Examining Your Negative Thoughts

Beck’s cognitive model (Beck et al., 1979) proposes that events are not directly responsible for the way we feel. Rather, it is the interpretation of those events – our appraisals, thoughts, or cognitions – that generates emotional responses. The model implies that we can change how we feel by changing how we think.

The CBT model describes different levels of cognition that underpin how we think about ourselves, other people, and the world, shaping our interpretations of events and how we respond to them. Moving from the deepest to the most superficial, these are:

• Core beliefs. These are understood as deep-rooted, global, and absolute judgments about oneself, other people, and the world (e.g., “I am competent”, “No one can be trusted”, “The world is dangerous and unpredictable”).
• Intermediate beliefs. These are understood as assumptions that guide behavior across situations. They are often stated in a conditional ‘if-then’ format (e.g., “If someone is nice to me, then they want something from me”).
• Automatic thoughts. These arise quickly and without any apparent effort, often in response to specific events (or to other thoughts, feelings, or memories). Automatic thoughts are interpretative ‘best guesses’ about the meaning or implication of events, but they are so immediate and familiar that we often assume they are true (e.g., your manager asks to speak to you, and you automatically think, “It’s bound to be bad news”).

Automatic thoughts that generate negative emotions (e.g., sadness, anxiety, or anger) are commonly referred to as ‘negative automatic thoughts’ (NATs). Some negative thoughts are accurate representations of the world. For example, thinking, “That person could hurt me too”, after witnessing an assault would be both negative and accurate. However, automatic thoughts are often inaccurate or biased in characteristic ways, and there is considerable evidence that different mental health problems are associated with specific biases in thinking. For example, people with obsessive compulsive disorder often believe that unpleasant or unacceptable thoughts can influence events in the world (Shafran & Rachman, 2004), while those with social anxiety tend to discount positive social interactions (Vassilopoulos & Banerjee, 2010). Beck (1963) and Burns (1980) have described common cognitive biases which are outlined in more detail in our information handouts Cognitive Distortions – Unhelpful Thinking Styles (Common), and Cognitive Distortions – Unhelpful Thinking Styles (Extended).

Cognitive restructuring is a key therapeutic strategy in CBT involving the identification, evaluation, and modification of cognitions that are distressing or associated with problematic behaviors (Beck et al., 1979; Wenzel, 2018). For instance, an individual with low self-esteem might notice the thought, “People don’t like spending time with me” and respond to this with the self-directed question, “How do I know that is true and does anything suggest it isn’t?” (i.e., evaluating the evidence supporting an automatic thought). Other restructuring techniques include distancing oneself from maladaptive cognitions, searching for alternative explanations, and exploring the impact of distressing thoughts and beliefs (e.g., Leahy, 2017; Waltman et al., 2021). Research suggests that cognitive restructuring is effective across a range of disorders (e.g., Ezawa & Hollon, 2023) and is associated with symptomatic improvement (e.g., Lorenzo-Luaces et al., 2015).

One common method for teaching cognitive restructuring is with thought records. Many variants of thought records exist and have been categorized by Waltman et al. (2019). These can range from three-column records designed to facilitate self-monitoring and teach clients the connection between thoughts and feelings, to seven-column records which facilitate the weighing of evidence for and against a negative thought. Sometimes clients may struggle with one method and find it helpful to be guided through the process in alternative ways.

This Examining Your Negative Thoughts exercise is designed to help individuals:

• Identify negative automatic thoughts and images.
• Evaluate these thoughts from a variety of perspectives, such as whether they are accurate, adaptive, or consistent with one’s goals.
• Generate a balanced response to their automatic thoughts that considers other important information, perspectives, and interpretations.
• Become more familiar with their automatic thoughts and the process of cognitive restructuring.

A key idea in CBT is that our thoughts affect how we feel and how we behave. People have hundreds of automatic thoughts every day that just ‘pop’ into their minds, and although they can feel convincing, they aren’t always accurate. Sometimes our thoughts are correct and sometimes they are just opinions or best guesses. Our thoughts can also be helpful or unhelpful. Noticing and examining your automatic thoughts can help you to see things more accurately, which can help you feel better. Can we do an exercise so we can practice with one of your negative thoughts?

