Core intervention: Thought record

What is a Thought Record?

A CBT (Cognitive Behavioural Therapy) Thought Record, is a cognitive technique used to examine the relationship between Thoughts, Feelings, and Behaviours. The Thought record provides insight into the connection between unhelpful thoughts, emotions, and behaviours. With this insight, clients can learn to break patterns.

When and how do you use a Thought Record?

You can use a Thought Record in situations where excessive emotions or unhelpful behaviours are present. Often, unhelpful thoughts underlie these experiences. Exploring unhelpful thoughts always yields valuable information. This could mean someone concludes that scary dogs can bite, but not all scary dogs will bite. The goal doesn't necessarily have to be a reduction in the feeling; accepting the feeling can also be a desired outcome. When you notice an unhelpful thought or response, you can suggest filling out a Thought Record together.
 

Step 1: Describe the situation using:

• Event (fact)
• Feelings (happy, angry, scared, sad, & ashamed)
• Thoughts (often automatic and unhelpful)
• Behaviour
• Consequence

Step 2: Once your client has mastered step 1, proceed to challenging the thoughts. During step 2, your client selects the Most Important Thought - the thought that triggers the most intense emotion - and assesses its credibility. Then, your client answers a series of critical questions to test the thought against reality and explore its effects.

Step 3: Formulate a helpful thought with sufficient credibility to promote a more neutral and realistic perspective. Also, reevaluate the old unhelpful thought based on the new credibility compared to the old thought from step 1.

💡Tips for using the Thought Record:

• It is important to identify the correct unhelpful thought. It is often something underlying, deeply integrated into someone's worldview. It should evoke intense emotions. This is also known as a "hot cognition."
  • Core beliefs: e.g., "I am not good enough."
  • Conditional beliefs: e.g., "If I drive in the evening, I will have an accident."
  • Rules for living: e.g., "I must never disappoint my friends."
• When using the Thought Record for burnout symptoms, there is extra emphasis on rules for living.
• In the beginning, it is important to let the client know that you will assist with filling out the record. Send a chat message if the thought record is filled out incorrectly. Common mistakes include:
  • Challenging a feeling instead of a thought.
  • Challenging a fact ("my colleague didn't call me back").
  • Challenging a superficial thought instead of a hot cognition (e.g., "I'm afraid to use public transportation" instead of "if I use public transportation, I lose control and spiral out of control").
• Since situations often evoke intense emotions, it is possible that someone's feeling doesn't change much after using this cognitive technique. In such cases, it can be helpful to add an additional step, such as using imagery for the alternative thought, searching for memories that align with this thought, or creating a behavioural experiment to gain new experiences in daily life.
• You can use a notification to remind your client to fill out a Thought Record in the app. Your client can also set this task themselves.
  
   

Sources

1. ten Broeke, E., & van der Heiden, C. (2008). Cognitieve therapie: de basisvaardigheden. (2de ed.). Boom.
2. Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten. Boom.