Change your thoughts using CBT – Part 1
Automatic Negative Thoughts
Of all of the symptoms of depression which emerge during an episode, changes in our thinking can often lead to significant distress. Suicidal thoughts can be present, although not always, and thinking in general can take on a much more negative slant.
In this article and the ones to follow, I aim to present to you how Cognitive Behavioural Therapy (CBT) can help you to address negative thoughts in an easy to follow, step by step, set of interventions.
To be clear however, Cognitive Behavioural Therapy offers something different than simply “positive thinking”, instead aiming to equip us with the skills to identify and evaluate our negative thoughts and generate more balanced alternatives which alleviate our depression symptoms.
The power of thoughts in depression
I’ve written elsewhere about the different signs of depression, and about how the Cognitive model of clinical depression as first suggested by Aaron Beck implies that it is our appraisals of events, our “negative automatic thoughts (sometimes also called automatic negative thoughts)” which give rise to changes in our emotions, behaviours and physiology.
To recap, Beck’s Cognitive Therapy suggests that depression symptoms are then maintained by further unhelpful changes in our behaviour and thinking, leading to clinical depression, rather than just a short period of low mood.
Take a look at the image below to see how this works:
Here we can see that the initial automatic negative thought, “she thinks I’m no good at this” leads to an emotional change (sadness, frustration), a behavioural change (avoid helping with the baby, avoid my partner) and a physiological change (reduced motivation).
If I have a strong belief in this particular negative thought, then it is likely to be activated each time a similar event occurs and I am likely to respond in the same emotional, behavioural and physiological way.
As such, the automatic negative thought and my belief in it goes unchanged, the unhelpful avoidance behaviours prevent opportunity to disconfirm the belief or to develop new skills to modify it, and this unhelpful cycle gets maintained.
Eventually, I become depressed.
How do I know that “she thinks I’m no good at this?”
Do I have evidence for this thought or am I just guessing that this is what she thinks? If I’m just guessing, or “mind-reading”, and it’s leading me to feel depressed and avoid her and the baby, then maybe it’s something that I need to check out? Furthermore, even if I did have evidence that “she thinks I’m no good at this?” Why would this be so bad for me? Babies don’t come with an instruction manual – there’s every chance that I might not be particularly skilled at child-rearing to begin with. What is it about the thought, “she thinks I’m no good at this” that causes me so much distress? With the skills I am going to introduce on this and the following pages, we are going to equip ourselves to address these issues.
Catching your negative thoughts
To alleviate our depressive thinking we first need to understand exactly which thoughts we need to pay particular attention to. In fact, the term which is given to such thoughts in Cognitive Behaviour Therapy, “Automatic Negative Thoughts (or “ANTS”)”, tells us a lot.
Of course, these thoughts are going to be negative in nature (more on this later) but most significantly for us at the moment is the fact that these thoughts are Automatic. By automatic, we tend to mean that these thoughts come unknowingly and in immediate response to particular events or stimuli. They flicker in from deeper consciousness, make their statement, and disappear again, almost too quickly for us to notice that they were there in the first place. They are habitual ways of appraising ourselves and the world which, through our familiarity and reliance upon them, just become part of the instinctive way we think about things.
Compare the Automatic Negative Thought with another type of thought, “Planning” for instance.
When I plan something, such as preparing a meal, the thoughts associated with this are in full awareness. “Go to the fridge”, “What would my wife like to eat?” “How shall I cook this?” All of these thoughts are there, in awareness, and open to scrutiny and adaptation from myself. With the Automatic Negative Thought, this is not so and as such our first step in getting to grips with them is to render them less “automatic”. To do this, we are going to use one of the staple tools of Cognitive Therapy, the Thought Record.
Take a look at the document below – click here to download your own CBT Thought Record
How to use a Thought Record in CBT
This is what we call a 7 column thought record. For now we are going to use just the first three columns, the ones labelled “Situation”, “Emotion” and “Thoughts”. You’ll recognise that these three columns are titled the same as some of the formulations which we have talked about previously.
To recap a little, sometimes, due to the automatic, fleeting nature of ANTS, we may link an emotion directly to an event. I might say for instance, “the baby’s crying is making me anxious”, or “my boss has made me angry.” But we are missing out an important factor here: It is not the baby crying that is making you anxious, nor your boss that is making you angry. It is the Automatic thought which follows your experience of the situation which generates the negative emotion.
So, for the purposes of our thought record, we are going to practice “catching” our ANTS.
If you’d like to have a go at this, the steps are easy. Firstly, for the next week, take your printed out thought record with you wherever you go. Take it to work, keep it with you at home, take it out when out visiting friends or family, etc. Whenever you notice yourself experiencing a strong negative emotion, be it low mood, anxiety or anger, write it down on the record in the column marked “Emotion”.
Of course, you might feel that it’s appropriate to find a discrete place to do this, like another room or other quiet area. I don’t expect you to whip out your thought record in the middle of a pub on match-day and start scribbling away at the bar! It is still useful however to ensure that you write down the emotion as close as possible in time to the event, just to keep the content and context as fresh in mind as possible.
