The enclosed techniques and procedures were developed with materials from a workbook of cognitive behavior techniques titled ‘Thoughts & Feelings’ and written by Matthew McKay, Martha Davis and Patrick Fanning. The workbook was published by New Harbinger Publications, Inc. In 1997.
NOTE: This technique, combined with CBT#01 & CBT#03 provides the basic protocol for Cognitive Process Correction [See CBP#10] and combines the strategies of Beck and Ellis for identifying and changing irrational thoughts.
The beginning of any technique starts with a trusting relationship with the child. Since this is the second technique in the protocol for cognitive change, the Mentor should have established a sanctioned and helping relationship. If this does not feel comfortable, talk to your Clinical Supervisor about the situation and consider which of the following actions to take.
- Teach language & concepts of the eight  limited thinking patterns:
- filtering: terrible, awful, disgusting, scary, horrendous, and the key statement “I can’t stand it!”
- polarized thinking – either/or
- overgeneralization – every, none, never, always, everybody, nobody – and global labels.
- mind reading – projection
- catastrophizing – ‘The sky is falling’.
- magnifying – huge, impossible, overwhelming
- personalization – direct comparison with others; tendency to relate everything to yourself.
- shoulds: should, ought, must
- Use exercises as appropriate.
- Documentation & Reporting of symptomatic manifestations of limited thinking.
- Introduce the use of Thought Journal +3 Added columns of 1) limited thinking patterns, 2) alternative thoughts, & 3) re-rating of feelings.
- focus on most distressing thoughts
- create alternative solutions using the following strategies
- shift focus
- coping strategies
- opposing thoughts
- search for proof
- find exceptions
- self talk
- shift focus
- Begin to create action plans to address the changes. Such plans should include a goal, an anticipation of time and place, and implementation steps, and an evaluation process.
Don’t believe everything you think!
This technique utilize limited-thinking patterns which occur as ‘leakage’ in the persons self talk or internal dialogue, and provides methods to help the child gain practice in identifying these patterns and the internal logic that results from them. The technique then continues to lead the child to analyze the reflex thoughts that s/he previously recorded, noticing which of the limited-thinking patterns s/he habitually employs in difficult situations. Finally, the child will need help to compose balanced, alternative self-statements that will become more believable than the painful automatic thoughts.
Challenging automatic thoughts is a powerful way to counter perfectionism, curb procrastination, and relieve depression and anxiety.
The technique is based on the cognitive therapy of Aaron Beck (1976), who pioneered this method of analyzing automatic thoughts and composing rational comebacks to refute and replace distorted thinking. This approach works well for abstract thinkers – people who can analyze their automatic thoughts to find thematic patterns of limited thinking.
Time for Mastery
The client should begin to get results in one to four weeks of analyzing automatic thoughts.
If you try all of the exercises of this technique and the child still has difficulty picking out limited-thinking patterns, don’t give up hope. Go on to technique #03, which will help you accomplish the same result by compiling the evidence for and against the thoughts that trigger painful emotions.
Instructions: The first responsibility is to teach the language & concepts of the Eight Patterns of Limited Thinking. Not all of these patterns need to be taught, if you have been able to identify the areas that the child uses, you can focus on them. The decision about what to teach ought to follow two principles: 1) the more information the child is able to acquire about how s/he thinks and the impact that it has upon his/her quality of life, the better, and 2) that the limits to optimal information sharing is a decision that should be made by the Clinical Supervisor and reviewed on a regular basis.
