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.
The Simple Thought Monitoring 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’. Thought records exist in multiple variants, depending on the needs and abilities of the client.
This worksheet is designed to help clients learn to identify negative automatic thoughts that cause (or which are associated with) changes in their emotional state. This is often not a straightforward skill to learn. A common goal in CBT is for clients to be able to identify and monitor their thoughts independently. However, introducing complex thought records too early in therapy can be confusing and difficult early experiences of thought monitoring can be an obstacle to clients’ engagement in therapy. Sometimes a graduated approach is helpful. Many clients benefit from a period of practice identifying negative automatic thoughts and associated emotions before moving on to the next step of examining potential biases in the negative thinking. Consisting of just three columns (Situation, Feelings, Thoughts), this thought record is a helpful introductory step to the process of cognitive restructuring in CBT.
“We have talked about how what we think affects the way we feel, and how thoughts often pop into our heads which make us feel anxious or sad. If we are going to work with your automatic thoughts we need to be able to catch them. One of the best ways of catching our thoughts is to use a thought record. Would you be willing to practice one with me now?”
- Situation. Entries in a thought record are completed with respect to specific situations or events. If you are completing a thought record retrospectively, you might start by cueing the client’s memory for a situation when they experienced a sudden or strong change in their emotions. Enough information about the situation should be recorded so that the event can be recalled and discussed when the thought record is reviewed.
- (If completing retrospectively) Can you think of a recent time when you felt a sudden change in how you were feeling?
- Describe what was happening. Who was there? Where were you? When did it happen? What were you doing?
- Emotions or feelings. One helpful aspect of thought records is their role in helping clients to distinguish between feelings and thoughts. A helpful ‘shorthand’ explanation is that emotions or feelings can typically be described using a single word (e.g. ‘afraid’, ‘sad’, ‘nauseous’) whereas thoughts typically require more than one word (e.g. “I’m going to fail”, “They don’t like me”). Helpful prompts to identify emotions include:
- How did you feel in that moment?
- What did you feel in your body?
- Try to think of one word that describes the emotion
- How strong was the feeling on a scale from 0 to 100?
- Thoughts. Clients should be encouraged to record automatic cognitions in the ‘thoughts’ column. Negative automatic thoughts often manifest as a verbal stream (e.g. “I’m so rubbish at this”) but automatic cognitions may also manifest as spontaneous imagery (e.g. image of myself being laughed at by other people) or involuntary memories (e.g. memory of the time that I was laughed at by my teacher). Helpful prompts to help clients to identify automatic cognitions include:
- What was going through your mind as you started to feel that way? It might have been words, a phrase, an image or memory. In the case of an image ask the client to reflect on what the image means. For example, if the client has an image of themselves frozen to the spot it may have an idiosyncratic meaning such as “I’m weak” or “I’m useless”.
- 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.