Denise Hashempour
1. Eliciting automatic negative thoughts.
2.Generating alternative ideas.
3. Testing automatic thoughts.
4. Modifying underlying assumptions.
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We are all often unaware of our negative
thoughts because they occur so quickly, often
we feel the emotion first. Using CBT
approaches we can help the client become
aware of their automatic thoughts and
therefore the connection to their emotional
state and vice versa in a number of ways.
Catching and highlighting shifts in emotions - If
we identify changes in mood in session we can
assist the client to identify associated thoughts.
Picturing the scene – if the client can identify events
or situations associated with emotional response,
the therapist can assist the client to picture the
distressing situation in detail to access the
automatic thoughts they were having at the time
Role Playing – If the trigger event is interpersonal in
nature role play may be more effective than
imagery.
Daily Record of dysfunctional thoughts – Client can
identify and become aware of automatic negative
thoughts.
Establishing meaning of the event – Client may
only remember vague details. Asking the client
about the significance of the event may help
access NAT’S
Behavioural tasks –Encouraging client’s to
monitor their thoughts and identify them
through the use of homework tasks.
Inductive questioning – Teaching the client to
ask themselves questions designed to explore
some of the possible reasons for their
emotional reactions.
Once automatic thoughts have been accessed
we need to help the clients develop alternative
ways of interpreting the events which are more
helpful. The client needs to develop these new
alternatives themselves rather than being told
what to think by the therapist.
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Distancing – Encourage client to stand back from their
thoughts in order to get a more objective view.
Role reversal – Getting client to discuss with the therapist
as with a friend the therapist arguing for the thought, the
client is encouraged to develop alternatives based on
available evidence
Socratic questioning – This involves asking client
questions which the client has the capacity to answer,
drawing attention to information relevant to issue being
discussed, but may be currently outside client’s focus.
Moving from concrete to abstract, encouraging client o
apply the new information to either re evaluate a previous
conclusion or construct a new idea.
Record keeping – Dysfunctional thought diaries to
encourage client to develop alternative views
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Alternative Thoughts
Hot Thoughts
Unhelpful thinking styles
1.Are always about something bad about
yourself
2. Are always self sabotaging
3. Are uninvited
4.Are believable
5. Are based
It can be difficult helping the client identify and
recognise their own automatic thoughts.
It is important not to assume this is because the
client is resistive to treatment.
 Look at and consider the meaning of words
and images.
 Continue with standard techniques including
review of upsetting events, mood changes
occurring in session and automatic thought
records. Review with client.
What is the effect of thinking this way ?
 Are you seeing things worse than they
actually are?
 Would this view help you to deal with the
problem ? Would another view be more
helpful?
 So what if this was true? Would it be really as
bad as what you are thinking?
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Is there anything you can do differently
How would you test out the accuracy of this
thought?
How would you find out if another view fits
better?
If you weren’t thinking so negatively what
would you do about this ?
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Do not intellectualise the problem by having
abstract discussions regarding emotions.
Do Slow the pace of therapy whenver there
are signs of emotional experience.
Encourage articulation of any flicker of feeling
elicited.
Work with client to formulate beliefs about
emotions
Do not insist client discusses the upsetting
thoughts, at the same time don’t change focus to
another unrelated subject.
Q – What feelings does thinking about it provoke?
Q-Are you afraid it will be painful to remember and
talk about?
Q-What thoughts are you having about thinking
about the situation?
Q – When was the first time you felt like this?
Q – What are the benefits/disadvantages to
discussing it?
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Look out for the client reporting and
volunteering unrelated or positive thoughts and
not reporting any negative thoughts.
Q – I notice you have come up with several
thoughts, but have avoided any negative
thoughts is there a reason for this?
Q Can you tell me more?
Q – Is it difficult for you to think of negative
thoughts.
You could also discuss the pro’s and con’s of
avoidance as a coping strategy.
Client blames therapist for distress
Statement – You’ve noticed a powerful link
between your thoughts and emotions
Q - I can see you are distressed by this it's
interesting that this appears to be aimed at me
is anyone else you feel may be responsible for
your NAT’s (Transference issues check)
Q – Can you describe the link between your
thoughts and emotions ?
Q – Can you see any link between your
increased thinking and increased emotions?
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Behavioural, cognitive and emotional
avoidance can make it hard to identify ‘hot’
cognitions
Avoidance or distress about tasks in therapy
can be used to help identify negative
thoughts about the therapy itself
Negative thoughts about therapy can help
identify and test out ‘hot’ cognitions
Negative thoughts in persistent depression
often does not respond to an increase in
questioning
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Guiding the client in identifying specific
thoughts and evidence may be useful in
undermining global and rigid thinking
processes
Small changes in thinking are valuable and
should be reinforced
Be mindful of your own unhelpful negative
thoughts when confronted with difficulties