1. SOWK6190/SOWK6127 Cognitive Behavioural Therapy and Cognitive Behavioural Intervention Week 5 - Identifying automatic thoughts and emotions Dr. Paul Wong, D.Psyc.(Clinical)

2. Outline Review of homework Recap of what we have learn This week’s agenda In-class activities Homework

3. Recap - Typical agenda for session 2 and beyond 1.Brief update and check on mood 2.Bridge from previous session 3.Setting the agenda 4.Review of homework 5.Discussion of issues on the agenda, setting new homework, and periodic summaries 6.Final summary and feedback

4. Key message universally upsetting Certain events are almost universally upsetting: a personal assault, rejection, or failure. However, people with psychological disorders often misconstrue neural or even positive situations and thus their automatic thoughts are biased.

5. Although automatic thoughts seem to pop up spontaneously, they become fairly predictable once the patient’s underlying beliefs are identified. The cognitive therapist is concerned with identifying those thoughts that are dysfunctional, that is, those that distort reality, that are emotionally distressing and/or interfere with the patient’s ability to reach her goals.

6. Automatic thoughts are usually: brief Quite brief; Shorthand Shorthand, e.g., “Ding” verbalvisual In verbal or visual form or both Can be evaluated Can be evaluated according to their validity and their utility 1.Distorted thought 2.Accurate but Distorted conclusion 3.Accurate but decidedly dysfunctional

7. Explaining automatic thoughts to patients pp.78-80 (please read carefully)

8. Eliciting automatic thoughts “What was going through your mind just then?” affect shift Key: take notice of affect shift can follow up with “how are you feeling right now?” do not ‘interrogate” If that doesn’t work out, do not ‘interrogate”

9. Identifying automatic thoughts in a specific situation It will be useful for goal setting!!

10. Identifying additional automatic thoughts The Socratic questioning technique comes in handy (pp.85): “What else went though your mind?” “Then what?” “Then what happened?”

11. Automatic thoughts vs. Interpretations AT are the actual words/pictures that have gone through the mind Interpretations are words that the client used to interpret the thoughts

12. In class activity 1 Please educate your client to identify automatic thoughts Try to do a few examples, i.e., ask for specific situation, interpretation, embedded in discourse etc.

13. Section 2: Identifying emotions Intense negative emotion is painful and may be dysfunctional if it interferes with a patient’s capacity to think clearly, solve problems, act effectively, or gain satisfaction. The therapist does not analyze ALL situations in which the patient feels dysphonic, however; cognitive therapy aims to reduce the emotional distress that is related to misinterpretations of a situation.

14. Do clarify confusion of thoughts and feelings when necessary Do this based on your clinical judgment!!!

15. Investigate further when the patient reports an emotion that does not seem to match the content of the automatic thoughts Especially with Chinese clients whose vocabulary for feelings are limited

16. In class activity 2: With your partner, please try to identify as many Chinese words for feelings as possible

17. Section 3: Evaluating Automatic thoughts Once AT are identified, the therapist can do: 1.Focus on the AT – “What did you DO after you had the thought?” 2.Find out more about the situation associated with the thought – “Tell me more about the situation.” 3.Explore how typical the AT is – “How often do you have this kind of thought?” 4.Identify other AT in the same situation – “Anything other thoughts do you have?” 5.Do problem-solving about the situation – “What do you think you should do?” 6.Explore the belief underlying the AT – “If this thought is true, what would it mean to you?” 7.Move on to another topic – “Can you tell me what else happened this week?”

18. How do you choose what to do? 1.What am I trying to accomplish in this session? 2.What did the patient put on the agenda? 3.Is this an important thought on which to focus?

19. Focusing on an AT Check how strong the thought and feeling are attached to it! If severe, then pursue…… (pp.107) Link with a bigger picture – “Could this be another example of how you consistently predict you will fail?” Use Socratic questioning to deepen the understanding of the thought or do problem-solving

20. Please do not CHALLENGE the thought because: 1.You do not know in advance that any given AT is distorted; and 2.A direct challenge violates a fundamental principle of cognitive therapy that of collaborative empiricism (this is the difference between a therapist and a layman) 3.Go to pp.108 and 109! – Questioning your though exercise. (Handout!)

21. Cognitive Distortions (the fun of CT begins) pp.119, let’s discuss them slowly!!

22. Questioning to evaluate the utility of automatic thoughts “What’s the advantage of continuously telling yourself, “I’ll never get it, I will never get it”?” “What’s the DIS-advantage of continuously telling yourself, “I’ll never get it, I will never get it”?”

23. Recap of this week materials Your roles: 1.To educate the client about AT and feelings associated with it 2.Help client to identify it 3.Use AT as an opportunity to make your client less distressed, less dysfunctional, come up with ways to deal with similar situations, teach client to be their own therapist.

24. You may FAIL because: 1.There are other more central automatic thoughts left unidentified or unevaluated 2.The evaluation of AT is implausible, superficial, or inadequate 3.The client has not sufficiently expressed the evidence she believes supports the AT 4.The At is also a core belief 5.The client understands “intellectually” that the AT is distorted but does not believe it on a ore “emotional level” 6.The client discounts the evaluation

25. Homework Make sure you know how to use the Questioning your thought exercise, do it as many times as you can on yourself!