How to identify automatic thoughts? - Chapter 12

This chapter will discuss identifying automatic thoughts.

The cognitive model states that the interpretation of a situation (rather than the situation itself), often expressed in automatic thoughts, influences one’s subsequent emotion, behavior, and physiological response. Of course some events are upsetting for everyone, but people with psychological disorders often misconstrue positive or neutral events. This means that their automatic thoughts are biased. Automatic thoughts are a stream of thinking that coexists with a bigger stream of thoughts. Everyone has automatic thoughts. People often are more aware of the emotion they feel as a result of their thoughts than of the thoughts themselves, but with a little training these thoughts can be conscious. When they are conscious most of us will do a reality check of these thoughts, but people with psychological disorders don’t question these thoughts and just accept them. Automatic thoughts are often in short hand form. For example: a client might think ‘damn’ and this means ‘ I was stupid to leave my cellphone at home’.

How can automatic thoughts be categorized?

Automatic thoughts can be evaluated according to their validity and their utility. The most common type of automatic thought is distorted in some way and occurs despite objective evidence to the contrary. A second type of automatic thought is accurate, but the conclusion the client draws may be distorted. A third type of automatic thought is also valid, but decidedly dysfunctional. Identifying and responding to automatic thoughts is usually helpful to a client and may produce a positive shift in affect. The automatic thoughts can be identified during a session while discussing a problem the client is experiencing. It is important that the therapist checks again at the end of the session to ascertain how well the client understands the cognitive model.

How can automatic thoughts be evaluated?

An action plan in identifying these automatic thoughts is to simply ask oneself: ‘What was going through my mind?’ when clients mood starts getting worse. As a therapist you will ask this question when clients describe a problematic situation that arose or when you notice a shift to negative affect during a session. In this latter situation it is often important to be alert to both verbal and nonverbal cues from the client, so as to be able to elicit their hot cognitions that is, important automatic thoughts and images that arise in the therapy session itself, and are associated with a change or increase in emotion. These hot cognitions can be about the client him/herself, the therapist, or the subject under discussion. They may interfere with the client’s concentration, motivation, feelings of worth, or the therapeutic relationship. If clients are unable to answer the question: ‘What was just going through your mind?’ the therapist can ask them how they are feeling and where in their body they experienced the emotion (this will heighten the emotional level during the session and the client might remember what it felt like to be in the situation again), elicit a detailed description of the situation, request that the client visualizes the distressing situation, suggest that the client and the therapist engage in role play, elicit an image, supply thoughts opposite to the ones you hypothesize actually went through their minds, ask for the meaning of the situation for them, or phrase the question differently. These are all techniques that may help clients in identifying their automatic thoughts. If clients are still unable to identify their automatic thoughts, the therapist should move on to another subject in order to not let the client feel as a failure.

What other problems may occur when treating automatic thoughts?

Clients may have other automatic thoughts about their (emotional or behavioral) reaction to the situation they had automatic thoughts about. Clients can have automatic thoughts before a situation, during a situation, or after a situation. Therapists should discover which thoughts were most distressing to a client.

If a client worries about many problems and can’t say which one is most important to him/her, the therapist might ask the client to hypothetically eliminate one problem, and determine how much relief the client feels if this problem wouldn’t be there. The problem the client feels most relieved about when eliminated is likely to be the most troublesome to the client. When the most troublesome problem is discovered the focus can be on identifying automatic thoughts and problem solving.

When you ask for clients’ automatic thoughts, you are seeking the actual words or images that have gone through their mind. Until they have learned to recognize these thoughts, many clients report interpretations, which may or may not reflect their actual thoughts. For example: The interpretation: ‘I couldn’t get myself to start reading’, actual automatic thought: ‘I can’t do this’. These interpretations should be changed into the real automatic thought to evaluate them effectively. Clients also sometimes report thoughts that are not fully spelled out, e.g. ‘Uh-oh”, the therapist guides the client to express the thought more fully.

External and internal stimuli can give rise to automatic thoughts. Clients can have automatic thoughts about their cognitions, their emotions, their behavior, or their physiological or mental experiences. Identifying automatic thoughts is a skill that comes naturally to some clients and is more difficult for others. Therapists need to listen closely to ensure that clients report actual thoughts, and may need to vary their questioning if clients do not readily identify their thoughts. Techniques that can be used are discussed in this chapter.