s distress reduced. He continued to work with
his thoughts in this way and within a few weeks saw how his
depression reduced. Within eight weeks his difficulties had reduced,
his sleep had improved and he had taken up an activity (teaching at
the local college). After 3 months he had improved even further.
As you can see, thought challenging can be very helpful for
reducing anxiety and/or depression. It can be time-consuming at
first, but it is important to write your thoughts down to help you
think clearly about them. The more you carry out this thought
challenging exercise, the easier you will find it. Eventually you will
not need to write your thoughts down as you start to challenge
your unhelpful thoughts more automatically as they occur.
It can be upsetting to see your unhelpful thoughts written down on
paper, but by the end of the exercise hopefully you will be feeling
better. If your thought has not changed, ask a friend to help you
with this, or take a thought that is easier to work with. You can also
plan to do something nice for yourself after you have spent some
time on your thought challenging exercises.
Pages 10 and 11 of this booklet are for you to practise using this
thought challenging technique. All the stages of thought challenging
are put next to each other in one table called a thought record.
Collect some examples as you did before and write down evidence
for and against your thoughts. Then write a revised thought that
takes all the evidence into account and re-rate how you feel. There
are no right or wrong answers. See what you can manage and
discuss this with your PWP in your next appointment.
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Questions to Help you Challenge your Negative Automatic
Thoughts
If you are struggling to think of evidence that does not support
your negative automatic thoughts, try answering some or all of the
following questions. You can write your answers in the fifth column
(Evidence against the unhelpful thought) of the thought records on
pages 10 and 11.
What would I say to a friend if they were in this situation and
thinking like this?
If someone who cared about me knew I was having this thought,
what might they say to me?
What will I think about this situation in five years time?
If I was not feeling upset/depressed/anxious, would I think about
this situation in a different way? How would I think about it
instead?
Are there any small things that suggest my negative thoughts are
not true that I am forgetting or discounting as not important? If so,
what are those things?
Am I jumping to conclusions or making generalisations? If so, in
what way?
Am I making any other thinking errors? If so, which ones? What
might be more realistic to think?
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Situation
What was
happening?
Where were
you? What
were you
doing? Who
were you with?
Emotion(s) Automatic thoughts
How did
you feel
emotionally?
How strong
was the
feeling from
0-100%?
Evidence for the
What was going through your unhelpful
mind just before you felt the
thought
strong emotion?
What were you afraid might
happen?
What would it say about
you/others/the situation/the
future?
How much did you believe
the thought 0-100%?
What FACTS are
there that suggest
this thought is true?
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Evidence against
the unhelpful
thought
What FACTS are
there that suggest
this thought is not
true?
Revised thought
What alternative
thought sums up ALL
the evidence? How
much do you believe
this thought 0-100%.
Emotion(s)
How do you
feel about the
situation now,
in light of your
revised thought?
Re-rate the
emotion you felt
from 0-100%.
Thought Challenging - Part Three
“The best way to increase the believability of your alternative or balanced
thoughts is to try them out in your day to day life”
– Greenberger & Padesky, 1995.
We learn things in two main ways:
 How we think about them
 How we feel about them
Sometimes you may have spent large amounts of time challenging your
thoughts to find that these two systems are at odds with each other. You may
rationally and logically think or know something but still have an incongruent
emotional reaction- “I know it but I don’t feel it!”
If this is the case it may be that with the support of your Psychological
Wellbeing Practitioner (PWP) you could design an experiment to test a
thought.
Case example
Ken had been married to Vera for many years. Just over a year ago Vera died
quite suddenly. Whilst she was alive Vera and Ken had a very traditional
relationship- he went to work while she took responsibility for cooking,
cleaning and organising the bills. Since Vera’s death Ken has felt he cannot
deal with all the things Vera dealt with and has started to feel very
overwhelmed. The growing list of uncompleted tasks was starting to have a
huge impact on Ken and he was worrying that he would never be able to
complete the tasks. As a consequence Ken is becoming increasingly worried he
will have to move in with his children or into a care home, a thought that
was starting to get him down. Ken identified a list of goals he would like to
complete with his PWP such as paying an overdue gas bill and making himself
a healthy meal but surmised with the following thought “Vera has gone and I
won’t be able to manage to do the things she used to”.
Ken then carried out an experiment to test this thought, as shown on the
worksheets on the following pages.
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Step One
 Using worksheet A (at the end of the booklet) write down the thought
you would like to test. This may be a thought you have collected from
a thought record sheet or from a session with your PWP.
 Rate your current belief in this thought (0-100%) and make a plan for
how you are going to test this thought and put it into action. Be
specific- when are you going to do it? How? Where? With whom?
Thought to Be Put Into Action
Testing It Out
What is the thought you want to put into
action?
What are you going to do?
Vera has gone and I won’t be able to
manage the things she used to.
How much do you believe
this thought?
90%
I am going to telephone the gas
company and try to pay my overdue
gas bill.
Where are you
going to do it?
By telephone
at home.
When are you
going to do it?
Tomorrow
morning at
9.15am.
Just me!
Who is involved?
Step Two
 Predict what you think will happen when you put your thought into
action. Rate how likely this is to happen (0-100%).
