Thought records are generally an effective intervention; however, some are more helpful than others. Below is a checklist you can use to check that a thought record is well done. You can find a copy of Checklist of Common Problems with Thought Records at http://www.newharbinger.com/38501.
G Is the situation a factual description of what occurred?
G Did my client identify and rate his or her feelings?
G Did my client identify his physical reactions?
G Is the behavior a factual description of what my client did?
G Is the thought my client wants to focus on a hot thought?
G Is the thought about self, others, or the future?
G Is the thought related to his or her negative feelings?
G Does the evidence against address the hot thought?
G Does the balanced thought address the hot thought?
It is important that the evidence you gather challenge the hot thought you are working on. For example, a colleague had passed Raoul in the hall and had not said hi. Raoul thought, My colleague is avoiding me. His evidence against his thought was, My bowling buddies are happy to see me. This evi- dence will help Raoul feel better, but it is not related to the thought, My colleague is avoiding me. In this situation you need to keep exploring Raoul’s thoughts using Questions to Identify Evidence Against Negative Thoughts to find evidence related to the hot thought you are working on.
It is equally important that the balanced thought directly address the hot thought. For example, if the original thought was about self, the balanced thought needs to be about self; if the original thought was about others, the balanced thought needs to be about others. When Raoul was assigned to work with junior colleagues, his original thought was My boss doesn’t respect me. After examining the evi- dence for and against, his initial balanced thought was I work very hard and do a good job. This is a generally helpful thought that will increase Raoul’s positive mood. If I were his therapist, I would be delighted that he was able to have such a positive thought about himself. However, the hot thought was about others (his boss), and the balanced thought needs to also be about others. A better balanced thought would be, Even though I was asked to work with junior colleagues, this does not mean my boss does not respect me. There is a lot of evidence that my boss still respects me and my work.
It is helpful to keep this list in mind when examining your clients’ thought records. Take a moment after your session is over and on your own review your client’s thought record, using the checklist. After you have used it a few times, it will become second nature.
Exercise 8.5: Common Problems with Thought Records
Practice using the checklist for identifying common problems in thought records.
Homework: Practice CBT
Before continuing with the next chapter, take some time to try the homework.
Apply What You Learned to a Clinical Example
Complete the following exercises.
Exercise 8.1: Suzanne Is Upset with Her Husband Exercise 8.2: A Therapist Is Having a Bad Day Exercise 8.3: Suzanne Is Asked to Be a Maid of Honor Exercise 8.4: Suzanne Reviews Her Balanced Thought Exercise 8.5: Common Problems with Thought Records
Apply What You Learned to Your Own Life
I think you only become a committed CBT therapist when you experience how helpful it can be to identify your own negative thoughts, step back and examine the evidence, and then develop a balanced thought.
Homework Assignment #1
What Is the Evidence?
This coming week, when you have a strong emotional reaction, try to identify the situation, identify and rate your feelings, and then identify your thoughts. Choose one thought to examine using Questions to Identify Evidence Against My Negative Thoughts. Record your answers on the following worksheet.
Examine the Reality of Your Thoughts
Thought I want to examine:Evidence for My Thought Evidence Against My Thought
Conclusion or thoughts that consider all the evidence:
Homework Assignment #2
How Probable Is My Prediction?
This coming week when you are anxious, notice your negative predictions. Rate the probability that each will occur, look at the evidence, and then rerate the probability. Try to use the How Probable Are My Predictions worksheet.
Homework Assignment #3
Is There Another Interpretation?
This coming week when you are upset by what someone did to you or by a situation, ask yourself if there is a more benign interpretation. Ask yourself if you are considering all of the facts of the situation. Are you blaming yourself for something you have no control over? Try to use the Other Ways of Understanding the Situation worksheet.
Apply What You Learned to Your Therapy Practice
It is time to start asking your clients to examine the evidence for their thoughts. Try to help a client identify her trigger situation and then identify and rate her feelings and thoughts. Once you have iden- tified a central thought, introduce the idea of looking for evidence and use the Questions to Identify Evidence Against My Negative Thoughts. Make sure that the evidence is concrete and addresses the hot thought. Use the Examine the Reality of Your Thoughts worksheet to record your client’s responses.
Let’s Review
Answer the questions under each agenda item.
Agenda Item #1: What are thought records?
• What are the essential steps in a thought record?
Agenda Item #2: Explain looking for evidence.
• How could you introduce looking for evidence to your clients?
Agenda Item #3: Find evidence that supports negative thoughts.
• Why is it important to look for facts that support negative thoughts?
Agenda Item #4: Find evidence against negative thoughts.
• What are three questions that will help gather information against a client’s negative thoughts?
Agenda Item #5: Develop balanced thoughts.
• How could you consolidate a balanced thought?
What Was Important to You?
What idea(s) or concept(s) would you like to remember?
What idea(s) or skill(s) would you like to apply to your own life?
What would you like to try this coming week with a client? (Choose a specific client.)