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Simple Thought Challenging Record

Worksheet

Disputing thoughts is a critical skill in cognitive therapy. The Simple Thought Challenging Record encourages clients to identify alternative perspectives to their negative thoughts. Encourage the client to record their thoughts, images, or memories in specific situations, and then to generate alternative perspectives. This worksheet assumes a certain level of familiarity with the concept of challenging thoughts and represents a pared-down version of the technique.

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Description

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 trigger our emotional responses. The model implies that we can change how we feel by changing how we think.

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

  • Core beliefs. These are understood as generalized statements that shape how an individual understands themselves, other people, and the world (e.g. “I’m competent”, “I’m unlovable”, “No one can be trusted”, “The world is dangerous and unpredictable”, “I’m adaptable”).
  • Intermediate beliefs. These are understood as a set of assumptions that guide behavior across different situations. They can often be stated in a conditional if-then format (e.g. “If someone is nice to me, it’s because they don’t know the real me”).
  • Automatic thoughts. These arise quickly and without any apparent effort throughout our day to day lives, often in response to specific events (or in response to other thoughts or memories). (Automatic) thoughts are not facts, but they are so immediate and familiar that we often assume them to be true (e.g. your parent asks to speak to you and you think “It’s bound to be bad news”).

“Automatic thoughts… are situation specific and may be considered the most superficial level of cognition” (Beck & Beck, 1995, p. 34)

Automatic thoughts that result in negative emotions (e.g. sadness, anxiety, anger) are commonly described as Negative Automatic Thoughts (NATs). Some negative thoughts are accurate representations of the world (e.g. thinking “He could hurt me too” after seeing an acquaintance act violently would be both negative and accurate). However, automatic thoughts are often inaccurate – biased in characteristic ways – and there is considerable evidence that different mental health problems are associated with particular biases in thinking. For example, people who suffer from certain types of anxiety often ‘catastrophize’, and people who are depressed often discount positive information. Beck (1963) and Burns (1980) have described common cognitive biases which are outlined in more detail in our information handout Unhelpful Thinking Styles.

This Simple Thought Challenging Record is a cognitive restructuring worksheet. ‘Cognitive restructuring’ describes the category of techniques that cognitive therapists use to help their clients to overcome their cognitive biases and think differently. The aim of these techniques is not to ‘think happy thoughts’ or to replace negative thoughts with positive ones, rather, it is to overcome biases and to think accurately. CBT therapists use a variety of techniques to help their clients to develop cognitive restructuring skills, but a mainstay is the ‘thought record’. This is a tool designed to help clients identify and challenge their negative automatic thoughts by writing them down. Thought records exist in multiple variants, depending on the needs and abilities of the client.

Encourage the client to record their thoughts, images, or memories in specific situations, and then to generate alternative perspectives. This worksheet assumes a certain level of familiarity with the concept of challenging thoughts and represents a pared-down version of the technique.

Instructions

“We have spent some time identifying your negative automatic thoughts, and we have talked about how thoughts aren’t facts even when they feel like they are true. Now, I want to help you to develop the habit of questioning and challenging your automatic thoughts. With this thought record we’re going to practice challenging your automatic thoughts by exploring alternative perspectives.”

  1. Automatic thought. If completing the thought record retrospectively, start by asking the client to recall a specific negative automatic thought. If the client has already documented negative automatic thoughts (e.g. with a previous thought record) you could refer back to some of those situations. Otherwise, begin by encouraging them to recall a specific instance in which they noticed negative thoughts, feelings, or responses. Remind the client that thoughts can be verbal or can come as an image.
    • What automatic thought should we work with?
    • What was going through your mind as you started to feel that way? It might have been words, a phrase, an image or memory.
  2. Alternative perspective. In the second column, the client should be encouraged to explore alternative views of the situation and to generate alternative interpretations. Therapists familiar with ‘traditional’ CBT thought records could consider this column to be similar to the ‘alternative thought’ that clients are encouraged to write as a summary once they have considered the evidence for and against a negative automatic thought. It is likely that the alternative perspective will be longer and more descriptive than the original thought, taking into consideration a number of points or pieces of evidence ‘against’ the automatic thought. It may not necessarily be positive. Rather, the aim is to counter bias in the original thought and to generate alternative ‘balanced’ ways of appraising a situation. Helpful prompts include:
    • What would a friend say to you if you told them about this thought?
    • If the automatic thought was being voiced by a ‘sad’ or ‘anxious’ part of you, what would the ‘wise’ or ‘compassionate’ part of
      you have to say?
    • Can you think of any times when this thought was not true?
    • Are there any exceptions to this thought?
    • Does anything make you think that thought is not entirely true 100% of the time?

    Support the client to finish the alternative perspective with a summary or statement that gives a more balanced, realistic interpre- tation of the situation.

References

  • Beck, A.T. & Beck J.S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford.
  • Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.