Prompts For Challenging Negative Thinking

The Prompts for Challenging Negative Thinking guides clients through a series of helpful questions aimed at re-evaluating negative thoughts.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Overview

Cognitive restructuring is an evidence-based intervention that involves identifying, evaluating, and modifying maladaptive cognitions, including negative automatic thoughts (NATs). The Prompts For Challenging Your Negative Thinking information handout is designed to guide clients through the process of evaluating negative automatic thoughts. It presents questions that help clients explore whether their negative thoughts are accurate, helpful, objective, and fit with the ‘bigger picture’.

Why Use This Resource?

This resource provides a structured approach to evaluating thoughts using targeted questions.

  • Guides clients in questioning the accuracy and utility of their negative thoughts.
  • Helps clients re-evaluate thoughts from different perspectives.
  • Promotes more balanced and adaptive thinking, and helps reduce distress.

Key Benefits

Accessible

Offers clear prompts for examining negative automatic thoughts.

Broad

Presents a wide variety of questions, ensuring they resonate with clients.

Practical

Helps clients become skilful in re-evaluating their thoughts through repeated use.

Who is this for?

Depression

Addressing self-critical and self-blaming thoughts that contribute to low mood.

Anxiety Disorders

Questioning catastrophic, anxiety-provoking automatic thoughts.

Perfectionism

Challenging extreme all-or-nothing thoughts related to performance.

Other Difficulties

Suitable for other difficulties where cognitive restructuring might be helpful, such as low self-esteem and social anxiety.

Integrating it into your practice

01

Identify

Help the client identify a negative automatic thought (NAT).

02

Question

Use the prompts to re-evaluate the thought from multiple angles.

03

Generate

Help the client develop a more balanced, alternative thought.

04

Practice

Encourage the client to continue challenging their negative thoughts for homework.

Theoretical Background & Therapist Guidance

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.

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).

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).

This Prompts For Challenging Your Negative Thinking information handout is designed to help clients evaluate negative automatic thoughts, generate balanced responses, and develop insight into problematic patterns of thinking.

What's inside

  • A selection of targeted questions for evaluating negative automatic thoughts.
  • An introduction to the resource for therapists.
  • Guidance for using the resource with clients.
  • Key references and recommendations for further reading.
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FAQs

The handout provides a series of prompts that help clients explore negative automatic thoughts from multiple angles, including how accuracy and useful they are.
Ideally, clients should use it immediately after identifying a negative automatic thought, while it is still fresh in their mind.
Use the resource with clients in-session and emphasize the benefits of consistent use. Highlight that re-evaluating negative thoughts can help reduce distress and gets easier with practice.

How This Resource Improves Clinical Outcomes

Using this resources helps clients:

  • Identify negative automatic thoughts.
  • Re-evaluate these thoughts, reducing their impact and associated distress.
  • Develop more accurate and helpful ways of thinking.

References And Further Reading

  • 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.