Psyc641 Lecture 04 Page: 1

Cognitive-Behavioral Psychotherapy
Lecture 4
Paul Linden, Psy. D.

Chapter 6: 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.
I. Characteristics of Automatic Thoughts
a. Automatic thoughts are a stream of thinking that coexists with a
more manifest stream of thought.
b. Generally people put a reality check on automatic thoughts, but
people who are in distress, may not engage in this kind of
critical examination.
c. Although automatic thoughts seem to pop up spontaneously,
they become fairly predictable once the patient’s underlying
beliefs are identified.
d. Automatic thoughts are usually quite brief and the patient is
often more aware of the emotion she feels as a result fo the
thought than the thought itself.
e. The emotion the patient feels is logically connected to the
content of the automatic thought.
f. Automatic thoughts are in shorthand form but can be easily
spelled out when the therapist asks for the meaning of the
thought.
g. Automatic thoughts can be in verbal form, visual form or both
h. Automatic thoughts can be evaluated according the their
validity and their utility
i. Three types
i. Thoughts that are a distortion of the objective evidence
ii. Thought that is essentially accurate but the conclusion
the patient draws may be distorted (ex. “I didn’t do what
I promised. Therefore I’m a bad person.”)
iii. Thoughts that are accurate, but lack utility
II. Explaining Automatic Thoughts to Patients
a. Examine and explain the connection between thoughts and
feelings
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b. Identification of the feeling and move back to the automatic

thought, evaluate and respond to the automatic thought, do
problem-solving if thoughts are true,
III. Eliciting Automatic Thoughts
a. Start the process in session when you notice a shift in the
patient’s mood.
b. Basic Questions: What was going through your mind just
then?
c. To identify automatic thoughts
i. Ask this questions when you notice a shift in (or
intensification of) affect during a session)
ii. Have the patient describe a problematic situation or time
during which she experienced a shift in affect and ask the
above question
iii. If needed, have the patient use imagery to describe the
specific situation or time in detail (as if it is happening
now) and then ask the question above.
iv. If needed of desired, have the patient role-play a specific
interaction with you and then ask the question above
d. Other questions to elicit automatic thoughts
i. What do you guess you were thinking about
ii. Do you think you could have been thinking about ____
or ____?
iii. Were you imagining something that might happen or
remembering something that did happen?
iv. What did this situation mean to you? (Or say about you?)
v. Were you thinking ____________?
e. It is important to examine and explore automatic thoughts when
they are reported. The patient is likely to have additional
automatic thoughts, the patient may also have a reaction to the
automatic thought, and there may be images affecting the
patient’s mood.
IV. Identifying the Problematic Situation
a. If patient has trouble, therapist may propose a number of
upsetting problems, asking the patient to hypothetically
eliminated one problem and determine how much relief the
patient feels.
b. Note: if after evaluating an automatic thought patient reports
little or no shift in mood, there is always some other more
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central automatic thought (intermediate thought) that has not as

of yet been discovered.
V. Differentiating between automatic thoughts and interpretations
a. Looking for the actual words or images that went through the
patients mind.
b. Interpretations may or may not reflect the actual thoughts.
(This is a particular problem with bright patients or patients that
use intellectualization as a defense. It also is one of the keep
differences between depressed versus character disorder
dysthymic patients)
VI. Differentiating between useful and relatively less useful automatic
thoughts
a. Until a patient learns to recognize specific automatic thoughts
he/she may report a number of thoughts. Some thoughts are
simply descriptive and innocuous, or irrelevant to a problem.
Relevant automatic thoughts are usually associated with marked
distress.
VII. Specifying Automatic thoughts Embedded in Discourse
a. Here there are implied rather than stated automatic thoughts
b. Need to question the patient to make implied thoughts overt
before attempting to respond or evaluate the embedded thought
Examples:

Embedded expression Actual automatic thoughts

I guess I was wondering Does he like me?
if he likes me.

I don’t know if going to It’ll probably be a waste

the professor would be of time if I go.
a waste of time.

I could get myself to start I can’t do this.

reading.

VIII. Changing the form of Telegraphic of Question thoughts

a. a telegraphic thought is unspecific “Uh oh”, “Oh well”
b. If automatic thought is expressed as a question have them
change the form to a statement.
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Chapter 7 Identifying Emotions

• The client’s emotional experience plays a critical role in cognitive
therapy. A major goal of therapy is symptom relief, a reduction in a
patient’s level of distress accomplished through the modification of
dysfunctional thinking.
• Although a therapist may recognize the excessive or inappropriateness
of an emotion, he acknowledges and empathizes with how the patient
feels, he dos not challenge or dispute the patient’s emotions but rather
focuses on evaluating the dysfunctional thoughts and beliefs
underlying her distress in order to reduce her dysphoria.
• The therapist does not analyze all situations in which the patient feels
dysphoric, cognitive therapy aims to reduce the emotional distress that
is related to misinterpretations or a situation.
• Cognitive therapy also seeks to increase the patients positive emotions
thought discussion of the patient’s interests, positive events that
occurred, positive memories and so forth.
I. Distinguishing automatic thoughts from emotions
a. Many patients do not clearly understand the difference between
what they are thinking and what they are feeling
b. Therapist organizes the patients experience into categories
(situation, automatic thought, and reaction (emotion, behavior,
and physiological response))
II. Focusing Technique (Eugene Genlin, 1979) Zig-Zag-Ahh
a. Clearing a space
b. Felt sense
c. Handle
III. Emotion Ideational Content
Sadness loss of something in the personal domain
Euphoria Perception or Expectation of Gain in the
personal domain
Anxiety threat real or imaginary (primary appraisal)
For which one lacks the resources to
neutralize the harm (secondary appraisal)
Anger (attack= anger) only able to account for
some episodes more general is any violation
of a rule held (a transgression) direct,
indirect and hypothetical
IV. Importance of Distinguishing Among Emotions
a. The connection among the thoughts, emotions and behavior
should make sense to the therapist. He investigates further
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when the patient reports and emotion that does not seem to
match the content of her automatic thought.
b. Some patients display a relatively impoverished vocabulary for
emotions.
i. Recall a specific event as if it were happening now.
ii. Creating an emotional chart that is based on the clients
experience of significant emotional events
iii. Using a negative emotional list (menu approach)
iv. With very limited patients you can use an emotional face
chart (frequently used with children)
c. Difficulty in rating degree of emotion
i. Important to know both what you are feeling but also the
degree of feeling
ii. Assess whether questioning and adaptively responding to
a thought or belief have been effective
iii. Gauging the intensity of an emotion in a given situation
helps the patient and the therapist determine whether that
situation warrants close scrutiny.

0% 25% 50% 75% 100%

Not sad Somewhat Medium Quite Saddest I

at all sad sad sad have been or
could imagine
being

• Create an emotional intensity scale that is based on the clients

experiences and that reference emotional events that make
sense to the client.
• Therapist uses this rating to decide what emotional experiences
to analyze, as well as to evaluate the effectiveness of the
intervention.