A thought record is a Cognitive Behavioral Therapy technique. It’s akin to chain analysis in DBT and to the ABCD tool that I’ve blogged about here before. All three psychotherapeutic techniques are about recognizing when your mood has taken a bad turn – e.g., fear or grief strike, seemingly out of nowhere – and then trying to identify the non-obvious patterns, so as to break out of them.
As I’ll explain, thought records are valuable in and of themselves, but they can also provide deeper insight into the core beliefs that lie at the heart of depression.
The elements of a thought record are:
i) a description of the situation you were in when the bad emotional turn occurred
ii) the resulting mood and its intensity
iii) the thoughts and perceptions going on just when the mood episode took hold, i.e., what was going through your mind in an automatic way just then
iv) an account of any cognitive distortions in the chain of thought that led to the mood.
Here are two examples from recent days.
Situation: I was having lunch with Anita at a sushi restaurant, sipping miso soup. I glanced at the calendar on my phone. Resulting mood: fear (50% intensity) and sadness (20% intensity). Automatic thoughts: “I have nothing planned for Monday. To avoid my symptoms taking hold, I need to keep busy and stay distracted. In the past, empty days have been bad. Monday will be a bad day”. Cognitive distortions: “fortune telling”, i.e., making unjustified predictions about the future; “negative filter”, i.e., overemphasizing the dark side of a situation; “thinking with feelings”, here, letting my fears and sadness drive my beliefs about Monday.
Situation: I was talking with my sister-in-law at her house around noon on a Sunday. I’d had a bad sleep the night before and was simply telling her about that. Resulting mood: fear (50% intensity), sadness (70% intensity), hopelessness (30% intensity). Automatic thoughts: “I remember being better before. I may never get back there. In fact, I may continue to get worse. I couldn’t stand that. Other people don’t have to deal with these symptoms. Why can’t someone fix me?”. Cognitive distortions: again, all of “fortune telling”, “negative filter” and “thinking with feelings”, along with “all or nothing” thinking and “blaming others”.
As I say, keeping thought records can be helpful when trying to find and combat what CBT calls core beliefs which underlie mental illness. Depression, e.g., tends to go along with core beliefs of helplessness and worthlessness. What do the pattern of my automatic thoughts and my recurrent cognitive distortions mean about my self-view, my view of the world, and of those around me? Looking at just the two examples above, I can detect the core beliefs that I am broken, that I can’t withstand my symptoms, and that other people aren’t like that. Put otherwise, that I am weak, vulnerable, defective, crazy.
Overturning such core beliefs is even harder than overcoming the recurring cognitive distortions. For one thing, the beliefs aren’t obviously mistaken. Consider mine. There simply are things I can’t do anymore because of my worsening bipolar disorder; the symptoms do feel terrible and frequently overwhelm me; and, though we all suffer, most people don’t experience anhedonia, near agoraphobia and suicidal-level despondency. It won’t do to just deny these things. The therapeutic dialectical strategy, instead, is to grant the partial truths behind the depressive core beliefs, but to challenge them by looking for a more balanced view. Thus, though some things are harder for me now, there are many challenging tasks that I can definitely still do (e.g., I can blog about psychotherapy.) And in the past I’ve recovered abilities which I lost temporarily, and that may well happen again. Or again, though the symptoms are awful, I have made it through them before, I have tools and people to help me, and even these last six months I’ve had good days. Finally, the more balanced view is that many people have mental illnesses, so that I’m far from alone.