Think CBT Therapy Journal October

Section 1. The Problem........................................................................................................................................................
2
Section 2. Personal Strengths / Resources................................................................................................................................ 3
Section 3. Reasons for Change.............................................................................................................................................. 4
Section 4. Personal Goals.................................................................................................................................................... 5
Section 5. Personal Values................................................................................................................................................... 6
Section 6. Session Learning Points........................................................................................................................................ 8
Appendix 1. Cross Sectional Assessment................................................................................................................................. 9
Appendix 2. Background Factors......................................................................................................................................... 10
Appendix 3. Anxiety / Depression Maintenance Cycle................................................................................................................. 11
Appendix 4. COGS A Maintenance Cycle.............................................................................................................................. 12
Appendix 5. Cognitive Conceptualisation Diagram Judith Beck (1993).............................................................................................13
Appendix 6. Basic Formulation............................................................................................................................................. 14
Appendix 7. Thought Record............................................................................................................................................... 15
Appendix 8. Cognitive Change Cycle..................................................................................................................................... 16
Appendix 9. Hierarchy of Anxiety Provoking Situations..............................................................................................................17
Appendix 10. Activity Planner.............................................................................................................................................. 18
Appendix 11. Pie Chart Showing Factors Which Determine Mood..................................................................................................19
Appendix 12. Daily Activity Diary.......................................................................................................................................... 20
Appendix 13. Activity Plan.................................................................................................................................................. 21
Appendix 14. Perfectionism Scale........................................................................................................................................ 22
Appendix 15. The Self Perception Continuum.......................................................................................................................... 23
Appendix 16. Point-Counterpoint Worksheet........................................................................................................................... 24
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Appendix 17. ABC Form.................................................................................................................................................... 25

Appendix 18. Behavioural Experiment Worksheet..................................................................................................................... 26
Appendix 19. Cognitive Structures........................................................................................................................................ 29
Appendix 20. Cognitive Errors............................................................................................................................................. 32
Appendix 21. Relapse Prevention Plan................................................................................................................................... 36
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Name / ID:
Date:
Introduction
This therapy journal combines a structured diary and basic primer to support your work throughout the Cognitive Behavioural Therapy (CBT) process. It is
designed to be used in conjunction with face to face CBT and will help you to maintain a record of your progress and reinforce important learning points.
The therapy journal can be used in five main ways:
1.
2.
3.
4.
5.
It provides a source of information and an explanation of the different stages of therapy.

It supports preparation for and learning following each CBT session.
It allows you to capture key learning points and important personal insights about the problems or challenges you are addressing.
It provides a record of the CBT process and allows you to track your progress in a logical and structured way.
It creates a personalised learning manual for future reference following completion of the CBT process.
What is Cognitive Behavioural Therapy?

An important starting point is to clarify exactly what we mean by Cognitive Behavioural Therapy or CBT. CBT is a highly structured and clinically proven
approach to managing a wide range of psychological, emotional and behavioural problems. It draws on a wide range of established psychological
techniques to change the negative thinking and behavioural patterns that maintain distress, interfere with our daily tasks and responsibilities and limit our
future potential.
CBT works by identifying and altering the causal links between negative thinking patterns, unhelpful behaviours, distressing emotions and physiological
symptoms. A wealth of research has consistently demonstrated that altering thinking and behavioural patterns can profoundly change the way we feel
emotionally and physically. CBT has been found to be effective across a wide range of psychological, emotional and behavioural problems including
anxiety, panic disorder, OCD, social phobia, trauma and PTSD, low self-esteem, health anxiety, eating disorders, insomnia, depression and motivational
problems.
Through the course of the CBT process, you will gain an insight into the causes and maintenance factors for your problem, you will learn new techniques
to change the way you think, act and feel and you will develop an increased level of personal resilience to manage difficult and challenging situations as
they arise.
Whilst you will explore and learn new approaches in your CBT sessions, the most effective change will take place in the time between your appointments.
CBT works by changing thoughts and behaviours. This requires dedication and consistent practice in your daily life. Your therapist will help you to identify
the necessary changes and provide the relevant tools and techniques, but the change will only happen if you commit to consistently undertaking the CBT
assignments agreed each week. This journal will help you in this task and provide a record of your progress.
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Section 1. The Problem

