FIGURE 1-The Cognitive Model. Core belief. I m incompetent. Intermediate belief. If I don t understand something perfectly, then I m dumb

Transcription

1 FIGURE 1-The Cognitive Model Core belief I m incompetent Intermediate belief If I don t understand something perfectly, then I m dumb Situation Automatic thoughts Reactions Reading this book This is too hard. I ll never understand this. Emotional Sadness Behavioral Closes book Physiological Heaviness in abdomen

2 FIGURE 2-Although some automatic thoughts are true, many are either untrue or have just a grain of truth. Typical mistakes in thinking include: 1. All-or-none thinking (also called black-and-white, polarized, or dichotomous thinking): You view a situation in only two categories instead of on a continuum. Example: If I m not a total success, I m a failure. 2. Catastrophizing (also called fortune telling): You predict the future negatively without considering other, more likely outcomes. Example: I ll be so upset, I won t be able to function at all. 3. Disqualifying or discounting the positive: You unreasonably tell yourself that positive experiences, deeds, or qualities do not count. Example: I did that project well, but that doesn t mean I m competent; I just got lucky. 4. Emotional reasoning: You think something must be true because you feel (actually believe) it so strongly, ignoring or discounting evidence to the contrary. Example: I know I do a lot of things okay at work, but I still feel like I m a failure. 5. Labeling: You put a fixed, global label on yourself or others without considering that the evidence might more reasonably lead to a less disastrous conclusion. Example: I m a loser. He s no good. 6. Magnification/minimization: When you evaluate yourself, another person, or a situation, you unreasonably magnify the negative and/or minimize the positive. Example: Getting a mediocre evaluation proves how inadequate I am. Getting high marks doesn t mean I m smart. 7. Mental filter (also called selective abstraction): You pay undue attention to one negative detail instead of seeing the whole picture. Example: Because I got one low rating on my evaluation (which also contained several high ratings) it means I m doing a lousy job. 8. Mind reading: You believe you know what others are thinking, failing to consider other, more likely possibilities. Example: He s thinking that I don t know the first thing about this project. 9. Overgeneralization: You make a sweeping negative conclusion that goes far beyond the current situation. Example: (Because I felt uncomfortable at the meeting) I don t have what it takes to make friends. 10. Personalization: You believe others are behaving negatively because of you, without considering more plausible explanations for their behavior. Example: The repairman was curt to me because I did something wrong. 11. Should and must statements (also called imperatives): You have a precise, fixed idea of how you or others should behave and you overestimate how bad it is that these expectations are not met. Example: It s terrible that I made a mistake. I should always do my best. 12. Tunnel vision: You only see the negative aspects of a situation. Example: My son s teacher can t do anything right. He s critical and insensitive and lousy at teaching. Thinking errors. Adapted from Aaron T. Beck, M.D.

3 FIGURE 3-HIERARCHY OF BELIEFS AND AUTOMATIC THOUGHTS Core belief I m inadequate. Intermediate 1. Attitude: It s terrible to be inadequate. beliefs 2. Assumptions: (positive) If I work extra hard, I can do okay. (negative) If I don t work hard, I ll fail. 3. Rules: I should always do my best. I should be great at everything I try Automatic thoughts when depressed I can t do this. This is too hard. I ll never learn all this.

4 FIGURE 4-COGNITIVE CONCEPTUALIZATION DIAGRAM Patient s name: Date: Diagnosis: Axis I Axis II Relevant Childhood Data Which experiences contributed to the development and maintenance of the core belief Core Belief(s) What is the most central belief about herself? Conditional Assumptions/Beliefs/Rules Which positive assumption helped her cope with the core belief? What is the negative counterpart to this assumption? Compensatory Strategy(ies) Which behaviors help her cope with the belief? Situation 1 What was the problematic situation? Situation 2 Situation 3 Automatic Thought What went through her mind? Automatic Thought Automatic Thought Meaning of the A. T. What did the automatic thought mean to her? Meaning of the A. T. Meaning of the A. T. Emotion What emotion was associated with the automatic thought? Emotion Emotion Behavior What did the patient do then? Behavior Behavior Cognitive Conceptualization Diagram. Copyright 1993 by Judith S. Beck, Ph.D.

5 FIGURE 5-TECHNIQUES TO ELICIT AUTOMATIC THOUGHTS Basic question: What was going through your mind just then? To identify automatic thoughts: 1. Ask this question when you notice a shift in (or intensification of) affect during a session 2. Have the patient describe a problematic situation or a time during which she experienced an affect shift and ask the above question. 3. If needed, have the patient use imagery to describe the specific situation or time in detail (as if it is happening now) and then ask the above question. 4. If needed or desired, have the patient role-play a specific interaction with you and then ask the above question. Other questions to elicit automatic thoughts: 1. What do you guess you were thinking about? 2. Do you think you could have been thinking about or? (Therapist provides a couple of plausible possibilities.) 3. Were you imagining something that might happen or remembering something that did? 4. What did this situation mean to you? (Or say about you?) 5. Were you thinking? (Therapist provides a thought opposite to the expected response. Summary of techniques to identify automatic thoughts. Copyright 1993 by Judith S. Beck, Ph.D.

6 FIGURE 6-QUESTIONING AUTOMATIC THOUGHTS 1. What is the evidence? What is the evidence that supports this idea? What is the evidence against this idea? 2. Is there an alternative explanation? 3. What is the worst that could happen? Could I live through it? What is the best that could happen? What is the most realistic outcome? 4. What is the effect of my believing the automatic thought? What could be the effect of changing my thinking? 5. What should I do about it? 6. What would I tell (a friend) if he or she were in the same situation? Questioning automatic thoughts. Copyright 1993 by Judith S. Beck, Ph.D.

7 FIGURE 7-Automatic Thought Record Date/Time Situation Automatic Thought Emotion What thought or actual situation led to unpleasant emotion? What thought went through your mind? What emotions (sad, anxious, angry, loneliness) did you feel at the time? What distressing physical sensations? How much do you believe it? How intense? (0-100%) Alternative Response Answer Alternative Response Answer What cognitive distortion? All-or nothing, mind reading, catastrophizing What s the effect of believing the automatic thought? What is the evidence that the automatic thought is true? What could be the effect of changing my automatic thought? What evidence that it is not true? What could I do about it? Is there an alternative explanation or outcome? What is the worst that could happen? Could I live through it? What is the best that could happen? What is the most realistic outcome? What would I tell a friend to do about it? What would he/she tell me to do? Outcome How much do I believe the automatic thought? What emotions do I feel? How intense? (0-100%) What will I do?