- Filtering This pattern is characterized by a sort of tunnel vision – looking at only one element of a situation to the exclusion of everything else. A single detail is picked out and the whole event or situation is colored by this detail. For example, a computer draftsman who was uncomfortable with criticism was praised for the quality of his recent detail drawings and asked if he could get the next job out a little more quickly. He went home depressed, having decided that his employer thought he was dawdling. He filtered out the praise and focused only on the criticism.Each person looks through his or her own particular vision tunnel. Depressed people are hypersensitive to loss and blind to gain. For anxious people, the slightest possibility of danger sticks out like a barb in a scene that might otherwise be safe and secure. People who experience chronic anger look through a tunnel that highlights evidence of injustice and screens out fairness and equity.Memory can also be very selective. A person may remember only certain kinds of events from their entire history and stock of experience. When you filter your memories, you often pass over positive experiences and dwell only on the memories that characteristically leave you angry, anxious, or depressed.The filtering pattern ‘awfulizes’ or ‘catastrophizes’ thoughts by pulling negative events out of context and magnifying them, while ignoring all the good experiences. The fears, losses, and irritations become exaggerated in importance because they fill your awareness to the exclusion of everything else. Key words for the filtering pattern are terrible, awful, disgusting, scary, horrendous, and so on. A key phrase is “I can’t stand it!”.
- Polarized Thinking This is black-and-white thinking, with no shades of gray allowed. The person insists on ‘either/or’ choices, perceiving everything at the extremes with very little room for a middle ground. People and things are good or bad, wonderful or horrible, delightful or intolerable. Since the interpretations are extreme, the emotional reactions are extreme, fluctuating from despair to elation to rage to ecstasy to terror.The greatest danger in polarized thinking is its impact on how the person judges him/herself. They could believe that if they aren’t perfect or brilliant, then they must be a failure or an imbecile. There’s no room for mistakes or mediocrity.
- Overgeneralization In this pattern, the person makes a broad, general conclusion based on a single incident or piece of evidence. One dropped stitch leads to the conclusion: “I’ll never learn how to knit”. They interpret a rejection on the dance floor as: “Nobody would ever want to dance with me”.This pattern can lead to an increasingly restricted life. Overgeneralizations are often couched in the form of absolute statements, as if there were some immutable law that governs and limits the chances for happiness. Some of the cue words that indicate a person may be overgeneralizing are all, every, none, never, always, everybody, and nobody.Another hallmark of overgeneralization is the global label for persons, places, and things you don’t like: Somebody who refused to give you a ride home is labeled a ‘total jerk’. A quiet guy on a date is a ‘dull clam’. Democrats are ‘kneejerk liberals’. New York City is ‘hell on earth’. Television is an ‘evil, corrupting influence’. You’re ‘stupid’ and ‘totally wasting your life’.Each of these labels may contain a grain of truth, but it generalizes and grossly exaggerates that grain into a global judgment. The overgeneralized label ignores all contrary evidence, making your view of the world stereotyped and one-dimensional.
- Mind Reading When you mind read, you make snap judgments about others. You assume you know how others are feeling and what motivates them: “He’s just acting that way because he’s jealous”, “She’s only interested in your money’, “He’s afraid to show he cares”.If your brother visits a new woman acquaintance three times in one week, you might conclude that he is (a) in love, (b) angry at his old girlfriend and hoping she’ll find out, (c) depressed and on the rebound, or (d) afraid of being alone again. Without asking, you have no way of knowing which is true. Mind reading makes one conclusion seem so obviously correct that you assume it’s true, act on it in some inappropriate way, and get into trouble.As a mind reader, you also make assumptions about how people are reacting to you. You might assume what a friend is thinking and say to yourself, “This close s/he sees how unattractive I am”. If s/he is mind reading too, s/he may be saying to him/herself, “S/he thinks I’m really immature”. You may have a casual encounter with your teacher and come away thinking, “They’re getting ready to flunk me”. These assumptions are born of intuition, hunches, vague misgivings, or a couple of past experiences. They are untested and unprovable, but you believe them nonetheless.Mind reading depends on a process called projection. You imagine that people feel the same way you do and react to things the same way you do. Therefore, you don’t watch or listen closely enough to notice that they are actually different. If you get angry when someone is late, you imagine everyone feels that way. If you feel excruciatingly sensitive to rejection, you expect that most people are the same. If you are very judgmental about particular habits and traits, you assume others share your beliefs.
