Index
Aabir Explores His Images exercise, 131
about this book, 2–4
active learning, 3
activities: monitoring daily, 204–208; planning mood-boosting, 209–215
affect regulation, 90
agendas: collaboratively setting, 67–69; working in a session, 69
Aiden Uses a Knife Again exercise, 232
all-or-nothing thinking, 110
analogy use, 203
anger, understanding, 108
anxiety: exposure therapy for, 223–245; how to understand, 106–107; safety behaviors and, 226–228, 243, 244. See also fears
Are My Predictions Accurate? worksheet, 239–240
audio files, 4; on explaining a Daily Activities Schedule, 204–205; on explaining exposure therapy, 231; on explaining goal setting to clients, 47–48; on explaining looking for evidence, 148; on explaining problem solving, 180; on identifying cognitive distortions, 118; on introducing the Understand Your Reaction worksheet, 89–90; on using questions to explore client problems, 27. See also Practice in Your Imagination exercises
automatic thoughts, 9, 248; core beliefs and, 18, 19, 249–250, 252; identifying, 122–124
avoidance: cycle of, 224–225; questions for considering, 230; safety behaviors as, 226
B
balanced thoughts, 163–167; consolidating, 165; creating a new image using, 166–167; managing stress using, 167; questions for developing, 163
Beck, Judy, 155
behavioral activation, 196–221; cycle of depression and, 197–198; daily activity monitoring in, 204–208; graded task assignments in, 215–217; and helping clients understand their depression, 199–204; homework assignments on, 219–220; increasing well-being through, 218; planning mood-boosting activities in, 209–215; research on effectiveness of, 198–199; steps in process of, 198
behavioral experiments, 224
behaviors: cognitive distortions and, 115–116; coping thoughts related to, 188; describing specific and concrete, 98; examples of vague vs. specific, 95; four-factor model for understanding, 10; helping clients identify, 94–96; influence of thoughts on, 12; linking thoughts to, 135–137; problems maintained by, 16–17
beliefs. See core beliefs
Benefits and Drawbacks of My Solutions worksheet, 185
black-and-white thinking, 110
brainstorming solutions, 180–183
C
Carol Wants to Apply for a Job exercise, 132
catastrophizing, 111
CBT. See cognitive behavioral therapy
check-in process, 62–66; components of, 63–64; dialogue example, 65; staying focused in, 64, 66
Checklist of Common Problems with Thought Records handout, 168
clarifying questions, 122
cognitive behavioral therapy (CBT): building blocks of, 7–11; definition of, 1; explaining to clients, 39; fundamental principles of, 1; homework on practicing, 259–260; self-application of, 3; study on effectiveness of, 2
cognitive distortions, 109–116; common types of, 110–112; dysfunctional behaviors and, 115–116; exercises for identifying, 112–113, 116; helping clients identify, 113–114; homework assignments on, 117–118, 120; worksheet for identifying, 114, 117
collaboration: in agenda setting, 67–69; in homework development, 70
Common Problems with Thought Records exercise, 168
compulsive rituals, 226
consequences of behaviors, 95
content specificity, 106
coping thoughts, 187–191
core beliefs: automatic thoughts and, 18, 19, 249–250, 252; clinical implications of, 20–21; downward arrow technique and, 252; identifying with clients, 248–252; psychosocial history and, 250–251; thoughts influenced by, 18–21; three types of, 18
Cycle of Avoidance diagram, 225
D
Daily Activities Schedule, 204–208
daily living activities, 209
depression: behavioral activation for, 196–221; CBT developed as treatment for, 1; daily activity monitoring for, 204–208; diagram on cycle of, 197; helping clients understand, 199–204; planning mood-boosting activities for, 209–215; relapse prevention for, 215; thoughts indicative of, 107–108
Develop Effective Exposure Tasks exercise, 234, 277
Develop Mood-Boosting Activities for Anna exercise, 211–212, 275
Dewei Uses Marijuana Again exercise, 69
Diana Wants to Go to College exercise, 127
doorknob therapy, 67
downward arrow technique, 252
dysfunctional behaviors, 115–116
E
emotions. See feelings
environment, in four-factor model, 8
Eulela Has a Very Bad Week exercise, 66
Evaluate Suzanne’s Homework exercise, 71–72, 268
evaluative thoughts, 103–105
Examine the Reality of Your Thoughts worksheet, 146, 170
Examples of Coping Thoughts handout, 190
exercise, physical, 209
