Evidence-Based Interventions for Automatic Thoughts

In general, the first set of interventions that a cognitive therapist will consider relates to the match or mismatch between the automatic thought and the situation or trigger. A common kind of distortion is negative fortune-telling, or predicting a negative outcome in a certain circumstance. Another common type of cognitive distortion is negative attribution. Negative attributions occur regularly in depression: Patients often blame themselves for perceived failure. Labeling is yet another type of cognitive distortion that lends itself to an evidence-based intervention. People engage in labeling as a shorthand way to describe themselves or others. Labels are often extreme and almost by definition are categorical. When the cognitive therapist hears a patient engaging in the process of labeling, he or she can undertake a series of interventions.

Alternative-Based Interventions

The second class of interventions in working with negative thoughts is the examination of alternatives. In some cases, a review of the evidence related to a negative automatic thought indicates that the original thought is not justified. In such instances, the patient can be asked for a more reasonable and accurate rendition of the situation.

A more formal strategy for encouraging alternative responses to negative automatic thoughts is a technique called the rational role-play. In this technique, the therapist asks the patient to state his or her automatic thoughts. Another strategy for examining reasonable alternatives to negative automatic thoughts involves homework. In this type of exercise, the patient is encouraged to identify possible alternative thoughts, even in the absence of evidence and even if the alternatives do not seem credible. The use of humor is another strategy for generating alternative perspectives to negative thoughts. Jokes and humor often require a sudden shift in perspective.

Another technique for encouraging alternative thoughts is to ask the patient how useful or adaptive the original negative thought was. Emotional reasoning is a type of negative thought that lends itself well to an examination of alternatives. Emotional reasoning occurs when people use their emotional response to a situation to justify the automatic thought that led to the response.

Developing Positive Thoughts

The interventions described here have focused on the identification and reduction of negative thoughts. Cognitive therapists also encourage the development of positive thoughts.

Meaning-Based Interventions

The third class of interventions used in working with automatic thoughts is the examination of the meanings attached to or the inferences that are drawn from different experiences. Often, the inferences are themselves automatic thoughts, which are about either other thoughts or the emotional and behavioral consequences of these thoughts. When a cognitive therapist asks the patient questions about the meanings or inferences that have been drawn from automatic thoughts, the discussion often moves from situation-specific thinking to more general and trait-like patterns of thought. The technique known as the downward arrow has been well-documented. Rather than disputing or challenging negative thoughts, the therapist asks the patient to assume that the first automatic thought is true or valid, then further queries the patient about the inference or conclusion that he or she has drawn. The therapist’s question can also be described as the “So what?” question, as in “So what if your thought is true? What would that mean about you?”