______________________ Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition
Example: C: Well, I just, well, I don’t know. [Client shifts position and looks down at the floor.] T: I just noticed that you sank into your chair. What were you thinking just then? C: I don’t get what you’re telling me. I was thinking that therapy won’t work for me. I am so stupid [automatic thought]. Technique: Recalling Situational Events The client can be prompted to recall a time over the past week in which they felt down, anxious, angry, or a similar emotion. The therapist works with the client to recall thoughts associ- ated with the emotional event. Example: T: Tell me about a time over the past week in which you felt anxious. C: Sure. Um, I had my job interview on Thursday at 9:00 a.m. and at 8:40 a.m. I was stuck in traffic. T: What was going through your mind when you noticed it was 8:40 a.m.? C: I only have 20 minutes to find the building, park, walk in, and find the office. I’ll never make it in time. I’ll never get a job [automatic thought]. Technique: Prioritizing Thoughts (J. S. Beck, 2020) The client may present several thoughts to the therapist. The therapist’s task then becomes figuring out which of these thoughts is the most distressing or which is the most relevant given the therapeutic goals. When presented with multiple thoughts, the therapist can target the ones that seem most appropriate to the goals of the therapy session and explore the thoughts with the client further to see to what degree they result in distress. In the following example, the client is working on identifying and modifying thoughts maintaining depression, leading to behavioral apathy and isolation. Example: C: I thought that maybe I should try something new, even though I haven’t really gotten out of the house much. I’d have to ride the bus, which would be just terrible. I thought that maybe I could have Joe go with me if I decided to go to the coffee shop. And I thought about how awful I’d feel if I had to go without Joe. T: [Selects the thought most congruent with treatment goals to explore further and asks for more data.] What were you envisioning the trip to the coffee shop would be like without Joe?
C: I’d be alone. People would stare at me. They would think that I am weird or something. T: What would it mean if they stared at you? C: I’ll never fit in [automatic thought]. T: And how do you feel when you think, “I’ll never fit in?” C: Depressed, like, why should I even bother trying? Technique: Clarifying Language (Leahy, 2017; J. S. Beck, 2020) Over time, brief phrases or words can take on more complex meanings. For example, the exclamation “Oh, fudge!” doesn’t mean, “Look, there’s fudge on the table.” It reflects a disap- pointment or problematic surprise and can hide important automatic thoughts. Example: T: What were you thinking when you heard the news about your friend’s promotion? C: I thought, “Whatever.” T: Hmm. What meaning does the term “whatever” carry for you? C: That’s a tough one. I guess it means, “Of course, she got promoted! She’s smart, driven, and doesn’t have prob- lems like me. I’ll never get promoted.” [automatic thought] Technique: Relationship Between Thoughts and Feelings The therapist can educate the client about the differences between thoughts and emotions and conduct exercises to help the client see the relationship between the two. Example: T: You couldn’t remember where you put your car keys, and you thought, “I am going nuts.” How did you feel
when you thought that? C: Scared, anxious.
T: Would you feel differently if you thought, “Everyone misplaces their keys from time to time. I’ll find them even- tually?” C: Calmer, more hopeful. I wouldn’t be as scared. Technique: Using Ratings to Identify a Key Automatic Thought (J. S. Beck, 2020) Once automatic thoughts are identified, the therapist must determine whether the thought is worth focusing on or if the team should move on to another thought or agenda item. This can be accomplished by considering several factors, including: How frequently does the individual have this thought? How
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