exercises (practice), 4; for behavioral activation, 212; for developing helpful goals, 55; for evaluating the Understand Your Reaction worksheet, 137; for explaining consequences of thoughts, 189; for exploring images and thoughts, 131, 132; for exposure therapy, 226, 228, 232; for focusing on problems and strengths, 38; for helping clients reach their own conclusions, 162; for identifying cognitive distortions, 113, 116; for identifying problems with thought records, 168; for identifying specific behaviors, 95; for identifying the meaning of situations, 127; for identifying thoughts about self, others, or the future, 106; for identifying trigger situations, 87, 89; for problem solving, 178; for reviewing balanced thoughts, 165; for using CBT theory to understand clients, 14, 15, 16, 18, 19, 20, 21; for weighing evidence against hot thoughts, 154; for working with depressed clients, 201, 212; for working within a session structure, 66, 69, 72. See also YOUR TURN! exercises
Explain CBT to Your Client handout, 39
Explain Goal Setting handout, 47
Explain the Structure of a Therapy Session handout, 61
exposure therapy, 222–245; effectiveness of, 228; explaining to clients, 230–231; fear hierarchy for, 231–232, 243, 244; homework assignments on, 243–244; implementing exposure in, 232–238; negative predictions about, 236–238; postexposure debriefing in, 238–242; preparing to do, 229–232; relapse prevention and, 242; tasks used in, 232–235, 238; theory behind, 223–224; types of, 228–229
F
facts vs. thoughts, 87–88
false alarms, 158
fears: categories of, 229; exposure therapy for, 223–245; hierarchies of, 231–232, 243, 244; how avoidance maintains, 224–225. See also anxiety
feedback, requesting from clients, 73
feelings: distinguishing thoughts from, 9, 91; empathy toward thoughts and, 25; explanation of emotions and, 90; helping clients identify, 90–93; images accompanying, 131; linking thoughts to, 135–137; physical reactions distinguished from, 9; rating process for, 92–93, 98, 108–109; thoughts related to, 12, 106–109, 127–128; worksheet for identifying, 138–139
Fennell, Melanie, 203
filtering, 110
Find the Facts exercise, 89
flower analogy, 203
focus, during check-in, 64, 66
four-factor model, 7–11; homework assignments on, 21–22; self-reflection exercise, 24; therapeutic use of, 81–83, 137
future: predictions about, 111; thoughts about, 104, 108, 119
G
goals, 46–58; defining problems and setting, 179; developing specific and measurable, 48–55; examples of general vs. specific, 49; homework assignments on, 56–57; introducing clients to, 46–48; prioritizing order of, 47, 55
Good Sleep Guidelines, 258
graded task assignments, 215–217
gratitude, expressing, 218
Guidelines for an Effective Activity Plan handout, 210
Guidelines for Helpful Homework handout, 70
guilt, understanding, 108
H
habituation, 223–224
handouts, 4; Checklist of Common Problems with Thought Records, 168; Examples of Coping Thoughts, 190; Explain CBT to Your Client, 39; Explain Exposure to Your Clients, 230; Explain Goal Setting, 47; Explain the Structure of a Therapy Session, 61; Good Sleep Guidelines, 258; Guidelines for an Effective Activity Plan, 210; Guidelines for Helpful Homework, 70; Identify Your Feelings, 90; Pleasurable Activities List, 210; Questions for a Balanced Thought, 163; Questions to Assess Your Client’s Safety Behaviors, 227; Questions to Develop Coping Thoughts, 189; Questions to Develop Helpful Goals, 51; Questions to Explore a Mood/Activity Relationship, 205; Questions to Explore Problems, 26; Questions to Explore Strengths, 33; Questions to Gather More Information about the Situation, 159; Questions to Help Set an Agenda, 67; Questions to Identify Evidence Against Negative Thoughts, 155; Questions to Identify Your Client’s Images, 131; Questions to Identify Your Client’s Predictions During Exposure, 237; Questions to Identify Your Client’s Thoughts, 134; Questions to Review the Therapy Session, 72; Thinking Traps, 110. See also worksheets
happiness, increasing, 218, 219–220
Help Cynthia Reach Her Own Conclusions exercise, 162, 273
Help Neale Identify a Specific Situation exercise, 86–87
Help Raoul Develop Coping Thoughts exercise, 190–191
Help Raoul Find New Solutions exercise, 182–183
Help Raoul Stay Focused During the Check-In exercise, 66
Help Suzanne Make Her Goals More Specific exercise, 53–54
Help Suzanne Take a Close Look at the Facts exercise, 160
helpful questions, 124–129
history, psychosocial, 38–39
homework: developing helpful, 70–71; reviewing during check-in, 63
