Cognitive Restructuring ADVANCED PSYCHOTHERAPY COGNITIVEBEHAVIORAL THERAPY Cognitive Restructuring
Cognitive Restructuring ADVANCED PSYCHOTHERAPY: COGNITIVE-BEHAVIORAL THERAPY
Cognitive Restructuring Focus on 2 major components: ◦ Identifying maladaptive thoughts and beliefs ◦ Challenging maladaptive thoughts and beliefs
Maladaptive Thoughts and Beliefs
Maladaptive Thoughts and Beliefs Automatic thought: brief stream of thought about ourselves or others ◦ Occur quickly through day as we evaluate and interpret situations ◦ Often occur outside of awareness Maladaptive automatic thought: distorted reflections of reality ◦ Accepted as true ◦ Manifestations of dysfunctional beliefs about yourself, the world, and/or future
Maladaptive Thoughts and Beliefs Intermediate beliefs: Attitudes or rules you follow that apply across situations ◦ Assumptions about the world ◦ Not based on objective evidence ◦ Often, “If X, then Y” ◦ “If I am thin, then I will be loved by others”
Maladaptive Thoughts and Beliefs Core beliefs: Fundamental beliefs about you, others, and the future; can be dysfunctional ◦ Drive intermediate beliefs and automatic thoughts ◦ Often formed in childhood ◦ Apply across situations ◦ Rigid and pervasive ◦ “I am unlovable”
How to Identify Automatic Thoughts Therapist: “So, Pamela, how have you been feeling this week? ” Pamela: “Just really sad…as usual. It seems like I’m always feeling that way. ” Therapist: “Did anything in particular trigger this sad feeling this weekend? ” Pamela: “Yes, I had to go to my cousin’s wedding, and it was really difficult because I started thinking about how I will never get married. ” Therapist: “Pamela, that’s what we call an automatic thought. It’s something that just pops into our heads over and over again without our really thinking about it or examining the truth of the thought. It affects the way we feel and act in a negative way. Maybe we should look at some of your automatic thoughts a little closer. ”
How to Identify Automatic Thoughts Therapist: “ So, let’s write down this automatic thought that you are having. I will never get married. Your going to your cousin’s wedding was the situation that triggered the thought, ‘I will never get married’. Pamela: “Yes, that’s true. ” Therapist: “When you were at the wedding and that thought came to you, how did you feel? ” Pamela: “I felt really sad and hopeless. ” Therapist: So, can you see how our thoughts can affect our mood and change the way we are feeling? ” Pamela: “Yeah, I guess if I hadn’t had that thought, I wouldn’t have felt so bad. ”
Eliciting Automatic Thoughts It is important for therapists to teach patients how to identify automatic thoughts during and outside of session. Be aware of patient’s hot thoughts during sessions. Hot thoughts are automatic thoughts that occur in combination with a change in emotion or mood. Hot thoughts are particularly poignant or strong thoughts that are often associated with dysfunctional core beliefs, and should be targeted in therapy.
Example of Hot Thought Patient: “My boss reprimanded me again yesterday” (sighs heavily. ) Therapist: “Tell me more. ” Patient: “Well, we were at a meeting; and I had just made my presentation, and he said he had expected a better product for the client. (voice gets softer, begins wringing hands). Therapist: “Your voice changed a little when you said that; tell me what is going through your mind right now? ” Patient: “I just feel like a failure at everything. My work has always been the one thing I was good at, and now I am failing at that, too. ” Therapist: “Let’s take a look at that line of thinking and the feelings it creates. It seems that when that thought entered your mind, your mood changed very quickly. Did you notice that? ” Patient: “Yeah, I guess it did upset me pretty fast. ”
Identifying Automatic Thoughts Because automatic thoughts may occur outside awareness, asking for a more detailed description of the situation is also helpful in pinpointing maladaptive thoughts. You could "take the patient back" to when it happened, using imagery (e. g. , Where were you when this happened? What time of day was it? ). If the patient reverts to past tense, remind him/her to tell the story in present tense to help bring back the thoughts and feelings that occurred in this situation. (See handout on cognitive distortions)
Identifying Intermediate and Core Beliefs Identifying Intermediate Beliefs ◦ Look for themes with automatic thoughts Identifying Core Beliefs ◦ Occurs in multiple parts of patient’s life (e. g. , at both work and home)
How to Challenge Thoughts/Beliefs Socratic questioning ◦ Asking a series of open-ended, brief questions that guide the patient to discover his/her idiosyncratic thoughts, feelings, or behaviors associated with a particular situation. ◦ Nonjudgmental but is based on therapist’s insight that the original premise of a thought or belief may be untrue ◦ The questions are designed to expose the dysfunctional thought or belief so that it may be challenged.