1. What happened? Ask the client to describe a recent situation that triggered a negative automatic thought. Suggested question:
   • "Can you think of a recent time when you noticed a sudden change in your mood. Where were you? Who was there? What were you doing? Let’s make some notes about what happened."
2. What was my negative thought? Help the client identify and record their negative automatic thought. It might take the form of a statement that ran through their mind, an image, or a memory. If the client reports an image or a memory, explore their appraisal of what that image or memory means to them. If they report multiple automatic thoughts, then identify the one which is the most distressing. This section is also an opportunity to record how the client felt when they had the negative thought. Clients should be encouraged to rate how much they believe their negative thought. Suggested questions:
   • "What went through your mind when that happened?"
   • "What were you saying to yourself?"
   • "Did you notice any images or memories at that moment? What did it mean to you?"
   • "When you felt that way, what was going through your mind?"
   • "How much do you believe this thought on a scale from 0–100%?"
3. Examine your negative thought from a variety of perspectives. Automatic thoughts can be examined from different perspectives, such as whether they are accurate or inaccurate, helpful or unhelpful, and biased or objective. Guide the client in re-evaluating their thought using the prompt categories described below. This exercise deliberately brings together different cognitive restructuring approaches so that clients can challenge their thought from a variety of perspectives.
   • Counter evidence. Help the client assess the accuracy of their automatic thought. What evidence supports it, and is this evidence good quality? Equally, what evidence does not support the NAT? Are there times when the client’s negative expectations haven’t happened?
   • Helpfulness. Help the client assess the utility of their automatic thought. Is it useful or problematic? What would be a more helpful way of viewing the situation? Help the client explore the short-term and long-term consequences of believing and/or acting on their negative thought.
   • Other perspectives. Help the client evaluate their thought from different points of view. How would other people make sense of the precipitating event? Equally, what would the client say to a loved one if they experienced a similar thought?
   • Bigger picture. Help the client see their automatic thought in context. How would they view this thought in 10 years’ time, or in the context of their entire life? What are they failing to notice by focusing on the content of this thought?
   • Thinking biases. Help the client spot any biases in their thought. Can they identify any cognitive distortions such as jumping to conclusions or emotional reasoning?
   • Suggested prompt: 
     • "There are lots of ways we can examine an automatic thought. Here are some questions that can help scrutinize yours. Let’s go through them one-by-one and see how they might apply."
4. What would be a more balanced and helpful thought? Help the client develop a new thought that synthesizes all the information you have discussed. What would be a more accurate and helpful way of viewing the precipitating event? This new thought may be considerably longer than the original thought as it incorporates more information. Clients should be encouraged to rate how much they believe their balanced thought. Suggested questions:
   • "Let’s summarize what we have discussed so far."
   • "Holding in mind all the things we have talked about, what would be a more accurate and helpful way of thinking about this situation?"
   • "Knowing what you know now, what is a more balanced and believable thought?"
   • "How much do you believe this new thought?"
5. What have I learned from this exercise? Encourage the client to reflect on their experience of the exercise, including the process of identifying and re-evaluating their automatic thought. What did they learn and how will they apply this learning in the future? Can they generalize these insights or new knowledge to other areas of their life? How do they feel after having evaluated their thought. Reflecting on the exercise can also be an opportunity to troubleshoot obstacles that may arise when the client examines their thoughts independently. Suggested questions:
   • Let’s reflect on this exercise:
     • "What was helpful about questioning your automatic thought?"
     • "What did you learn about your thinking?"
     • "Which questions (if any) shifted your thinking the most?"
     • "How might this apply to the problem(s) that brought you to therapy?"
     • "When and where would it be useful to evaluate your thoughts again?"
     • "How do you feel now?"

Additional guidance

Other tips for helping clients get the most from this exercise include the following:

• Encourage the client to select a recent automatic thought that is easy to recall and generates some emotion.
• If the client identifies multiple thoughts, select one to work on (e.g., a ‘hot’ thought that is compelling and/or distressing). In the case of images, ask the client to identify what the image means to them.
• Encourage the client to work through all the questions in the handout (some prompts may be less productive than others). The more the client scrutinizes an automatic thought, the less compelling it tends to become.
• Consider recording the client’s balanced thought on a flashcard so that they can review it in relevant situations.
• Useful homework assignments that follow on from this exercise include practicing examining negative thoughts in-situ and/or devising behavioral experiments to test out the accuracy of the client’s new, balanced thought.
• Remind the client that evaluating thoughts takes time to master: the more they practice, the easier and more helpful it will become.

Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324-333. DOI: 10.1001/archpsyc.1963.01720160014002.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

Burns, D. D. (2022). Feeling great: The revolutionary new treatment for depression and anxiety. PESI.

Ezawa, I. D., & Hollon, S. D. (2023). Cognitive restructuring and psychotherapy outcome: A meta-analytic review. Psychotherapy, 60, 396–406. DOI: 10.1037/pst0000474.

Leahy, R. L. (2017). Cognitive therapy techniques: A practitioner’s guide (2nd ed.). Guilford Press.

Lorenzo-Luaces, L., German, R. E., & DeRubeis, R. J. (2015). It’s complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review, 41, 3-15. DOI: 10.1016/j.cpr.2014.12.003.

Shafran, R., & Rachman, S. (2004). Thought-action fusion: A review. Journal of Behavior Therapy and Experimental Psychiatry, 35, 87-107. DOI: 10.1016/j.jbtep.2004.04.002.

Vassilopoulos, S. P., & Banerjee, R. (2010). Social interaction anxiety and the discounting of positive interpersonal events. Behavioural and Cognitive Psychotherapy, 38, 597-609. DOI: 10.1017/S1352465810000433.

Waltman, S. H., Codd III, R. T., McFarr, L. M., & Moore, B. A. (2021). Socratic questioning for therapists and counsellors: Learn how to think and intervene like a cognitive behavior therapist. Routledge.

Wenzel, A. (2018). Cognitive reappraisal. In S. C. Hayes & S. G. Hofmann (Eds.), Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy (pp.325-337). Context Press.