Over 50 types of cognitive distortion have been identified. These fall into three general categories 1. Making Inferences 2. Evaluating how important these inferences are 3. Attributing responsibility or control.
Over 50 types of cognitive distortion have been identified. These fall into three general categories 1. Making Inferences 2. Evaluating how important these inferences are 3. Attributing responsibility or control.
Over 50 types of cognitive distortion have been identified. These fall into three general categories 1. Making Inferences 2. Evaluating how important these inferences are 3. Attributing responsibility or control.
I. Deciding whether to focus on an automatic thought a. How much do you/did you belief this thought? How did this thought make you feel emotionally? b. Find out more about the situation associated with the automatic thought c. Explore how typical the automatic thought is. d. Identify other automatic thoughts and images in the same situation e. Do problem-solving about the situation associated with the automatic thought f. Explore the belief underlying the automatic thought. (if this were true what would it mean to you?) g. Move on to another topic.
II. Focusing on an automatic thought
a. How much do you believe this thought now (0-100%) b. How does this thought make you feel (emotionally) c. How strong (0-100%) is this emotion III. Questioning Automatic Thoughts a. What is the evidence? (What evidence supports this idea, what evidence against this idea?) b. Is there an alternative explanation? c. What is the worst that could happen? Could I live though it? What is the best that could happen? What is the most realistic outcome? d. What is the effect of my believing the automatic thought? What could be the effect of changing my thinking? e. What should I do about it f. What would I tell _______________ (a friend) if he or she were in the same situation? • Purposely select an automatic thought that seems important 1. significantly contributes to the patient’s distress, 2. is not an isolated idea but recurrent theme that is likely to crop up again, 3. seems distorted or dysfunctional, 4. severs as a model in teaching the patient how to evaluate and respond to automatic thoughts. IV. Identifying Cognitive Distortions Cognitive Behavioral Therapy Lecture 5 Page: 2
• Over 50 types of cognitive distortion have been identified which
generally fall into three general categories 1. Making inferences (Drawing a conclusion that is more or less based on evidence) 2. Evaluating how important these inference are 3. Attributing responsibility or control • Distortions in Making Inferences (An Inference is when we draw conclusions) a. All or None Thinking (See the world as black and white) b. Fortune-Telling (Sure that we known the precise outcome of some event a serious example of Fortune-Telling is nay-saying) c. Mind-Reading (I just know that everyone thinks I am ….) d. Selective Abstraction (make up our minds too early, coming to a conclusion based on one (usually an emotional) piece of evidence) e. Overgeneralization (take a conclusion already formed and inappropriately applies them to other situations example: I am a mechanical dunce) f. Arbitrary Inference (Leaping to a conclusion all of the above actually represent arbitrary Inference, but the problem is worth noting separately) • Distortions in Evaluating Importance a. Thinking with “Shoulds” “Ought To’s” and “Musts” Ellis called this “musterbation” b. Awfulizing (Exaggerate the importance of a negative event) c. Egocentrism: a belief of perspective that you are the center of the world…at times it is important to note that it “It isn’t always about you.) d. Childhood Fantasy: I want what I want and I want it now, as an adult we are not guaranteed a happy ending. e. Minimizing (ignoring important aspects denying the importance of problems, and can often lead to hidden resentments) • Distortions in Attributing Responsibility or Control a. Blaming (inappropriate assumptions that other people or circumstances are responsible for your stress) b. Personalizing (pointing the finger at yourself rather than the outside world, Interpreting neutral events as personal attacks example the cancellation of a performance) Cognitive Behavioral Therapy Lecture 5 Page: 3
c. Helpless Thinking (There is nothing that I Can Do. Central to the
entire concept of the revolution of hope and the cope system is to recognize and avoid helpless thinking) V. Teaching patients to correctly label their cognitive distortions is not critical but when appropriate is helpful. a. correctly placing a dysfunctional thought into the correct category has little to do with the effectiveness or a therapeutic intervention b. however, when patients can understand that a particular automatic thought belongs to a category of automatic thoughts it may help them to identify thoughts of this type in the future. c. In a practical sense, if a patient grasps the concepts quickly and easily, it is a good idea to provide some training into the categories of cognitive distortions and possible even provide them with a reference sheet for future reference. d. However, if the patient struggles with the concepts, remember your goal is provide symptom relief and not to help the patient obtain a masters degree in psychology.
VI. Question to evaluate the utility of automatic thoughts.
• Many dysfunctional thoughts have usefulness to them, but are dysfunctional because their cost is greater than their benefit. However, if you do not recognize their benefit and provide a substitute thought with greater benefit you will not be successful at getting the patient to shift from the cognitive distortion. (This is a version of cognitive therapy defenses) VII. Assessing the effectiveness of evaluating the automatic thought • How much do you believe the thought now (0-100%)? • How do you feel about the situation (0-100%)? VIII. Conceptualizing why the evaluation of an automatic thought was ineffective a. There are other more central automatic thoughts and/or images left unidentified or unevaluated. b. The evaluation of the automatic thought is implausible, superficial or inadequate. c. The patient has not sufficiently expressed the evidence she believes supports the automatic thought. d. The automatic thought itself is a core belief Cognitive Behavioral Therapy Lecture 5 Page: 4
e. The patient understands intellectually that the automatic
thought is distorted but does not believe it on a more emotional level. (key her is a failure to recognize the utility of the AT) f. The patient discounts the evaluation. Chapter 9 “Responding to Automatic Thoughts” I. Dysfunctional Thought Records (DTR) A. Therapist should master DTR B. Plan to introduce DTR in 2 steps C. Ascertain that patient really grasps and believes in the cognitive model D. Patient demonstrate an ability to identify automatic thoughts and emotions before introduction of DTR E. Patient demonstrate success in completing the first four columns on her own before introducing the last two columns F. Therapist should verbally evaluate at least one important automatic thought with the patient that produces a decrease in dysphoria prior to DTR G. If the patient fails to complete homework assignments using he DTR, therapist should elicit automatic thoughts about doing the DTR. II. Motivating Patients to Use DTR A. Some patients gravitate to DTR very quickly, but some do not. B. Introduce it as an experiment. C. Evaluate automatic thoughts in connection to DTR III. When DTR is not helpful A. Do not over emphasize the importance of DTR; it is a tool of therapy, not the therapy itself. B. Stuck points are opportunities in therapy not failures. IV. Additional ways to Respond to Automatic thoughts A. Doing DTR mentally B. Reading previous DTR’s C. Dictating a modified DTR to someone else D. Using/Reading Coping Card E. Listening to audiotape of therapy or reviewing therapy notes