Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
distressing (emotionally, behaviorally, physiologically) is this thought? Would focusing on the thought help in achieving the therapeutic goal? Is the thought dysfunctional? The following example illustrates a rating of the degree of distress. The thera- pist has the client rate the degree of intensity of his emotions associated with his automatic thoughts to determine which thought is associated with considerable distress. The “hot thought” in the following example is “I am a bad accountant,” and this thought will be targeted further. The thought “My boss will be angry with me” does not produce much distress and therefore will likely not be explored further. Note that it is unrealistic to aim to reduce a rating of a thought or belief to zero; rather, the goal is to reduce the rating to a reasonable, functional level. Example: T: So, you thought, “I am a bad accountant.” How did this make you feel? C: Annoyed at myself. T: How annoyed does it make you feel? On a scale from 0 to 100, with 0 being not annoyed at all and 100 being the most annoyed you could imagine being, how annoyed were you? C: About 80: I get really annoyed. T: And this other thought, “My boss will be angry with me,” how does this make you feel? C: Worried. T: And on the scale? C: Probably about 20, just a little bit worried, really. Evaluating and Modifying Automatic Thoughts Interventions for evaluating and modifying automatic thoughts may be used once automatic thoughts have been identified. Technique: Identifying Cognitive Distortions (Beck, 1979; J. S. Beck, 2020; Leahy, 2017) Psychological problems are viewed as the result of recurring patterns of distorted thinking. Evaluating whether an auto- matic thought (or other cognition) reflects a dysfunctional pattern can assist the client in modifying thoughts and beliefs. Cognitive distortions are also sometimes referred to as thinking errors or mistakes. Box 1 lists examples of cognitive distortions. Technique: Questioning the Evidence (J. S. Beck, 2020) Through questioning, the therapist can guide the client through a process of evaluating their automatic thoughts. This process attempts to help the client discover a more realistic perspective on the matter. The client no longer solely focuses on the negative (or positive) aspects of the situation but consid- ers other information as well. The evidence, both supporting and disconfirming the thought, is explored.
Example: C: I always do the wrong thing when it comes to parent- ing my children. T: What is the evidence that you always do the wrong thing? C: The kids always seem to behave poorly. T: OK. Is there other evidence that you always do the wrong thing? C: My wife tells me so. T: OK. So, the kids behave poorly, and your wife criti- cizes you. Is that right? Anything else? C: Yes, that’s right. That’s pretty much the nuts and bolts of it. T: All right, then. Let’s look at evidence that disputes the thought, “I always do the wrong thing when it comes to parenting my children.” C: What do you mean? T: What evidence is there that you don’t always do the wrong thing? C: Well, my kids get good grades—I help them with their homework. T: That seems essential. What else? C: I spend a lot of time with my kids, and actually, come to think of it, they don’t always behave poorly. And they seem to do better when I get them to bed earlier. T: So, you help your kids with their homework and look after their needs? C: Yeah. I guess I do some things right. Technique: Considering Alternatives (J. S. Beck, 2020) Through this technique, the therapist encourages the client to consider alternative explanations for an outcome that is reasonable, realistic, and rational. Example: C: I asked her out on a date, and she said she couldn’t go this Saturday. More proof that I’ll never have a girlfriend. T: What other explanations might there be for her say- ing no to your invitation? C: I don’t know. She did seem hurried. She mentioned something earlier in the week about having to rush to leave town to meet up with her family for a camping trip. T: So, she may have something else to do on Saturday? C: It’s possible.
146
EliteLearning.com/Psychology
Powered by FlippingBook