The starting point is to clearly identify and understand the problem and how it affects you. Please use this section through discussion with your therapist
to answer the following questions. Your understanding of the problem may develop and change as the CBT process progresses.
What are the presenting problems / symptoms?
What triggers the problem?
How frequently / intensely do you experience the problem?
How does this affect your work / social / personal life?
When you experience the problem, what do you notice about your
thoughts?
When you experience the problem, how do you feel emotionally?
When you experience the problem, how do you feel physically?
When you experience the problem, what do you do or avoid

doing?
What makes the problem worse?
What makes the problem better?
What do you think caused or predisposed you to the problem in

the first place?
Section 2. Personal Strengths / Resources

Identifying and capitalising on your strengths and personal resources is an important part of achieving change and overcoming problems. Think about
your skills, knowledge, experience, abilities and qualities. Think about what you recognise in yourself and what other people recognise in you. Your
strengths will play an important part in the development of your CBT plan.
Skills
Knowledge
Experience
Abilities
Personal Qualities
Section 3. Reasons for Change

Use this section to identify the key reasons why on balance, you want the change to take place. Identify the pluses and minuses of committing to change
and be clear about the benefits and costs of change, so that you can prepare yourself for challenges or sacrifices in order to achieve your goals.
Pluses
Minuses
Section 4. Personal Goals

Now that you have identified the presenting problem, your strengths and the reasons for change, its time to shift your focus to the things that you want to
achieve or change. Try to make your goals Specific, Time-bound, Adaptive and Rewarding (STAR). Focus on what you will do, rather than what you will
stop or avoid doing. Some examples could be: finding 30 minutes each day to practice relaxation; trying out assertiveness skills with work colleagues;
dedicating 45 minutes each evening to talk to my children or partner about their day; learning how to discharge negative thoughts; traveling independently
to meet friends twice weekly for a meal or drinks; spending two hours each day exercising, cleaning or preparing healthy food; attending a social group or
club each Wednesday evening; joining a dance class or starting a training course; planning and Completing home improvements within three months;
role modelling resilience or emotional control when being challenged.
Presenting Problem
Short-term Goals (1-4 weeks)
Medium-term Goals (2-5

Months
Longer-term Goals (6-12

Months
Section 5. Personal Values

Our values provide a basis for guiding the way we act to overcome problems and achieve our goals. Use this section to decide which of the
following values will be the most important to you in overcoming problems and focusing on what you want to change in your life. Use the
checkboxes to indicate the relative importance of each value. There are no right or wrong answers. (H = highly important, M = moderately
important and L = less important).
H
Highly
Important
Value & Description
M
Moderately
Important
L
Less
Important
1. Accepting: to be open to and accepting of myself and other people.

2. Affectionate: to display and express love or strong feelings for others.
3. Aspiring: to actively seek opportunities and strive for success.
4. Assertive: to respectfully stand up for my rights and balance my needs with the needs of others.
5. Authentic: to be genuine, honest and true to myself.
6. Caring: to be helpful and considerate to myself and others.
7. Challenging: to stretch and continuously learn how to improve myself and encourage change in others.
8. Compassionate: to recognise and act to alleviate suffering for myself and others.
9. Conforming: to be respectful and obedient of helpful rules and obligations.
10. Cooperating: to work collaboratively and harmoniously with others.
11. Courageous: to be brave and persistent in the face of fear, threat or difficulty.
12. Creative: to be imaginative, resourceful and innovative.
13.
Curious: to be open-minded, exploratory and interested.
14. Emotionally aware: to be open to and receptive to my own feelings and the feelings of others.
15. Encouraging: to promote and reward behaviour that I value in myself and others.
16. Equality: to treat others fairly and as equals.
17. Fairness: to be just, rational and reasonable.
18. Fitness: to maintain or improve my physical, psychological and emotional wellbeing.
19. Flexible: to adjust and adapt readily to changing circumstances
20. Forgiving: to come to terms with or let go of negative feelings towards myself and others.
21. Friendliness: to be friendly and companionable towards others.
22.
Generosity: to share and give freely to myself and others.
23. Gratitude: to be appreciative and valuing of the things that I have in my life.
24. Honesty: to be truthful and sincere with myself and others.
25. Humility: to be modest about my contributions, allowing my achievements to speak for themselves.
26.
Humour: to seek and engage in the humorous side of life.
27. Independent: to be self-directive and able to support myself.
28. Industrious: to be hard-working and productive with my time and resources.
29. Open-minded: approach issues from a receptive and objective perspective, taking time to consider other points of view.
30. Orderly: to be properly prepared and organized in my life.
31. Patient: to wait calmly for what I want or need.
32. Respectful: to be polite, considerate and show positive regard to others.
33. Responsible: to take responsibility and ownership of my actions.
34. Safe: to act in a secure, protective and stable manner.
35. Self-aware: to be aware of my own thoughts, feelings and actions, considering how I come across to others.
36. Self-disciplined: to act according to my goals and values, rather than my vulnerabilities or weaknesses.
37. Tenacious: to persist despite problems and difficulties and without giving up.
38. Tolerant: to come to terms with, acknowledge and respect things that clash with my own opinions.
39. Trusted: to be discrete, loyal, faithful, sincere and reliable.
Now choose the six most important values that will be crucial in the achievement of your goals. Insert these into the following table:
Priority
Personal Value
1.
2.
3.
4.
5.
6.
Section 6. Session Learning Points

