![]() ![]() ![]() Similarly, thoughts that begin with the phrase “What if … ?” indicate doubt that a patient may not actually hold. A straightforward way of responding to negative thoughts in the form of a question is to simply ask your patient “How about if we rephrase that question as a statement?”, or “If we rephrased that as ‘I am useless’ how much would you have agreed with it in that moment?”. Thoughts in the form of a question can be more productively phrased as a statement, changing “Why am I so useless?” to “I am useless”, to which the client can assign a belief rating. Exploring the evidence for a thought phrased in this format has the potential to invite more questions than it provides answers. Thoughts in the form of a question such as “Why am I so useless?” are not a statement which the client believes to be true. Phrasings that may prove problematic for the successful completion of thought records include: Other types of thoughts are not amenable to thought records, or may initially be phrased in unhelpful ways that require reformulation. When examining the evidence for and against a negative automatic thought it is essential that the thought be in the form of a statement that the client believes to be true. ![]() Make sure that the thought is phrased correctly as a statement of fact ![]() In this article we will explore our top ten recommendations for what to do when the thought records don’t work. Despite their apparent simplicity there are numerous pitfalls that even experienced cognitive behavioral practitioners can fall into when using thought records. Common difficulties occur when patients report only minimal emotional shifts, or say “It makes sense, but I don’t feel any different”, or “I know it but I don’t feel it”. It can be disappointing and frustrating for patients and therapists when this core technique doesn’t help. However, most clinicians who practice CBT will have had the experience of teaching their patient to use a thought record to examine the evidence for and against a thought – but finding the technique unproductive. Many patients find that recording and challenging their negative automatic thoughts is an enlightening process and countless thousands have been helped by learning this conceptually simple but simultaneously powerful technique. Practically, thought records are often modified to facilitate their desired purpose – different types of thought records have been designed to better suit identification versus disputation for example – but at its core this cognitive restructuring technique is now a mainstay of modern cognitive behavioural therapy (CBT). The columnar thought record format was developed further by Padesky and Greenberger who added two additional columns to their design to encourage the expression and examination of evidence for and against the negative automatic thought. The Daily Record Of Dysfunctional Thoughts prompts patients to generate a ‘rational response’ to negative automatic thoughts. He introduced the Daily Record Of Dysfunctional Thoughts which was designed to be used once patients were proficient at disputing thoughts. Amongst other techniques for exploring, examining, and ‘reality-testing’ automatic thoughts and images Beck recommended that “Recording cognitions and responses in parallel columns is a way to begin examining, evaluating, and modifying cognitions”. The introduction of thought records was an innovative technical feature of Beck’s cognitive therapy for depression. ![]()
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