During this week, special attention should be paid to work with automatic thoughts as a part of cognitive-behavior therapy (CBT). The task of a therapist is not only to identify cognitions that determine human behaviors but also to modify them, following specific rules and schemas. Wright, Basco, and Thase (2017) created two chapters about the approaches to schemas’ and automatic thoughts’ identification and modification processes.
One of the main ideas of the chosen reading is that CBT aims to encourage patients to stop, analyze, ask questions (if necessary), adopt changes, and move forward. A therapist should give some recommendations and directions without direct interference with the person’s core beliefs. Such a task is characterized by a number of rules and restrictions, and Wright et al. (2017) introduced a list of methods and schemas for identifying and modifying automatic thoughts and core beliefs. Psychoeducation, guided discovery, imagery, role-play exercises, Socratic questioning, decatastrophizing, and reattribution are examples of models (not all) available to therapists for their work with mentally ill patients.
The reading under analysis may be divided into three main sections: methods to identify automatic thoughts, approaches to modify automatic thoughts, and CBT schemas to change core beliefs. Wright et al. (2017) developed seven processes with the help of which therapists reveal automatic thoughts. Recognizing mood shifts and psychoeducation are the steps to generate emotionally charged cognitions and explain the nature of thoughts. Guided discovery is proved to be one of the most common techniques due to its simple but up to the point tasks like being specific, using one topic/line of questioning, or using empathy skills.
Thought recording and imagery are directed to recognize automatic thoughts without focusing on the details that may confuse patients. Role-play exercises are based on therapist-patient cooperation, whilst checklists require only a patient to be involved. The same methods, along with a life history review and inventories, can be applied to identify schemas. Socratic questioning, examining evidence, reattribution, and using cognitive continuum are techniques to modify automatic thoughts and schemas (Wright et al., 2017). Therapists encourage patients to use their skills and change their lives in regards to their current needs and problems.
Vignettes, cases examples, and videos are properly integrated into the book under consideration. Guided discovery is a technique demonstrated in the case example where Anna, a 60-year-old woman, has depression. A therapist asks direct questions to focus on one event or one person and help the patient uncover automatic thoughts about her problems. In videos, a therapist applies the same model to her patient, Brian, and poses questions to reveal negative thoughts for treatment. Thoughts recording and imagery are the methods introduced in the video where Dr. Brown works with Eric. Compared to thoughts recording where mechanical statements are given to save time and cover as many aspects as possible, imaginary is characterized by patient’s full engagement and desire to cooperate (Wright et al., 2017).
Examining the evidence is an effective method to modify thoughts for patients who are not confident in their abilities, and the role of a therapist is integral (videos with Brian and Kate). A case example with Max, a bipolar disorder patient, explains the worth of cognitive errors identification. Thoughts modifications by generating rational alternatives in Brians’ and Eric’s cases are presented in videos.
There are also several videos to support the methods of cognitive rehearsal and coping cards for Kate, and cases examples of Max and Terry to explain how decatastrophizing works. In the next chapter, Wright et al. (2017) referred to the already mentioned case of Brian and the work of Dr. Sudak in order to explain how different questioning techniques (guided discovery or imagery) work. The case example of Maria (depression) focuses on the downward arrow technique with pressure and analysis playing a significant role. As soon as the schema is identified, it has to be modified. Wright et al. (2017) used Maria’s case example to examine evidence and Alison’s case example to list advantages and disadvantages. Vignettes turn out to be helpful through the chapters to explain how to connect identifying and modifying processes during the work with the same patient.
One of the most significant benefits of the authors’ points is the possibility to cover as many techniques as possible. The reader is able to identify several methods, learn how to apply each of them in a particular situation, and specify if another option is appropriate in the same situation. There are many tables where learning experiences and major concepts are mentioned. It helps the reader to memorize information in different ways.
The strength of the chosen principles lies in defining options for therapists to recognize automatic thoughts and modify them in accordance with the existing environment and skills of their patients. At the same time, there is one weakness – the absence of the same structure for discussing all concepts. For example, one technique to modify or identity thoughts or schemas may be supported by several cases and outcomes. However, some techniques like Socratic questioning to modify schemas do not include a patient or a case, proving its appropriateness.
To avoid misunderstandings or the necessity to think about additional examples and situations, it is recommended to organize all the sections in the same way. Firstly, such an approach is helpful in comparing techniques and memorizing their usage. Secondly, it is easy to understand the work of every principle within the same context. It is also necessary to admit that the points mentioned by Wright et al. (2017) may provoke the development of one mistake – the role of a therapist in identifying and modifying automatic thoughts. When the authors said that the role of a therapist (cooperation) in role-play exercises is critical, it should not mean that other methods do not require a therapist’s participation.
In general, the information offered in the chosen chapters properly describes the essence of identifying and modifying different processes in CBT. Automatic thoughts introduce the problems patients are not able to identify when they address to a therapist for help. Schemas are the guides for therapists to support patients and recognize their concerns. In both cases, identification and modification are the integral steps of a treatment plan.
The use of a number of case examples and videos prove that the offered techniques are not only some theoretical assumptions in the CBT field. Vignettes and particular patients’ situations are real, and the reader should use this week reading as a good chance to understand why all automatic thoughts must be identified and then modified. The approaches to work with patients vary in cognitive behavior therapy. A therapist has to be properly prepared, recognize the benefits and potential problems in the usage of a technique, and make a final decision, relying on personal experience and critical evaluation.
Reference
Wright, J. H., Basco, M. R., & Thase, M. E. (2017). Learning cognitive-behavior therapy (2nd ed.). Arlington, VA: American Psychiatric Publishing, Inc.