Use this table to record the most important learning points from each session.
Session / Date
What did we cover?
What did I learn?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Appendix 1. Cross Sectional Assessment

Use this diagram to identify the different factors that maintain the problem.
The Problem
Thoughts
Feelings
Behaviours
Bodily Sensations
Appendix 2. Background Factors

Use this table to identify significant events in your life, what you learnt about yourself and how this shaped your beliefs. Sometimes our personal beliefs
can be influenced by difficult or painful events, periods where we did not receive the emotional support we needed or times of personal risk and danger.
Other times, we may find that we developed unhelpful or unrealistic beliefs in spite of supportive and healthy early life experiences.
Age
What Happened?
What Did I Learn?
How Did This Shape My Beliefs?
3-7
8-11
12-16
17-21
22-25
26-35
36+
10
Appendix 3. Anxiety / Depression Maintenance Cycle

Trigger/Reaction
Meaning/Appraisal
Behaviour
Mood/Feelings
11
Appendix 4. COGS A Maintenance Cycle
1. Negative Bias
Over-estimation of
threats and
under-estimation of
coping ability
8. Internal/Negative
Focus of Attention
Focusing on body
sensations and
negative cues
7. Reactive Problem
Solving
Over examining
possible negative
outcomes >>>
indecision
2. Cognitive Intrusions
Distressing thoughts
and images
3. Type 1 Worry
Worry about specific
situations or events
THE PROBLEM
6. Cognitive
Avoidance/Control
Distracting self or
trying to prevent
negative thoughts
4. Type 2 Worry
Beliefs about worry
positive / negative
12
5. Uncertainty
Intolerance
Over planning and
preparing to
compensate for
the unknown
Identify the factors that keep the problem going
13
Appendix 5. Cognitive Conceptualisation Diagram

(Judith Beck, 1993)
Cognitive Conceptualisation Diagram Judith Beck (1993)
Relevant Childhood Data
Core Belief(s)
Conditional Assumptions/Beliefs/Rules
Compensatory Strategies
Situation 1
Situation 2
Situation 3
Automatic Thought
Automatic Thought
Automatic Thought
Meaning of the AT
Meaning of the AT
Meaning of the AT
Emotion
Emotion
Emotion
Behaviour
Behaviour
Behaviour
14
Appendix 6. Basic Formulation

Use this form to identify the factors that have contributed to and maintain the current problem.
How would I describe the current problem?
How did my early experiences contribute to negative patterns of thinking, unhelpful behaviours and distressing emotions?
What are the core negative beliefs about myself, others and the world?
What Rules / Assumptions do I live by?
What helps me cope?

Helpful
Unhelpful
15
Appendix 7. Thought Record

Use this form to identify Negative Automatic Thoughts (NATs) that typically result in negative self-appraisals and emotional distress.
Situation/ Trigger
Negative Automatic
Thoughts And Irrational
Beliefs About Myself
And Others
Unhealthy Feelings And

Behaviours
What situations or events

trigger the problem?
When this happens, what do I

think or believe about myself or
others? (Rate 0-100%)
When I have these thoughts,

how do I tend to feel
emotionally?
How do I feel physically?
What do I tend to do?
Evidence Supporting /
Opposing my Negative
Thoughts And Irrational
Beliefs
Realistic
Assessment Or
Interpretation
What is the actual evidence for

and against the negative
thoughts?
What is a more realistic

and helpful way to view
this?
What do I notice about my thoughts - step back and just observe what's happening? How does thinking this way help me? What's a more realistic
interpretation? Are these just thoughts? Am I really defined by my thoughts? Tolerate the uncertainty and discomfort - make the NATs less relevant.
Shift my focus on to helpful and rational things.
16
Appendix 8. Cognitive Change Cycle

