SOWK6190/SOWK6127
Cognitive Behavioural Therapy and Cognitive Behavioural Intervention
Week 5 - Identifying automatic thoughts and emotions
Dr. Paul Wong, D.Psyc.(Clinical)
Outline
Review of homework
Recap of what we have learn
This week’s agenda
In-class activities
Homework
Recap - Typical agenda for session 2 and beyond
1. Brief update and check on mood
2. Bridge from previous session
3. Setting the agenda
4. Review of homework
5. Discussion of issues on the agenda, setting
new homework, and periodic summaries
6. Final summary and feedback
Key message
Certain events are almost universally
upsetting: a personal assault, rejection, or
failure.
However, people with psychological
disorders often misconstrue neural or even
positive situations and thus their automatic
thoughts are biased.
Although automatic thoughts seem to pop up
spontaneously, they become fairly predictable
once the patient’s underlying beliefs are identified.
The cognitive therapist is concerned with
identifying those thoughts that are dysfunctional,
that is, those that distort reality, that are
emotionally distressing and/or interfere with the
patient’s ability to reach her goals.
Automatic thoughts are usually:
Quite brief;
Shorthand, e.g., “Ding”
In verbal or visual form or both
Can be evaluated according to their validity
and their utility
1. Distorted thought
2. Accurate but Distorted conclusion
3. Accurate but decidedly dysfunctional
Explaining automatic thoughts to patients
pp.78-80 (please read carefully)
Eliciting automatic thoughts
“What was going through your mind just then?”
Key: take notice of affect shift
can follow up with “how are you feeling right now?”
If that doesn’t work out, do not ‘interrogate”
Identifying automatic thoughts in a specific
situation
It will be useful for goal setting!!
Identifying additional automatic thoughts
The Socratic questioning technique comes
in handy (pp.85):
“What else went though your mind?”
“Then what?”
“Then what happened?”
Automatic thoughts vs. Interpretations
AT are the actual words/pictures that have
gone through the mind
Interpretations are words that the client used
to interpret the thoughts
In class activity 1
Please educate your client to
identify automatic thoughts
Try to do a few examples, i.e., ask
for specific situation,
interpretation, embedded in
discourse etc.
Section 2: Identifying emotions
Intense negative emotion is painful and may be
dysfunctional if it interferes with a patient’s
capacity to think clearly, solve problems, act
effectively, or gain satisfaction.
The therapist does not analyze ALL situations in
which the patient feels dysphonic, however;
cognitive therapy aims to reduce the emotional
distress that is related to misinterpretations of a
situation.
Do clarify confusion of thoughts and feelings when
necessary
Do this based on your clinical judgment!!!
Investigate further when the patient reports an emotion that
does not seem to match the content of the automatic
thoughts
Especially with Chinese clients whose
vocabulary for feelings are limited
In class activity 2:
With your partner, please try to identify as
many Chinese words for feelings as possible
Section 3: Evaluating Automatic thoughts
Once AT are identified, the therapist can do:
1.Focus on the AT – “What did you DO after you had the thought?”
2.Find out more about the situation associated with the thought – “Tell
me more about the situation.”
3.Explore how typical the AT is – “How often do you have this kind of
thought?”
4.Identify other AT in the same situation – “Anything other thoughts do
you have?”
5.Do problem-solving about the situation – “What do you think you
should do?”
6.Explore the belief underlying the AT – “If this thought is true, what
would it mean to you?”
7.Move on to another topic – “Can you tell me what else happened this
week?”
How do you choose what to do?
1. What am I trying to accomplish in this session?
2. What did the patient put on the agenda?
3. Is this an important thought on which to focus?
Focusing on an AT
Check how strong the thought and feeling are attached to
it!
If severe, then pursue…… (pp.107)
Link with a bigger picture – “Could this be another example
of how you consistently predict you will fail?”
Use Socratic questioning to deepen the understanding of
the thought or do problem-solving
Please do not CHALLENGE the thought because:
1. You do not know in advance that any given AT
is distorted; and
2. A direct challenge violates a fundamental
principle of cognitive therapy that of
collaborative empiricism (this is the difference
between a therapist and a layman)
3. Go to pp.108 and 109! – Questioning your
though exercise. (Handout!)
Cognitive Distortions
(the fun of CT begins)
pp.119, let’s discuss them
slowly!!
Questioning to evaluate the utility of
automatic thoughts
“What’s the advantage of continuously
telling yourself, “I’ll never get it, I will never
get it”?”
“What’s the DIS-advantage of continuously
telling yourself, “I’ll never get it, I will never
get it”?”
Recap of this week materials
• Your roles:
1. To educate the client about AT and feelings
associated with it
2. Help client to identify it
3. Use AT as an opportunity to make your client
less distressed, less dysfunctional, come up with
ways to deal with similar situations, teach client
to be their own therapist.
You may FAIL because:
1. There are other more central automatic thoughts left
unidentified or unevaluated
2. The evaluation of AT is implausible, superficial, or
inadequate
3. The client has not sufficiently expressed the evidence
she believes supports the AT
4. The At is also a core belief
5. The client understands “intellectually” that the AT is
distorted but does not believe it on a ore “emotional
level”
6. The client discounts the evaluation
Homework
Make sure you know how to use the Questioning your
thought exercise, do it as many times as you can on
yourself!