- Catastrophizing If you ‘catastrophize’, a small leak in the sailboat means it will surely sink. A contractor whose estimate gets underbid concludes he’ll never get another job. A headache suggests that brain cancer is looming. Catastrophic thoughts often start with the words “what if”, and lead to a conclusion that the outcome of the stated event will be overwhelming, rather than merely difficult or inconvenient.You read a newspaper article describing a tragedy or hear gossip about some disaster befalling an acquaintance, and you start wondering, “What if it happens to me? What if I break my leg skiing? What if they hijack my plane? What if I get sick and have to go on disability? What if my son starts taking drugs?” The list is endless. There are no limits to a really fertile catastrophic imagination.
- Magnifying When you magnify, you emphasize things out of proportion to their actual importance. Small mistakes become tragic failures. Minor suggestions become scathing criticism. A slight backache becomes a ruptured disk. Minor setbacks become cause for despair. Slight obstacles become overwhelming barriers.Words like huge, impossible, and overwhelming are magnifying terms. This pattern creates a tone of doom and hysterical pessimism.The flip side of magnifying is minimizing: When you magnify, you view everything negative and difficult in your life through a telescope that enlarges your problems. But when you view your assets, such as your ability to cope and find solutions, you look through the wrong end of the telescope so that everything positive is minimized.
- Personalization There are two kinds of personalization. The first kind involves directly comparing yourself with other people: “He plays piano so much better than I”, “I’m not smart enough to go with this crowd”, “She knows herself a lot better than I do”, “He feels things so deeply while I’m dead inside”, “I’m the slowest person in the office”.Sometimes the comparison is actually favorable to the person: “He’s dumb (and I’m smart)”, “I’m better looking than she is”. The opportunities for comparison never end. And, even when the comparison is favorable, the underlying assumption is that your worth is questionable. Consequently the person must continue to test their value, constantly measuring themselves against others. If they come out better, they have a moment’s relief. If they come up short, they feel diminished.The second is the tendency is to relate everything around you to yourself.A depressed mother blames herself when she sees any sadness in her children. A businessman thinks that every time his partner complains of being tired, he means he’s tired of him. A man whose wife complains of rising prices hears the complaints as attacks on his ability as a breadwinner.
- Shoulds In this pattern, the person operates from a list of inflexible rules about how they and other people should, must, have to act. The rules are right and indisputable. Any deviation from the particular values or standards is bad. As a result, they are often judging others and finding fault. People irritate them. They don’t act correctly and they don’t think correctly. They have unacceptable traits, habits, and opinions that make them hard to tolerate. They should know the rules, and they should follow them.One woman believed that her husband should want to take her on Sunday drives. She decided that a man who loves his wife ought to take her to the country and then out to eat in a nice place. The fact that he didn’t want to meant that he “only thought about himself”. Cue words indicating the presence of this pattern are should, ought, or must.Personal shoulds are just as hard on the person who constructed them as they are on other people. They feel compelled to be or act a certain way, but they fail to ask objectively if it really makes sense. Psychiatrist Karen Horney (1939) called this the “tyranny of shoulds”. It also should be noted that ‘shoulds’ make someone wrong.
Here is a list of some of the most common and unreasonable shoulds:
- I should be the epitome of generosity, consideration, dignity, courage, and unselfishness.
- I should be the perfect lover, friend, parent, teacher, student, or spouse.
- I should be able to endure any hardship with equanimity.
- I should be able to find a quick solution to every problem.
- I should never feel hurt; I should always be happy and serene.
- I should know, understand, and foresee everything.
- I should always be spontaneous, but also always control my feelings.
- I should never feel certain emotions, such as anger or jealousy.
- I should love my children equally.
- I should never make mistakes.
- My emotions should be constant. Once I feel love, I should always feel love.
- I should be totally self-reliant.