Use the left side of this diagram to map out the cycle of triggers, automatic thoughts, emotions, behaviours and beliefs about different situations. Use the
questions on the right side of the diagram to identify helpful and realistic interpretations to alter the meaning of your thoughts and beliefs.
TRIGGER
What happened or what did
I first notice?
LEARNING /
INTERPRETATION
THOUGHTS
What does this mean the

next time I am triggered?
What automatic thoughts did

I have in that moment?
BELIEFS /
ASSUMPTIONS
BEHAVIOURS
What does this mean about

me, other people or the
future?
What did I do or avoid

doing?
FEELINGS
What did I feel emotionally
and physically?
17
Appendix 9. Hierarchy of Anxiety Provoking Situations

First write down all of the situations which you find anxiety provoking. Secondly, add them to the table below in rank order. Identify any "safety" or
"avoidance" behaviours in the third column. In the final column, rate how distressed you normally feel in each of the situations from 0 (no distress) to 10
(maximum distress).
Rank Order
Situation / Event
Safety Behaviours
Distress
0 10
18
Appendix 10. Activity Planner

Plan and undertake activities for each day of the week. Use the Barometer to rate your overall mood for each day.
Instructions: Use this chart to plan out helpful, rewarding and enjoyable activities for each day of the week. Try to think of a minimum of one activity for
each AM and PM box. Examples can include simple things such as cooking a favourite meal, cleaning and washing, gardening, tidying a room,
decorating, visiting a friend, meeting for coffee, going for a walk, swimming, washing the car, going to the cinema, shopping, planning a short trip,
undertaking repairs, hobbies such as knitting, fishing, and cycling, joining an interest group, learning a new skill or language.
To
insert
information, please right click on the mood chart and select Edit Data. Insert a number between1-10 to plot your mood.
1-3 - Low Mood / Feeling Unsafe
Activity
4-5 - Moderate Mood / Feeling Neutral
6-8 - Good Mood / Feeling Content
9-10 - High Mood / Feeling Excited
Monday
AM
Tuesday
AM
Wednesday
AM
Thursday
AM
Friday
AM
Saturday
AM
Sunday
AM
"Write your activity

in here"

in here"

in here"

in here"

in here"

in here"

in here"
PM
PM
PM
PM
PM
PM
PM

in here"

in here"

in here"

in here"

in here"

in here"

in here"
Activity
19
Appendix 11. Pie Chart Showing Factors Which Determine Mood

To insert information, please right click on the pie chart and select Edit Data.
20
Appendix 12. Daily Activity Diary

Use this diary to make a note of what you were doing and how you were feeling at different times during the week.
07:00-09:00
MONDAY
Doing
Feeling
TUESDAY
Doing
Feeling
WEDNESDAY
Doing
Feeling
THURSDAY
Doing
Feeling
FRIDAY
Doing
Feeling
SATURDAY
Doing
Feeling
SUNDAY
Doing
Feeling
10:00-12:00
13:00-17:00
18:00-21:00
22:00-00:00
21
Appendix 13. Activity Plan

Complete this log to identify regular activities and tasks which are consistent with your personal goals and values. Record the date in the green
column. Use the blue section to plan out in advance rewarding activities that maintain your personal responsibilities and commitments. Use the pink
section to identify enjoyable or interesting activities that boost your sense of enjoyment or personal pleasure. Finally rate your mood at the end of
each day in the yellow section.
Date
Completing Rewarding Responsibilities That Provide

a Sense of Achievement
AM
PM
Undertaking Pleasurable Activities that are Personally

Enjoyable and Interesting
AM
PM
Mood
(0-100%)
22
Appendix 14. Perfectionism Scale

Use this scale to estimate your beliefs about how perfect you have to be in different areas of your life to feel OK or valued.
0%
50%
Poor
100%
Balanced
Perfect
1. What is the belief we are testing?.....................................................................................................................................................................