homework assignments: on behavioral activation, 219–220; on describing specific situations and behaviors, 97–98; on exploring client problems, 41–42; on exposure therapy, 243–244; on identifying cognitive distortions, 117–118, 120; on identifying stressors and strengths, 40, 43; on looking for evidence, 169–170; on practicing CBT, 259–260; on problem solving, 192–194; on rating your own feelings, 98; on setting specific goals, 56–57; on structuring therapy sessions, 74–76; on Understand Your Reaction worksheet, 99–100; on using the four-factor model, 21–22
hopes, thoughts as, 132
hot thoughts, 103, 145, 147, 155, 163
How Probable Are My Predictions? worksheet, 157
How Thoughts Influence Feelings and Behavior exercise, 12–14, 264
I
Identify a Client’s Stressors and Strengths worksheet, 34–35
Identify Clients’ Thoughts, Feelings, Physical Reactions, and Behavior exercise, 15–16, 264
Identify Situations, Thoughts, Feelings, Physical Reactions, and Behavior exercise, 10–11, 263
Identify Specific, Measurable Goals exercise, 49–50, 267
Identify Suzanne’s Safety Behaviors exercise, 227–228
Identify Suzanne’s Thoughts about Self, Others, and the Future exercise, 105, 270
Identify the Cognitive Distortion exercise, 112–113, 272
Identify Your Feelings handout, 90
if...then statements, 18
imagery, 129–131; exploring with clients, 130–131; practicing coping thoughts using, 190; practicing new solutions using, 186; recreating situations using, 129–130. See also Practice in Your Imagination exercises
imaginal exposure, 229
in vivo exposure, 228
“Incorporating Imagery into Thought Records” (Josefowitz), 131
intermediary beliefs, 18
interpretations, alternative, 158–159, 171
Isabella Lists Her Worries exercise, 129
JKL
Jamar Is Feeling Depressed exercise, 212
Jim Forgets His Wallet exercise, 106
journal writing, 218
Julie Has a Terrible Week exercise, 113
“Just Ask” questions, 122
kindness, practicing, 218
labeling feelings, 90
learning, active, 3
Lee Learns to Ask a Question exercise, 18
life, simple rules about, 18
Linehan, Marsha, 31
looking for evidence: against negative thoughts, 151–163; explaining to clients the process of, 148; homework assignment on, 169–170; supporting negative thoughts, 149–151; thought records and, 147
M
magnifying problems, 111
Maia Was Attacked exercise, 228
Maria’s Symptom Maintenance Cycle exercise, 17, 265
Mary Treats Her Son Badly exercise, 95
memories, painful, 150
Mind Over Mood (Greenberger & Padesky), 147
mind reading, 111
minimizing problems, 111
Miriam Wants a Better Marriage exercise, 55
mood: asking clients to rate, 63; planning activities to boost, 209–215; related to thoughts, 133–134
mood-boosting activities, 209–215; examples of, 209–210; guidelines for planning, 210–211; monitoring mood before/after, 212–214; overcoming roadblocks to, 214–215
Mooney, Kathleen, 33
Myran, David, 1
N
Nasir Has a Busy Clinic exercise, 178
negative paths, 81
negative problem orientation, 175
negative thoughts: finding evidence against, 151–163; finding evidence supporting, 149–151
Notice Raoul’s Change in Mood exercise, 133–134
O
online materials, 3–4
Other Ways of Understanding the Situation worksheet, 161
others, thoughts about, 104, 107, 119
overgeneralizing, 110
P
Padesky, Christine, 33, 147, 155
painful memories, 150
patterns of limited thinking, 110
pause button, 82
personalizing, 111
Persons, Jackie, 155
perspectives, alternative, 158–159
physical reactions: feelings distinguished from, 9; helping clients identify, 94; linking thoughts to, 135–137
pleasurable activities, 209–210
Pleasurable Activities List, 210
positive problem orientation, 175–177
positive psychology, 218
post-traumatic stress disorder (PTSD), 130
Practice in Your Imagination exercises, 4; for explaining a Daily Activities Schedule, 204–205; for explaining exposure therapy, 231; for explaining goal setting, 47–48; for explaining looking for evidence, 148; for explaining problem solving, 180; for explaining session structure, 62; for exploring client problems, 27; for reviewing sessions with clients, 73; for understanding your reactions, 89–90
Predict Your Mood worksheet, 213
predictions: probability of negative, 156–158, 170; related to exposure tasks, 236–238; thinking trap on making, 111
probing questions, 122
problem solving, 173–195; brainstorming solutions in, 180–183; choosing a solution in, 184–187; developing coping thoughts for, 187–191; explaining to clients, 179–180; homework assignments on, 192–194; identifying problems for, 177–180; positive problem orientation for, 175–177; research on effectiveness of, 175; steps in process of, 174, 192; theory behind, 174