- I should assert myself but I should never hurt anybody
- I should never be tired or get sick.
- I should always be at peak efficiency.
Along with the Forms is a Summary of the Limited-Thinking Patterns. Run off a copy for the child you are working with and give it to them for easy reference and reminder. The Clinical Supervisor may also want to share a copy with parents and teachers. In this way, they can learn the language and concepts and help the child identify when s/he thinks in a limited way. The sharing of this information needs the informed consent of the child. This means that the child is fully informed of the sharing of information and the reason for sharing it, and agrees to have such information shared. Even though this information itself is not ‘personal’, it can quickly become a method for supervising adults to identify and exploit a personal weaknesses in the child.
Documentation & Reporting
Remember that one of your responsibilities is to document and report the symptomatic patterns of the child’s thinking, feeling and behavior. You should be reporting the limited thinking habits and recording the words used to describe the specific habits and giving them to your Clinical Supervisor.
There are three exercises [CBT#02-001,CBT#02-002 & CBT#02-003], which are designed to help ensure that a child understands the concepts and notices and identifies limited-thinking patterns. If the child is able to identify his/her own thinking patterns without additional help, you do not need to use these exercises. If they are necessary, the child should work through the exercises one after another. S/he can refer back to the above summary and carefully analyze how each statement or situation is based on one or more limited-thinking patterns. Once the exercise is completed, you and the child should analyze the material together and you can indicate where more work is needed.
Now that the child has learned to identify limited-thinking patterns, it’s time to apply this new skill to the Thought Journal +3. New columns have been added to the blank form [CBT#02-004]. The child now has space to fill in his or her limited – thinking patterns, balanced or alternative thoughts, and a re-rating of feelings.
The process should start by analyzing the child’s most distressing reflex thoughts to see which limited-thinking pattern each one fits best. The child may find evidence of more than one limited-thinking pattern, so have him/her write down all that apply. In the next column, have the child rewrite his/her automatic thoughts in a more balanced way, or compose an alternative thought that refutes the automatic thought. You can refer to the section that follows to help them counter the limited-thinking patterns. In the last column, have them re-rate their bad feeling now that they have worked on their automatic thoughts. The feelings should be less intense after this work.
Composing Alternative Thoughts
Listed below are alterative responses to eight limited thinking patterns. After the child has mastered the information, s/he may use it as a reference when s/he is having problems with a particular pattern. These concepts should have been taught to the client already and a copy of the reference materials given to them.
- Focusing on the negative
- Filtering out the positive
- Shift focus.
The person is stuck in a mental groove, focusing on things from the environment that typically frighten, sadden, or anger them. In order to conquer filtering you will have to teach the child to deliberately shift focus. S/he can shift focus in two ways:
- Place their attention on coping strategies for dealing with the problem rather than obsessing about the problem itself. You may wish to teach some problem solving strategies in order to make the process more effective.
- Teach the child to focus on the opposite of his/her primary mental theme. For example, if s/he tends to focus on the theme of loss, instead help him/her focus on what s/he still has that is of value. If the theme is danger, focus instead on things in the environment that represent comfort and safety. If the theme is injustice or stupidity or incompetence, shift focus to what people do that does meet with approval.
Part of the role of the Mentor in this and all of the other cognitive errors along with teaching the child the language and concepts and helping them identify his/her own limited thinking, is to dispute those thoughts: This is done through the interruption of the thought process to remind the client of what s/he is doing in situ and the insistence of the use of the refocusing strategies.
2. Polarized thinking
- Seeing everything as awful or great, with no middle ground
- Think in percentages
The key to overcoming polarized thinking is to help the child stop making black-or-white judgments. People are not either happy or sad, loving or rejecting, brave or cowardly, smart or stupid. They fall somewhere along a continuum. They are a little bit of each. Human beings are just too complex to be reduced to either/or judgments. However, such arguments will most often fall on deaf ears. The key is to teach the child how to quantify. If they have to make these kinds of ratings, then get them to think in terms of percentages: “About 30 percent of me is scared to death, and 70 percent is holding on and coping”, “About 60 percent of the time s/he seems terribly preoccupied with him/herself, but there’s the 40 percent when s/he can be really generous”, “Five percent of the time I’m act stupidly; the rest of the time I do all right”.
