Cognitive Behavioral Therapy Lecture 5 Page: 1

COGNITIVE BEHAVIORAL PSYCHOTHERAPY

LECTURE 5

Chapter 8 Evaluating Automatic Thoughts

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
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• 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)
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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
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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