 Generate an alternative prediction and rate how likely you think this is
to happen (0-100%).
Predicting the Worst
What’s the Alternative?
What do you fear is going to happen?
What are your alternative predictions?
I will not be able to cope with all the
questions I will be asked, I will get
really upset and have to end the callthis would make me sad and mean I
can’t cope.
I will be able to cope with the
questions and manage the gas bill
despite feeling upset.
How likely do you think this
is? (0-100%)
How likely do you think this
is? (0-100%)
85%
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15%
Step Three
 Before you act have a think about what problems might arise and stop
you acting on your plan to do the experiment. Think about internal
things like lack of motivation or fear and external things like sorting
childcare. Try to plan in advance so that these difficulties do not arise.
What may stop you?
Clearing the way
What things may get in your way?
How will you overcome these?
I know I will get scared and perhaps
tearful before making the call and
this may put me off.
I’m not sure where to find the
telephone number.
Although I know I will be scared and
tearful I know this feeling will pass
and I will tell myself this. I know I
have coped with scary things in the
past and will remind myself of this.
I will make sure I have the gas bill
with the phone number to hand.
Step Four
 Carry out your plan!
 Fill in worksheet B (at the end of the booklet) as soon as possible after
you have completed your experiment. Consider what you learnt, how
can you change your original thought as a result? How strongly do you
believe this new thought? What will you do differently in the future? Or
do you need to conduct another experiment?
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Reviewing your prediction
What happened?
Write your original prediction below
Briefly describe what happened
I will not be able to cope with all the
questions I will be asked, I will get
really upset and have to end the callthis would make me sad and mean I
can’t cope.
How likely did you originally
think this was?
85%
I phoned the gas people and spoke to
a nice man who took his time and
helped me pay the bill over the
telephone. He also helped me by
explaining I could set up a direct
debit so that it will be paid
automatically in the future. He is
going to send me the paperwork. I
felt pleased afterwards.
My Learning
Doing Things Differently
How would you change your original
thought to account for new learning?
Although Vera has gone I am able to
do some of the things she used to do
for myself.
Based on the new thought what may you do
differently in the future?
I will have more confidence in trying
to do some of the things she used to
do. If I get scared and upset I will
remind myself that it’s OK not to
know but that other people can and
will help me find the answer.
How much do you believe this new
thought?
How much do you still believe your
original thought?
50%
60%
Looking Forward
Are there any further experiments I could complete that might be helpful?
I think I need to keep doing the things Vera did to get some more confidence. I
might ask my daughter to teach me to cook some simple meals and if this goes
well I could enrol on a cookery course.
Step Five
 Review how your experiment went at your next appointment with
your PWP.
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Remember…
 Your experiments are designed to test YOUR thoughts so be CREATIVE
- you could pick active experiments like Ken’s which involve doing an
activity for real, simulations with a friend, observation experiments,
surveys or simple data gathering from books or internet.
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WORKSHEET A
Thought to Be Put Into Action
Testing It Out
What is the thought you want to put into
action?
What are you going to do?
Where are you
going to do it?
When are you
going to do it?
How much do you believe
this thought?
Who is involved?
Predicting the Worst
What’s the Alternative?
What do you fear is going to happen?
What are your alternative predictions?
How likely do you think this
is? (0-100%)
How likely do you think this
is? (0-100%)
What may stop you?
Clearing the way
What things may get in your way?
How will you overcome these?
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WORKSHEET B
Reviewing your prediction
What happened?
Write your original prediction below
Briefly describe what happened
How likely did you originally
think this was?
My Learning
Doing Things Differently
How would you change your original
thought to account for new learning?
Based on the new thought what may you do
differently in the future?
How much do you believe this new
thought?
How much do you still believe your
original thought?
Looking Forward
Are there any further experiments I could complete that might be helpful?
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References
In creating this booklet the following resources were usedChellingsworth, M. & Farrand, P. (2011), Behavioural experiments in low
intensity CBT, The University of Nottingham.
Greenberger, D. & Padesky, C. (1995), Mind over Mood: Change how you
feel by changing the way you think, New York: The Guilford Press.
Lovell, K (2000), SHADE: A self help manual for anxiety and depression,
accessed on 17th April 2012 at http://www.gptraining.net/pal/mentalhealth/doc/shade.doc
Richards, D. & White, M. (2009), Reach out educator manual, 2nd edition,
Rethink.
When to seek further help
Some people need further professional help. It is your decision, but we
would strongly recommend that you go to see your doctor or discuss with
your PWP if any of the following are present:
 You feel that life is not worth living, you have thoughts of harming
yourself or others, or have harmed yourself. If you feel like this when
your worker is not available you can contact:
o The duty worker at the Mental Health Access Team on 01226
707600, Mon - Fri, 9am – 5pm.
o Your GP practice
o Your GP practice out of hours service
o NHS Direct 24 hours a day – 1111
o A&E at Barnsley hospital in an emergency.
 You misuse alcohol or drugs.
 You do not feel that you have improved using this manual.
If any of the above are present feel free to discuss this with your PWP or
GP. You are not alone and there are other services and help that can be
offered.
Booklet produced by Mental Health Access Team, Barnsley (2013)
South West Yorkshire Partner NHS Foundation Trust
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