Once you have written down the type of negative emotion that you are feeling, we need to give it an intensity rating. I’d like you to do this using a 0 to 100 scale, just like a percentage, with 0 indicating an absence of intensity and 100 representing the emotion as being as intense as it possibly could be. If you struggle with rating the intensity of emotion, then just aim for an approximation, as close as you feel you can rate it. We don’t need decimal point accuracy, all that we want to do here is to start the process of linking the emotion, and its intensity, with the thoughts that pass through our mind at the time.
Take a look at the picture below to see what a completed “Emotion” column might look like:
Feelings, Thoughts, Behaviour
Next, we want to pay attention to the situation, or event, which preceded the negative emotion. This is generally a fairly easy thing to do. For example, we are very likely to be able to pinpoint that argument with our spouse, or making that mistake at work as being the events which immediately preceded our change in emotion.
However, there are some situations in depression which require a little more thought and explanation.
Have you ever just woken up already feeling low or depressed? This is not an uncommon experience in depression and it is one of the peculiar situations in which people become confused when using thought records. If we’ve only just woken up and are feeling depressed, then surely there hasn’t actually been a preceding situation or event for our minds to appraise in a negative way? So what do we write in the “Situation” column?
Take a look at the diagram below.
Here we see that we can appraise the actual internal presence of low mood in a negative way which leads to further low mood. Often in depression, people can wake up, notice that they are feeling less than great and then experience an Automatic Negative Thought (e.g., It’s going to be another bad day) which appraises the internal event negatively, thereby extending the low mood throughout the day.
So, in the “Situation” column on the thought record, we may write something like “woke up, already feeling depressed.”
Take a look at the example thought record below which illustrates the kind of data we should have caught so far
The last step in catching our Automatic Negative Thoughts?
Yes, you guessed it – the “Thought” column. It has been suggested (although seemingly hard to verify…) that we have between 50000 and 70000 thoughts each day. That’s a lot of thought records! But don’t worry, we are only interested in a very specific type of thought, what CBT pioneer Christine Padesky terms a “Hot Thought.”
The Hot Thought is the actual thought which directly relates to the change in emotion, the thought that, when looked at objectively appears to make a clear link between what’s gone on in our heads and our emotional state.
Take a look the Emotion-Thought pairs below and have a think about which thoughts are “Hot Thoughts” and which ones are not (Hint: Only three are Hot Thoughts):
The Hot thoughts were numbers 1, 3 and 5. Can you see why? Each of the three hot thoughts are logically associated with the emotion that they trigger. For example, the Hot Thought, “They’re taking advantage of me,” is the type of thought content which would lead someone to feel defensive, and, as a consequence, angry that someone would do this to them. Similarly, the Hot thought, “I’m just a failure,” generates the emotion of sadness because it reflects the individual’s perceived lack of success with their situation. Lastly, the Hot Thought, “She might be getting sick,” carries with it a reflection of threat, that their loved one is potentially unwell, and as such the emotion of anxiety is activated.
In contrast to these Hot thoughts, it’s unlikely that the thought “the baby looks happy” would generate any sort of anxiety or fear. Similarly, deciding to arrange a meeting for this morning or thinking about taking the bins out, would not automatically lead to anger or sadness respectively. Get the idea?
The Hot Thought is the one which appears to relate most closely to the emotion experienced. This is what we want to “catch” in our thought records.
So, the next stage in our thought catching is to write down our Hot Thoughts in the “Thought” column. When you have written in the “Emotion” and “Situation” columns, write down the types of thoughts which were passing through your mind at the time of the event. Please don’t expect to be able to identify the Hot Thought straightaway – there will be many different thoughts going through your mind at the time of the event. Write down whatever thoughts which you feel are associated with the emotion and the situation – use the prompts at the bottom of the “Thoughts” column to help you. Once you have done this, spend a bit of time reviewing the thoughts and try and identify one which appears to have a logical link to the emotion which you have experienced. Again, we’re not looking for perfection, just as close as you can will do. Our goal here is to practice making these Automatic Negative Thoughts less Automatic.
The final stage in our foray into thought catching is to rate the strength of our belief in the thought. Although it’s not something that we tend to think about much, our strength of belief in a thought can vary dependent upon time and situation. It’s possible to have the thought, “I’m a crappy dad” and believe it quite intensely when in a particular situation, struggling to feed the baby its bottle for instance. Later in the day however, when I might manage to rise a smile from the baby, my strength in the belief, although still being active to a degree, may have reduced slightly. Therefore, by using the Thought record to catch our degree of belief in a Negative Automatic Thought, we are able to also explore how strength of belief fluctuates, and how this fluctuation interacts with our emotions and depression symptoms.
Have a look at the picture below to see how the thought record might look with the first three columns completed.
Now practice challenging your negative thoughts
Well done! You have taken your first steps to changing the way you think. Download the thought record and take it with you wherever you go, getting as much practice with thought catching as you can over the next week.
The more you practice, the better at it you will become, and the more equipped you are to deal with your depression symptoms. The next article will look at how we can actually begin to change these thoughts and pave the way for developing more helpful, balanced ways of thinking.