In this quantification, the clinician may wish to dispute the rating and negotiate a better percentage. This is not a process of arguing with the client, simply a process of prodding them to reconsider in their own mind the degree of concern they are feeling.
- Making sweeping statements based on scanty evidence
- What’s the evidence?
- There are no absolutes
- No negative labels
Overgeneralization is exaggeration – the tendency to take a button and sew a vest on it. Again, the client can fight overgeneralization by quantifying. Instead of using words like always, never, huge, awful, massive, minuscule, and so on they are urged to quantify it as specifically as possible. For example, if you catch the client thinking [saying] , “I have a huge pile of homework, I’ll never get it done”, dispute the word huge and ask them to rephrase with a quantity: “I have five lessons to complete in three days”.
Another way to avoid overgeneralization is to lead the client to examine how much evidence they really have for such a conclusion. If the conclusion is based on one or two cases, a single mistake, or one small symptom, then they should throw it out until they have more convincing proof. This is such a powerful technique that most of the next chapter is devoted to amassing evidence for and against hot thoughts.
The client is well served to stop thinking in absolutes by avoiding words such as every, all, always, none, never, everybody, and nobody, and the clinician disputes these words whenever they are said. The Mentor may want to keep tabs of the number of overgeneralized words said in a given conversation and to use this quantification with the child to bring home the indisputable use of exaggeration.
Statements that include these words ignore the exceptions and shades of gray. Help the child replace absolutes with words such as may, sometimes, and often. Be particularly sensitive to absolute predictions about the future such as “No one will ever love me”. They are extremely dangerous because they can become self-fulfilling prophecies. [See Interpersonal Expectancy Effects Training]
Make sure that you help the client pay close attention to the words used to describe themselves and others. Replace frequently used negative labels with more neutral terms and encourage them to do so. For example, if they call their habitual caution cowardice, replace it with care. Think of their excitable mother as vivacious instead of ditzy. Instead of blaming themselves for being lazy, they may reconceptualize themselves as laid-back. Practice and habit are important factors in absorbing these new thoughts so the process of identifying such errors shifts from the clinician to the client. Reframe the mental representation through a use of different words.
4. Mind Reading
- Check it out
- Evidence for conclusions?
- Alternative interpretations?
In the long run, the child is probably better off getting in the habit of making no inferences about people at all. They can either believe what someone tells them or hold no belief at all until some conclusive evidence comes their way. They can be helped to treat all of their notions about people as hypotheses to be tested and checked out by asking them.
Sometimes people can’t check out their interpretations. For instance, they may not be ready to ask their daughter if her withdrawal from family life means she’s pregnant or taking drugs. But they can allay their anxiety by generating alternative interpretations of her behavior. Perhaps she’s in love. Or premenstrual. Or studying hard. Or depressed about something. Or deeply engrossed in a project. Or worrying about her future. By generating a string of alternative possibilities, they may find a more neutral interpretation that’s as likely to be true as their direst suspicions. This reframing process also underlines the fact that you really can’t know accurately what others are thinking and feeling unless they tell you.
- Assuming the worst will happen
- What are the odds?
Catastrophizing is the royal road to anxiety. As soon as you catch the child catastrophizing, ask, “What are the odds?”. Help them to make an honest assessment of the situation in terms of odds or percent of probability. Are the chances of disaster one in 100,000 (.001 percent)? One in a thousand (.1 percent)? One in twenty (5 percent)? Looking at the odds helps you realistically evaluate whatever is frightening you.