Problem-Solving Worksheet, 174
problems: defining with clients, 177–178; how behaviors maintain, 16–17; how thoughts maintain, 11–12; positive orientation to, 175–177; prioritizing with clients, 31; process for understanding, 25–27, 28–30; questions for exploring, 26–27, 28–30, 41–42; setting goals for multiple, 47
prompting questions, 122
psychosocial history, 38–39, 250–251
Q
questions: asking helpful, 124–129; for assessing safety behaviors, 227; for challenging hot thoughts, 155–156; for considering avoidance, 230; for developing balanced thoughts, 163; for developing coping thoughts, 189; for examining evidence against hot thoughts, 152; for exploring mood/activity relationship, 205; for exploring problems, 26–27, 28–30, 41–42; for exploring psychosocial history, 38; for exploring strengths, 33–34; for finding new solutions, 181; for helping to define problems, 178; for identifying images, 131; for identifying predictions about exposure, 237; for identifying specific situations, 85–86; for identifying thoughts, 122, 124–129, 134–135; for reviewing therapy sessions, 72–73; for setting an agenda, 67; thoughts expressed as, 132
Questions for a Balanced Thought handout, 163
Questions to Develop Coping Thoughts handout, 189
Questions to Develop Helpful Goals handout, 51
Questions to Explore a Mood/Activity Relationship, 205
Questions to Explore Problems handout, 26
Questions to Explore Strengths handout, 33
Questions to Gather More Information about the Situation handout, 159
Questions to Help Set an Agenda handout, 67
Questions to Identify Evidence Against Negative Thoughts handout, 155
Questions to Identify Your Client’s Images handout, 131
Questions to Identify Your Client’s Predictions During Exposure handout, 237
Questions to Identify Your Client’s Thoughts handout, 134
Questions to Review the Therapy Session handout, 72
R
Raoul’s Boss Is Difficult exercise, 87
Raoul’s Cycle of Depression exercise, 201
Raoul’s Stressor’s and Strengths worksheet, 37, 266
rating feelings, 92–93, 98, 108–109
Raymond Drinks Too Much exercise, 116
reactions: worksheet for understanding, 82, 89–90, 99–100, 124, 136, 137, 139–140. See also physical reactions
reassurance seeking, 226
reflective statements, 122
relapse prevention: behavioral activation and, 215; exposure therapy and, 242
Renee Tries to Catch Up at School exercise, 72
reviewing therapy sessions, 72–73, 76
Richard’s Boyfriend Wants to End the Relationship exercise, 106
Roger Doesn’t Want to Go to the Doctor exercise, 16
Ruda Attends Playgroup exercise, 38
S
safety behaviors, 226–228, 235, 243, 244
schemas. See core beliefs
self: creating a new image of, 166–167; thoughts about, 104, 107, 119
self-assessment questions, 260
Separating Facts from Thoughts worksheet, 88, 269
session structure. See therapy sessions
shame, understanding, 108
Sharon Is Invited for Coffee exercise, 15
should statements, 108, 111–112
Shula Eats Dessert example, 115–116
situations: examples of vague and specific, 85; four-factor model for understanding, 8, 21–22; identifying specific and concrete, 84–87, 97; identifying the meaning of, 124–127; recreating using imagery, 129–130; separating facts vs. thoughts about, 87–88. See also trigger situations
sleep guidelines, 258
Socratic questioning, 147, 162
solutions to problems: brainstorming, 180–183; choosing, 184–187
Sophia Completes the Understand Your Reaction worksheet exercise, 137
strengths: exploring your own, 40; identifying client, 33–35, 43
stress management, 167
stressors: exploring your own, 40; identifying client, 32–33, 34–35, 43
Suzanne Avoids the Other Teachers exercise, 226
Suzanne Goes to the School Fair exercise, 189
Suzanne Is Asked to Be a Maid of Honor exercise, 162
Suzanne Is Upset with Her Husband exercise, 154
Suzanne Reviews Her Balanced Thought exercise, 165
Suzanne’s Stressors and Strengths worksheet, 34–35
symptom maintenance cycle, 17
T
therapeutic relationship, 25, 96
Therapist Is Having a Bad Day exercise, 162
therapy sessions, 59–77; attitudes on structuring, 60, 75; basic components of, 60; collaboratively setting an agenda for, 67–69; developing helpful homework in, 70–72; explaining the structure of, 60–62; homework assignments on structuring, 74–76; in Raoul’s therapy, 256–259; requesting client feedback on, 73; reviewing with clients, 72–73, 76; starting with a check-in, 62–66; in Suzanne’s therapy, 253–256; working the agenda in, 69
