From , , Cognitive Behavioral Therapy 5306

Issue Links: Cognitive Behavioral Therapy 5306

Topics: Psychotherapy

1. They are short, snappy, and spontaneous, as in, “I’m going to die,” “I look like an idiot,” “I’ll be just like my father,” or even more abbreviated phrases, such as, “Oh no!” Automatic thoughts can be positive, but people tend not to seek help in those cases.
2. They may be overgeneralizations, as in “I’ll never amount to anything,” or “Nobody can help me,” so they can include absolutes, such as:
   • Always
   • Never
   • Everybody
   • Nobody
   • Everyone
   • No one
   • Anything
   • Everything

   These extreme words usually make the thought patently false, as Rodney Dangerfield shows. “I told my psychiatrist everyone hates me. He said I was ridiculous: Everyone hasn’t met you yet.”

3. Automatic thoughts may use should, must, or ought, terms which often provoke guilt trips, as in “I should have visited my father in the nursing home more often when I had the chance,” or “I must do better.” Albert Ellis warns against this self-flagellation: “Don’t should on yourself.” And many therapists note, “Should and never are two words you should never use.”
4. Automatic thoughts are almost always accepted when they occur, even though they are usually irrational. Hours later, or in therapy, or when filling out a thought record, however, the fear of getting expelled because you slept through a final exam seems much less plausible.
5. Automatic thoughts can breed more automatic thoughts, letting hyperactive fear turn a forgotten blood pressure pill into an imminent funeral, or a single low-flying plane into the sequel to 9/11. A chain of thoughts leading to disaster can be a warning sign for automatic thoughts.
6. Automatic thoughts are usually related to the fears and standards of the thinker. Thus a woman who was brought up to be a people pleaser may have automatic thoughts beginning with the birthday card she forgot to send, or the meatloaf she feels was not good enough for her guests. The consequence of these thoughts might have the theme of disappointing people, and losing their friendship.
7. A strong feeling that seems unrelated to anything in the environment, or is out of proportion to the situation, may signal automatic thoughts. Perhaps the stranger you just saw reminds you subconsciously of the neighborhood bully from your childhood, and you are feeling helpless and angry.

The Value of Summarizing

Ask clients to summarize the ideas you are teaching, the way their distorted thinking has changed, and so on throughout the session. Summarizing (as opposed to merely describing) helps people process information. It also gives you feedback about how clients are making sense of what is going on in session, so you can make midcourse corrections. Summarize your clients’ thoughts to make sure you’re interpreting their words and feelings correctly, giving you a reality check, and also letting clients feel understood.