Prompts For Challenging Your Negative Thinking
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’.
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 (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).
This Prompts For Challenging Your Negative Thinking information handout is designed to help clients:
- Evaluate negative automatic thoughts from a variety of perspectives, including how accurate, helpful, and objective they are.
- Generate a balanced response to automatic thoughts that takes into account the new information they have considered.
- Develop insight into problematic patterns of thinking and helpful questions that support balanced thinking.
"People have hundreds of automatic thoughts every day that just ‘pop’ into their mind, but they aren’t always accurate. Sometimes our thoughts are correct and sometimes they are just opinions or best guesses – some therapists say, “You can’t believe everything you think”. Either way, they affect how you feel and behave. Noticing and examining your automatic thoughts can help you to see things more accurately, which can help you feel better. Would you be willing to look at this together?"
- Encourage the client to use this resource to examine negative thoughts soon after they have arisen, while their memory is fresh.
- If the client identifies multiple thoughts, prompt them to work on one thought at a time. In the case of images, ask the client to reflect on what the image means to them.
- Encourage the client to work through all the questions in the handout. The more the client scrutinizes an automatic thought, the less compelling it tends to become.
- Other tasks that might follow on from examining negative thoughts include summarizing the client’s learning on a flashcard, 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.