How to Challenge Thoughts/Beliefs The Dysfunctional Thought Record (DTR) ◦ See handout #2 ◦ The first three columns are used for identifying troubling situations and the accompanying emotions and dysfunctional thoughts.
How to Challenge Thoughts/Beliefs Help the patient question automatic thoughts by asking ◦ What evidence is there that this thought is true? ◦ What evidence is there that this thought is not true? ◦ What would I tell someone I loved if they were in this situation and had these thoughts? ◦ How likely is it that this is true? What are the odds? ◦ If my automatic thought is true, what is the worst that could happen? ◦ If my automatic thought is true, what is the best thing that could happen? Once evidence has been generated, combine it to form a more balanced thought.
Situation Automatic Thoughts Emotions Evidence to Support Thought Evidence Alternative That Doesn’t Thought Support Thought Rate Mood Now What thought went through your mind? How much do you believe it? What emotion did you feel at the time? Rate how intense were they? (1 -100) What has happened to make you believe thought is true? What has happened to prove thought is not true 0 -100 Out of breath when I played in the park with my granddaughter What actually happened? Where? What? How? When? What is another way to think of this situation?
Situation Automatic Thoughts Out of breath when I played in the park with my granddaughter I am too old to play with her I can’t do what I used to do I have nothing to offer my family I am no good to my family Emotions Evidence to Support Thought Evidence That Doesn’t Support Thought Alternative Thought Rate Mood Now
Situation Automatic Thoughts Emotions Out of breath when I played in the park with my granddaughter I am too old to play with her Defeated I can’t do what I used to do Sad I have nothing to offer my family Disappointed Hopeless I am no good to my family Hopeless (80) Worthless (90 Evidence to Support Thought Evidence That Doesn’t Support Thought Alternative Thought Rate Mood Now
Situation Automatic Thoughts Emotions Evidence to Support Thought Out of breath when I played in the park with my granddaughter I am too old to play with her Defeated I can’t do what I used to do Sad My family has to look in on me more often than they used to. I have nothing to offer my family Disappointed Hopeless I am no good to my family Hopeless (80) Worthless (90 Evidence That Doesn’t Support Thought Alternative Thought Rate Mood Now
Situation Automatic Thoughts Emotions Evidence to Support Thought Evidence That Doesn’t Support Thought Out of breath when I played in the park with my granddaughter I am too old to play with her Defeated I can’t do what I used to do Sad My family has to look in on me more often than they used to. I can still babysit my grandkids I have nothing to offer my family Disappointed Hopeless I am no good to my family Hopeless (80) Worthless (90 I contribute to my family in new ways, such as offering support I am able to do many things physically, though I have more limitations Alternative Thought Rate Mood Now
Situation Automatic Thoughts Emotions Evidence to Support Thought Evidence That Doesn’t Support Thought Out of breath when I played in the park with my granddaughter I am too old to play with her Defeated I can’t do what I used to do Sad My family has to look in on me more often than they used to. I can still babysit my grandkids I have nothing to offer my family Disappointed Hopeless I am no good to my family Hopeless (80) Worthless (90 Alternative Thought Because of my COPD and getting older, I have more I contribute to physical my family in limitations new ways, than I used to, such as but I am able offering to offer them support many valuable things and I am able to do contribute to many things my grandkids’ physically, lives though I have more limitations Rate Mood Now
Situation Automatic Thoughts Emotions Evidence to Support Thought Evidence That Doesn’t Support Thought Out of breath when I played in the park with my granddaughter I am too old to play with her Defeated I can’t do what I used to do Sad My family has to look in on me more often than they used to. I can still babysit my grandkids I have nothing to offer my family Disappointed Hopeless I am no good to my family Hopeless (80) Worthless (90 Alternative Thought Because of my COPD and getting older, I have more I contribute to physical my family in limitations new ways, than I used to, such as but I am able offering to offer them support many valuable things and I am able to do contribute to many things my grandkids’ physically, lives though I have more limitations Rate Mood Now Hopeless (10) Worthless (5)
- Slides: 23