Many people are innumerate, meaning that they do not use numbers well. This may apply to you or to the child. It may be helpful in this case to research actual data. Are you aware, for example, that in 1999 more children in the United States were killed by air bags, than by violence in schools? Are the odds greater of being hit by lightning or being shot in school? The internet may be a way to seek out these comparisons.
- Enlarging difficulties
- Minimizing the positive
- Get things in proportion
- No need to magnify
To combat magnifying, stop using words like terrible, awful, disgusting, horrendous, etc. In particular, banish phrases like: “I can’t stand it!”, “It’s impossible!”, “It’s unbearable!”, are examples of exaggeration in thinking which can lead to counterproductive levels of emotional reactions. You can stand it, because history shows that human beings can survive almost any psychological blow and can endure incredible physical pain. You can get used to and cope with almost anything. Try saying to yourself phrases such as ‘I can cope’ and ‘I can survive this”.
This process of self talk is detailed as Technique # 21.
- Assuming the actions of others always relates to you
- Comparing yourself to others
- Check it out
- We all have strong and weak points
- Comparison is meaningless
When you catch the child comparing him/herself to others, remind him/her that everyone has strong and weak points. By matching your own weak points to others with corresponding strong points, you are just looking for ways to demoralize yourself.
The fact is, human beings are too complex for casual comparisons to have any meaning. It would take you months to catalogue and compare all the thousands of traits and abilities of two people.
If you assume that the reactions of others are often about you, force yourself to check it out. Maybe the reason the teacher is frowning isn’t that you’re late. Make no conclusion unless you are satisfied that you have reasonable evidence and proof.
Personalization is one of the most significant characteristics of what is metaphorically call ‘mental illness’. A child who personalizes everything is a child at high risk. For some, it will be meaningless to say that we all have strong or weak points; you may need to qualify these statements. Sometimes, you may be able to have peers talk about their weaknesses [as they see them] in front of the client – or you may simply identify when other people do this.
- Holding arbitrary rules for behavior of self and others
- Comparing yourself to others
- Flexible rules
- Values are personal
The child should be asked to reexamine and question any personal rules or expectations that include the words should, ought, or must. Flexible rules and expectations don’t use these words because there are generally exceptions and special circumstances. Ask the child to think of at least three exceptions to the rule, and then imagine all the exceptions there must be that you can’t think of. The child may get irritated when people don’t act according to their values. But personal values are just that—personal. They may work for the person who holds them, but, as missionaries have discovered all over the world, they don’t always work for others. People aren’t all the same. The key is to focus on each person’s uniqueness – his or her particular needs, limitations, fears, and pleasures. Because it is impossible to know all of these complex interrelations, even with intimates, no one can be certain whether their values apply to another. They are entitled to an opinion, but must allow for the possibility of being wrong. They must also, allow for other people to find different things important.
You may also want to make a gift of the Serenity Plea to this child.
Balancing or alternative thoughts may suggest actions you and the client can take, such as checking out assumptions, gathering information, making an assertive request, clearing up misunderstandings, making plans, changing your schedule, resolving unfinished business, or making commitments. The client should circle those items and plan when s/he will put them into action.
It may be difficult, time consuming, or embarrassing for the child to follow his/her action plan. You may need to help the client break down the plan into a series of easier steps and schedule each step. Behavior that is inspired by balancing or alternative thoughts will greatly reduce the frequency and power of the negative automatic thoughts.
Continue for a week with the Thought Journal, identifying automatic thoughts and analyzing them for limited-thinking patterns. After a week the child should be adept at recognizing habitual patterns of limited thinking. They will begin to notice those automatic thoughts popping up in stressful situations. Eventually they will recognize limited-thinking patterns in real life, and correct them with balancing or alternative thoughts as they go. If they still have trouble spotting the limited-thinking patterns after a week of practice, you may decide to have them go on to the next technique [#3] and try the ‘evidence for/evidence against’ approach. It may be a better alternative for them.