Identifying and responding to automatic thoughts and emotions

Automatic Thoughts and Cognitive Behavioral Therapy

A primary objective of cognitive therapy is to identify some underlying patterns, thought processes, behaviors and assumptions within the patient that might light the way to the root of a cognitive dissonance. As we work with patients to uncover these dissonances, certain patterns occur commonly across a wide variant of disorders or dysfunctions. Among them, automatic thoughts are a common occurrence and can often reveal behavioral tendencies that contribute directly to one's condition. As the discussion here will show, automatic thoughts often play a large but unseen role in the negative emotions experienced by those suffering with various cognitive dissonances, disorders or dysfunctions.

Advantages and Disadvantages:

One of the primary advantages to identifying Automatic Thoughts and explaining them to the patient is the degree to which this will arm the patient with the awareness to begin combating his or her own dysfunctional tendencies. As the text by Beck (1995) points out, before any such patterns are illuminated for the patient, they might seem highly obscured and their consequences almost random. The individual who manifests automatically negative interpretations of a situation and who may as a result experience anxiety, panic, despair, depression, hopelessness, anger, resentment or a host of other negative experiences, may not have the presence of mind without the assistance of an objective counselor to recognize the role played by automatic thoughts. According to Beck, "although automatic thoughts seem to pop up spontaneously, they become fairly predictable once the patient's underlying beliefs are identified. The cognitive therapist is concerned with identifying those thoughts that are dysfunction, that is, those that distort reality, that are emotionally distressing and/or interfere with the patient's ability to reach her goals." (p. 76)

One potential disadvantage may stem from the process of helping the subject to become more adept at identifying and rooting out negative automatic thoughts. Beck notes that while some patients may catch on quickly, others may struggle to understand, identify, recontextualize and eliminate automatic thoughts. This can lead to a frustration which in and of itself can worsen the subject's emotional disposition. That said, such frustration will ultimately pass when the patient is able to familiarize himself with problematic patterns. The gains cited above to the therapeutic process are not only too great to pass up in light of this potential disadvantage but it may be argued that one's chances of receiving successful care will depend heavily on the ability to integrate an understanding of automatic thoughts.

Personal Disposition/Rationale on Use in CBT:

To this point, in my engagement of Cognitive Behavioral Therapy, I would consider it a necessity of the highest order to provide patients with a clearer understanding of automatic thoughts. This is based on the rationale that ultimately a patient must learn to intervene with such thoughts if one is the ultimately overcome the patterns that lead to manic episodes, panic attacks or other recurrent symptoms of an anxiety disorder. It is my role as the therapist to provide the patient with all the necessary knowledge and resources to identify these patterns. Absent that illumination, it is more than likely that a patient will continue to engage in these derailing automatic thoughts even as he or she faces a battery of cognitive behavioral therapy exercises. This can significantly undermine the therapy process.

Questions to Elicit Automatic Thoughts:

One of the best ways to identify automatic thoughts in the patient is to show the patient instances where he or she tends to engage these patterns. Asking questions is the primary vehicle for the therapeutic process, and the properly framed question can yield meaningful insight into ways that a subject can preemptively avoid engaging in such behaviors. One question that might yield an automatic thought is: "How are you feeling today?" Another is, "Did anything in particular upset you this week?"