Monitoring thoughts and feelings

After the client has been recording daily activities for a week or two, it is useful to introduce the idea of structured diaries (e.g., Greenberger & Padesky, 1995). The technique provides individuals with a new way of approaching and thinking about distressing situations because of the way that they are taught to structure their experiences. With the collection of a number of such situations, the therapist and client may become aware of certain themes emerging from the material. The first column typically asks for a brief description of the situation that led to the experience of distress. The second column asks the individual to list the emotion experienced in the situation; it can usefully include a percentage rating of the strength of the emotion so that the therapist can readily gauge exactly how distressing the situation was. The third column is designed for the recording of negative automatic thoughts (NATs) that occurred in the situation. The identification of NATs is straightforward for some people with depression (and other emotional disorders), and within a week or two such individuals readily make the distinction between feelings and automatic thoughts. However, some individuals need more practice before they can make the distinction, but it is important to continue the monitoring exercise until the distinction becomes clearer. Some individuals, even with practice, report that they have no thoughts to record and that the emotional reactions simply occur "out of the blue". We will return to this problem shortly.

Once clients have mastered the simpler three-column technique, the next step is to introduce a more complex monitoring form which expands the structured monitoring to five columns. The additional two columns require clients to find one or more alternative interpretations to the interpretation that is reflected in their automatic thoughts. Having found an alternative interpretation, the clients are then asked to rerate their degree of belief in the original interpretation.

The crucial part of the five-column technique obviously depends on clients' willingness to search for alternative interpretations of situations that they may have interpreted in a particular way for many years. It is well known from studies of reasoning that individuals (in whatever mood state) find it difficult to draw alternative conclusions when they have already reached a conclusion that is congenial with a current mental model; indeed, many biases reflect the early termination of a search for conclusions when such an interpretation has been found (e.g., Power & Wykes, 1996). For example, if someone's currently dominant schematic model represents the self as a failure, then the interpretation of a situation as another instance of failing is congenial with this model, and no alternatives will normally be sought. The converse occurs for someone whose dominant schematic model of the self is that of a success, when situations will be readily interpreted to reflect instances of further success, even though such interpretations may not necessarily be accurate. Depressed clients may need considerable encouragement to search for alternative explanations to their favoured conclusions in many situations. The therapist should carefully avoid being drawn to dispute and argue with these cherished interpretations, but, instead, as Padesky (1994) has cogently argued, should try to use the process of guided discovery, which enables clients themselves to identify alternatives, rather than having the alternatives thrust upon them.

One of the key problems that we noted above with the three- and the five-column techniques is that clients sometimes report that emotions "come out of the blue" without any prior automatic thoughts. The early cognitive therapy view of this problem was that it was merely a matter of time and of practice before such clients would be able to identify their NATs. Of course, such a strategy does run the risk that has sometimes been attributed to psychoanalytic therapies, namely, of bringing about the phenomenon rather than the phenomenon having genuine causal validity; that is, cognitive therapy clients might come to experience NATs, just as Freudian patients come to have Freudian dreams and Jungian patients come to have Jungian dreams. An alternative theory that we have spelled out in our SPAARS model is that some emotions really do come "out of the blue" (Power & Dalgleish, 1997; 1999). Although some emotional reactions follow the occurrence of

Figure 8.2 The SPAARS model of emotion, showing sadness-related outcomes

conscious appraisals, there appear to be a number of phenomena that do not require such conscious processes (see Figure 8.2). In addition, we propose that emotions can also result from automatic processes that occur outside awareness; these automatic processes may be the consequence of the frequent repetition of particular appraisal-emotion sequences, as in the child who is shouted at repeatedly coming to be afraid of anyone shouting, and this reaction continuing into adulthood as an automatic reaction. With such cases, the best way forward is to explore where the reactions have originated rather than insist that the NATs are there, while, nevertheless, continuing to encourage the client to record as much information as possible about these automatic responses.

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