Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
The goal of therapy is to help the client transition from distorted and maladaptive thoughts to healthy and adaptive thoughts to help the individual adaptively cope and function. Standard methods used to accomplish these goals include: • Identifying automatic thoughts. • Evaluating automatic thoughts. • Modifying automatic thoughts. Identifying automatic thoughts must occur before the thoughts being evaluated or modified. Each of these interventions may be implemented using the following techniques, presented with examples involving dia- logue between the client and therapist, constructed to illustrate and reflect simplified versions of such interactions. Note that the techniques presented here are not an exhaustive list of all the techniques available in cognitive therapy for addressing automatic thoughts. Identifying Automatic Thoughts Identifying automatic thoughts comes easily for some clients and not so easily for others. Sometimes clients may mislabel an emotion as an automatic thought. Others may firmly state that they don’t have thoughts before they experience an emotion, that the situation automatically elicits their emotions without a thought mediating the response. The following techniques provide some strategies for identifying automatic thoughts. Technique: Questioning The therapist asks the client questions to elicit automatic thoughts. Examples of questions include (1) What was going through your mind at that moment? and (2) What were you thinking at the time? Clients can be taught to be their own therapists and learn to ask themselves these questions outside of therapy as well when they notice they are feeling distressed. Example (C = client; T = therapist): C: I was sitting by the phone and just felt so depressed when my boyfriend didn’t call me last night. T: What were you thinking when you were sitting by the phone? C: He hasn’t called. He doesn’t love me [automatic thought]. Technique: Targeting a Behavior or Affect Shift (in session) (J. S. Beck, 2020) During a session, the therapist may note that a client’s nonver- bal behavior has shifted or that their emotions have changed. This is an excellent time to inquire about what was running through the client’s mind.
• How would your experiences change if you substituted an alternative belief for the dysfunctional belief? Guided discovery refers to the therapist acting as a guide for the client in modifying maladaptive thoughts and beliefs. Through guided discovery, the therapist’s questions and the pair’s discussion will elicit cognitions (J. S. Beck, 2020). The therapist may determine which cognitions have the potential to be upsetting for the client and can then use guided discov- ery and questioning to help the client gain distance, evaluate validity and utility, and address maladaptive beliefs (J. S. Beck, 2020). This can lead to developing coping skills, modifying cognitions, and developing more realistic and rational perspec- tives. For example, the therapist may guide the client to explore the costs and benefits associated with a particular pattern of thought rather than simply point out the maladaptive nature of the thought. Like Socratic questioning, guided discovery is not intended to trap the client in or lead the client to adhere to a set of beliefs prescribed by the therapist. Instead, it seeks to offer opportunities for the client to discover and use new pieces of information and experiences in the effort to think and behave more adaptively and healthily. Techniques associated with cognitive therapy are conducted via these practices. The following sections present a few techniques used in cognitive therapy. The information is organized into categories reflecting the abovementioned cognitions: automatic thoughts, intermediate beliefs, and core beliefs. Techniques for Addressing Automatic Thoughts Automatic thoughts are not unique to individuals with psy- chological problems, nor are automatic thoughts inherently problematic. As previously described, cognitions can contrib- ute to distress when irrational, dysfunctional, maladaptive, or unhelpful. Difficulties can arise for many reasons. Perhaps the individual is unaware of having a particular pattern of automatic thoughts, resulting in emotional distress and prob- lematic behavioral choices. Perhaps the individual believes that thoughts are always accurate and has never attempted to test them. Or maybe the thoughts are actually realistic, but the pattern of thinking is not adaptive (e.g., rumination); in this scenario, thoughts can undoubtedly be accurate but not helpful. Remembering that automatic thoughts are the type of cogni- tion most easily accessed by individuals, one goal of the cog- nitive therapist is to assist the client in beginning to identify automatic thoughts so that they can then evaluate and modify distorted thought patterns. Later, the therapist helps the cli- ent assess the thoughts through questioning while modeling a logical and rational approach. It is important to note that questioning a thought is not the same as directly disputing it. Also, remember that the goal of this process is not to alleviate all forms of distress (distress is normal in response to certain events), negative emotions (negative emotions are inevitable parts of the human experience), or negative thoughts (some negative thoughts are realistic and not distorted).
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