Chapter 9: Cognitive Work/Addressing Negative Thinking

Question 1

3 types of interventions to address negative thinking + questions

Answer 1

1. evidence-based methods, which examine the evidence for and against specific ideas: What is the evidence for and against this thought?
2. alternative-based methods, which emphasise the development of alternative thoughts: What are alternative ways to think in this situation?
3. meaning-based methods, which examine the meanings that clients attach to their thoughts: What are the implications of thinking this way?

Question 2

when is each of the 3 interventions to address negative thinking useful?

Answer 2

1. evidence-based methods: when the negative thought likely represents distorted thinking, or thinking that is at least more negative than the situation warrants
2. alternative-based methods: after examining the evidence-related question, ask the client to question whether his or her thinking is the only, or the most helpful way to think about the situation
3. meaning-based methods: examine whether the situation has activated core beliefs, and whether maladaptive inferences are being made in the situation

Question 3

common cognitive distortions

Answer 3

1. all or nothing thinking
2. cataztrophization
3. fortune telling
4. mind reading
5. dysqualifying the positive
6. magnefication/minimization
7. selective abstraction (mental filter)
8. overgeneralization
9. misattribution
10. personalization
11. emotional reasoning (bc sth feels bad, it must be bad)
12. labeling

Question 4

evidence-based methods rationale

Answer 4

• realist assumption
• cognitive model takes the position that our perceptions are based on two sources:
  1. the facts or circumstances of a situation in which we find ourselves, and
  2. our beliefs, assumptions and schemas
• it is the interaction between these two sources that conspires to lead to situation-specific thinking, or what are also called automatic thoughts –> whereas accurate appraisals of the world are driven more by perceptual and specific elements observed in moment-to-moment experience, distorted automatic thoughts are driven more by core beliefs, assumptions, or schemas

Question 5

evidence-based methods strategies

Answer 5

1. examining the evidence related to negative thoughts
2. identifying unrealistic expectations
3. examining attributional biases
4. reattributing causes using pie charts
5. change labeling
6. changing dichotomous thinking into graduated thinking

Question 6

evidence-based methods strategies : examining the evidence related to negative thoughts

Answer 6

• Behavioral experiments in which clients can compare their thoughts to the evidence
• straightforward: ask clients about the evidence they use to understand a given situation or trigger event
• attend to various aspects of the evidence, including its type, quality and amount
• contrast these pieces of supportive evidence with data that do not fully support, or that are inconsistent with the original thought
• socratic questioning

Question 7

evidence-based methods strategies : identifying unrealistic expectations

Answer 7

• determine what evidence clients would use to confirm or disconfirm their prediction
• ask about worst case-outcome, best-case outcome and the most realistic outcome and then determine the evidence that fits each potential outcome
• have clients identify how they will collect the relevant evidence
• homework assignments in which they can collect the evidence
• compare homework expectations with actual outcomes

Question 8

evidence-based methods strategies : examining attributional biases

Answer 8

(locus, stability, specificity)

• address attributional biases whenever they appear
• ask for more details about the problematic situation and expose the tenuous relationship that may exist between the event and the attributions made in the situation

Question 9

evidence-based methods strategies : reattributing causes using pie charts

Answer 9

• name the various causes of an outcome
• client has to consider all possible sources of the outcome and match their attributions to the circumstances of the event, as much as possible

Question 10

evidence-based methods strategies : change labelling

Answer 10

• socratic questioning can be employed to help the client to see the way that labels constrain future interactions and often actually become self-fulfilling
• let client specify which behaviours or attributes they see that support the label
• examine the evidence related to these behaviours and attributes and identify behaviours and attributes of the labeled person that are inconsistent with the label

Question 11

evidence-based methods strategies : changing dichotomous thinking into graduated thinking

Answer 11

• help clients recognise that they are using categorical terms for what is more likely a continuum
• ask the client whether they can recognise an underlying continuum
• identify anchors, benchmarks for various places on the continuum and evaluate whether the original automatic thought fits that continuum

Question 12

emotional reasoning

Answer 12

• occurs when a client uses their emotional responses to a situation to validate the cognitions that preceded them
• is an error in logic, (if B follows A, A causes B) –> so you need to find out the “real” trigger

Question 13

alternative-based methods strategies

Answer 13

1. generating and evaluating alternative thoughts

2. cultivating positive thoughts

Question 14

alternative-based methods strategies: generating and evaluating alternative thoughts

Answer 14

• Generate alternative thoughts if there is not much evidence for the thought or if the thought is not helpful
• identify advantages and disadvantages of of both the original and the revised thought
• rationale role play: play out negative and more adaptive cognitions
• add two new columns to thought record: alternative thought and emotional and behavioural consequences of alternative thought
• use of humour to make previous statements seem silly or funny
• discussion of how useful or helpful it is to entertain the negative thought
• make client aware of contradictory thoughts
• have a prepared and ready response to negative thoughts (TIC-TOC: I can’t do it. Even a little bit helps)

Question 15

alternative-based methods strategies: cultivating positive thoughts

Answer 15

• sometimes discussion of a negative thought demonstrates that although the thought has negative consequences, it is actually based on a positive underlying concern (e.g. always worrying mother is a responsible parent)
• possible to see the positive aspects of negative thoughts and to reframe or restate the thought from this perspective (positive reframing)

Question 16

meaning-based methods

Answer 16

• “So what?”
• when clients are asked to examine this question, they spontaneously begin to consider the broader conceptual implications of the thoughts
• downward arrow: rather than challenge the original automatic thought, the therapist considers the thought to be true, the client is ask what the implications of “fact” are, response is accepted as fact, inference of that is examined and so on
• typically these broad inferences (last inference that can be drawn) reflect core beliefs or schemas about the self or the world

Question 17

realistic negative thinking

Answer 17

• move toward a more behavioural and action-oriented strategy that helps the client change what can be changed and accept what has to be accepted
• increase self-care activities, enhance positive life skills, enlist available social resources and supports
• worry time: restrict worrying to certain prescribed time of the day or of the week