The cornerstone of cognitive therapy is the ability of the therapist and their client to identify and subsequently challenge thoughts and beliefs that reinforce negative thinking. In order for therapy to progress it is important for the client to understand that their thoughts do not necessarily reflect the truth of their situation. A variety of standard procedures are used to this end:
Thought Catching. We have certain automatic thoughts that pop into our heads the moment we hear, think or become involved in situations. These can be either positive or negative. When you hear a knock at the door is your automatic reaction ‘ah, good, a visitor’, or, ‘oh no, someone is at the door?’ The second example is that of a negative automatic thought (NAT). Of course many of the situations we encounter are ambiguous. For example, if you see a couple talking and one or both look in your direction are they talking about you, or are they simply looking in your direction?
People with depression are frequently inclined towards NATs. The therapist may begin a course of treatment by selecting an incident that leads to or feeds into depression and asking the person to list the thoughts and feelings they experienced relating to that incident. The therapist and client then go through the list and determine which items on the list seem reasonable and which are NATs resulting from the incident.
Task Assignment. During task assignment the client predicts the things he or she feels will go wrong during, say, a social interaction. Between sessions the client is encouraged to engage in one of the scenario’s they have outlined. During the next session the therapist unpacks the extent to which the predictions were accurate or fear-based and inaccurate. In the vast majority of the cases the client overestimates the negative outcomes prior to the task being undertaken.
Reality Testing is another technique focused on disproving certain beliefs. Once again simple tasks might be agreed in order to disprove the assumption. For example, contacting a colleague to disprove no one will ever speak to them.
Cognitive Rehearsal. If a situation is likely to occur, the therapist and client work together on the likely details. They work carefully through the scenario taking notes at possible points of difficulty. The whole scenario is worked through until a point of happy conclusion. Once completed, the hurdles are discussed in turn while the therapist encourages their client to generate solutions for overcoming each one. If a real block turns up then Task Assignment may be adopted.
The aforementioned procedures represent a sample of commonly used cognitive techniques and typify an approach of illuminating thoughts and beliefs that block progress and challenging these whilst replacing them with practical solutions and other more positive outcomes.
Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.