thinking style, 110
thinking traps, 110–112; helping clients identify, 113–114, 120; worksheet for identifying, 114, 117. See also cognitive distortions
Thinking Traps handout, 110, 120
thoughts: automatic, 9, 18, 122–124, 248–249; balanced, 163–167; as cognitive distortions, 109–116; coping, 187–191; distinguishing feelings from, 9, 91; empathy related to, 25; evaluating self, others, or future, 103–106, 119; examining the reality of, 146; feelings related to, 12, 106–109, 127–128; four-factor model for understanding, 135–137; hopes or questions as, 132; hot, 103, 145, 147, 155, 163; images accompanying, 131; influence of core beliefs on, 18–21; looking for evidence about, 147, 148, 149–163; mood shifts related to, 133–134; problems maintained by, 11–12; questions for identifying, 122, 124–129, 134–135; separating facts from, 87–88; worksheet for identifying, 138–139
trigger situations, 83–89; facts vs. thoughts about, 87–88; identifying specific and concrete, 84–87; worksheet for identifying, 83–84
U
uncertainty, tolerance of, 158
Understand Janice’s Reactions exercise, 19
Understand Janice’s Vicious Cycle and Core Beliefs exercise, 20
Understand Mayleen’s Depression exercise, 203, 274
Understand Your Depression worksheet, 202, 220
Understand Your Reaction worksheet, 82, 89–90, 99–100, 124, 136, 137, 139–140
unless I…statements, 18
Use Graded Task Assignments exercise, 216–217, 276
V
video clips, 4; on brainstorming and choosing solutions, 186; on check-in and agenda setting, 69; on creating balanced thoughts, 166; on defining problems and setting goals, 180; on developing a fear hierarchy, 232; on developing coping thoughts, 191; on explaining CBT to clients, 39; on explaining depression to clients, 204; on exposure therapy, 236, 242; on identifying feelings, physical reactions, and behavior, 96; on identifying thoughts, 128; on identifying trigger situations, 89; on imagery for exploring thoughts, 131; on looking for evidence, 156; on monitoring mood before/after activities, 214; on planning mood-boosting activities, 212; on probability of predictions, 158; on reviewing sessions and asking for feedback, 73; on setting specific therapy goals, 55; on taking a close look at the facts, 161; on understanding your client’s presenting problem, 31
virtual exposure, 228–229
W
web resources, 3–4
well-being, increasing, 218, 219–220
What Are My Feelings and Thoughts? worksheet, 138–139
What Are My Thinking Traps? worksheet, 114, 117
What Is This Person Thinking? exercise, 14
What Is Your Trigger? worksheet, 83–84
What Thoughts Go with These Feelings? exercise, 109, 271
Wilson Feels Tense exercise, 72
worksheets: Are My Predictions Accurate?, 239–240; Benefits and Drawbacks of My Solutions, 185; Examine the Reality of Your Thoughts, 146, 170; How Probable Are My Predictions?, 157; Identify a Client’s Stressors and Strengths, 34–35; Other Ways of Understanding the Situation, 161; Predict Your Mood, 213; Problem-Solving, 174; Separating Facts from Thoughts, 88; Understand Your Depression, 202, 220; Understand Your Reaction, 82, 89–90, 99–100, 136, 137, 139–140; What Are My Feelings and Thoughts?, 138–139; What Are My Thinking Traps?, 114, 117; What Is Your Trigger?, 83–84. See also handouts
worries: images associated with, 131; listing, 128–129
XYZ
Yonas Asks a Question exercise, 127
YOUR TURN! exercises, 3; answers to, 263–277; on behavioral activation, 204–205, 211–212, 216–217; on exposure therapy, 227–228, 231, 241; for focusing on client problems and strengths, 27, 37; for helping clients develop coping thoughts, 190–191; for helping clients reach their own conclusions, 162; for identifying cognitive distortions, 112–113; for identifying safety behaviors, 227–228; for identifying specific, measurable goals, 49–50, 53–54; for identifying the meaning of situations, 125–126; for identifying thoughts about self, others, or the future, 105; for identifying trigger situations, 86–87, 88; on looking for evidence, 148, 160; on noticing mood shifts, 133–134; on problem-solving process, 180, 182–183; on thoughts related to feelings, 109; for understanding a client’s depression, 203; for understanding your reactions, 89–90; for using CBT theory to understand clients, 10–11, 12–14, 15–16, 17; on working within a session structure, 62, 66, 71, 73. See also exercises (practice)
