1. SOWK6190/SOWK6127 Cognitive Behavioural Therapy and Cognitive Behavioural Intervention Week 6 - Responding to automatic thoughts and modifying intermediate beliefs 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. Dysfunctional Thought Records (DTR) Key: With proper instruction and encouragement from the therapist, clients may use DTRs on a fairly regular basis.

4. Patients are more likely to use the DTR if it is properly introduced, demonstrated, and practiced: 1.The therapist should have mastered the DTR himself before presenting it to a patient; 2.The therapist should plan to introduce the DTR in two stages over two or more sessions. Stage 1 covers the first four column; Stage 2. the last two columns; 3.Make sure the client has a grasp of it; 4.The client should demonstrate an ability to identify her automatic thoughts and emotions before being introduced to the DTR; 5.Make sure the client can finish the first four columns first before introducing the last two columns; 6.Evaluate the outcomes of making use of the first columns; and 7.Check the DTR as a homework.

5. Motivating clients to use the DTR Set this as an homework and ask clients to compare the old “feeling” with the new “feeling”. If that didn’t work out, please try to find that out from the client’s own word.

6. Additional ways to respond to automatic thoughts 1.Doing a DTR mentally 2.Reading a previously written DTR or notes from therapy that contain an identical or similar automatic thought 3.Dictating a modified version or a DTR to someone else to write down or having someone else read previously written responses 4.Reading a coping card (pp.215-216) 5.Listening to a therapy session or part of one on audiotape.

7. Identifying and Modifying Intermediate Beliefs

8. Cognitive Conceptualization

9. Recap Intermediate beliefs includes: –Attitudes –Rules –assumptions

10. My advice: The more you use it, the more you will get at it.

11. Identifying Intermediate Beliefs 1.Recognizing when a belief is expressed an automatic thought; 2.Providing the first part of an assumption; 3.Directly eliciting a rule or attitude; 4.Using the downward arrow technique; 5.Examining the patient’s automatic thoughts and looking for common themes; 6.Reviewing a belief questionnaire completed by the patient.

12. Using the downward arrow technique Ask the client for the meaning of this thought, assuming the automatic thought were true. Continue to ask for meanings until an important core belief is discovered. Example questions: –If that’s true, so what? –What does it mean to you?

13. Educating clients about Beliefs “Where do you think you learned these ideas (belief)?” “Do you think there is other person who faces the same situation as you do, but have a different belief?”

14. Formulating a new belief “What belief would be more functional for the patient?” Check p.151

15. Modifying beliefs It is usually neither possible nor necessarily desirable to reduce the degree of belief to 0%. 1.Socratic questioning 2.Behavioral experiments 3.Cognitive continuum 4.Rational-emotive role plays 5.Using others as a reference point 6.Acting “as if” 7.Self-disclosure.