2. What is a realistic alternative belief?.............................................................................................................................................................
3. What can I do to test the realistic alternative belief?.........................................................................................................................................
23
Appendix 15. The Self Perception Continuum - Where Are You On This Scale?
Totally
Worthless
Totally
Worthwhile
0%
100%
Disrespectful
Selfish
Lazy
Ruthless
Cold (emotionless)
Taking
Unfair
Pitiless
Abusive
Offensive
Insensitive
Selfish
Unfaithful / Disloyal
Indifferent
Respectful
Helps Others
Works Hard
Kind
Warm
Giving
Fair
Compassionate
Caring
Empathic
Sensitive
Considerate
Faithful / Loyal
Determined
24
Appendix 16. Point-Counterpoint Exercise

This exercise is designed to identify, assess and modify dysfunctional assumptions and rules that keep the problem going.
There are four simple steps:
1. Start by identifying dysfunctional assumptions and rules in the pink top left box. e.g. "If it's not perfect, then I have failed. "I can't cope with
criticism." "I must always work hard to demonstrate my value."
2. Identify the compensatory behaviours in the orange bottom left box. e.g. Develop high standards. Work hard. Over prepare. Look out for
shortcomings and correct. Avoid seeking help.
3. Identify the rational alternatives in the blue top right box. e.g. Not achieving a target doesn't mean I am a failure." "I don't like criticism, but I
know it doesn't define me and I can tolerate it." "I can do my best whilst exercising realistic standards and showing self compassion."
4. Finally, identify realistic behaviours in the green bottom right box. e.g. Acting according to my goals and responsibilities, not my mood. Doing
things that I find positively reinforcing, even when I don't feel like it.
Dysfunctional Assumption
Rational Alternative
Compensatory Behaviours
Realistic Behaviours
25
Appendix 17. ABC Form
Activating Situation
Beliefs About The Situation
What Triggered The Problem?
Automatic Thoughts
Assumptions
Consequences
Cognitive
Emotional
Behavioural Physiological
Beliefs
26
Appendix 18. Behavioural Experiment Worksheet

Use this worksheet to identify and test out how you think and behave in challenging or stressful situations. The purpose of the experiment is to learn
about how your predictions, assumptions or beliefs about the situation can influence your behaviour, feelings and any physical reactions. The purpose of
the exercise is not to measure how well you perform, but to test your beliefs and learn something about the situation.
Prediction
1. What is the prediction or belief that you are testing? (Rate 0-100%)
2. What do you expect to happen?
3. How would you know if it came true? (Evidence)
27
Experiment
4. What situation can you choose to test this prediction or belief?
5. What safety behaviours will you suspend during the experiment?
Outcome
6. What happened?
7. How accurate was your original prediction or belief about the situation? (Rate 0-100%)
Evaluation
28
8. What did you learn from the experiment?
9. What helpful conclusions can you draw from this?
10. How does this change your prediction or belief about similar situations in the future?
29
Appendix 19. Cognitive Structures

Managing Unwanted Thoughts
In Cognitive Behavioural Therapy, we give particular focus to the nature, force, frequency and content of negative thoughts. Thoughts play a key role in
determining how we feel and what we do. If we interpret a situation negatively, it can profoundly influence the way we react. This in itself is fairly obvious.
We have all been in situations where we have misinterpreted or misunderstood something, reacted in an unhelpful manner and then found that we had
made an error of judgement.
Making mistakes in how we read and interpret situations is part of normal human behaviour. We are not programmed to get everything completely right all
of the time. The world is a complex place and people are different. The problem arises when we think in patterns that systematically lead to negative
feelings and behaviours, where our thoughts automatically generate unrealistic or catastrophic outcomes, where we get trapped in a vicious cycle of
negative appraisals and where we are unable to maintain a balanced and realistic perspective. These negative thinking patterns can become reflexive
and engrained, leading to unwanted negative emotions such as anxiety or depression and influencing our behaviour in self-defeating ways.
So How Do Thoughts Work?

In this section, we will discover how thoughts are structured and organised in layers, how different types of thinking errors contribute to emotional distress
and unwanted behaviours and finally how changing thinking can influence the way we feel.
Layers of Cognition
We can think of negative cognitions or thoughts at four levels Negative Core Beliefs > Dysfunctional Assumptions > Irrational Rules > Negative
Automatic Thoughts (NATS). These different levels form a cognitive processing chain or schema for how we see ourselves, other people, the world and
the future.
Unhelpful thinking patterns can also lead to compensatory and maladaptive behaviour as we act out or avoid our negative perceptions.
Negative Automatic Thoughts (NATS)

NATS are fleeting automatic thoughts that can be conscious or almost at the edge of our awareness. They form an internal monologue that can negatively
influence how we automatically interpret situations and react to feelings. Some typical examples include:
I cant cope.
They dont like me.
I feel bad.
I am going to get it wrong.
Its not fair.
30
Negative Rules
Negative rules are strict thinking principles that tend to be all or nothing, dogmatically applied and rarely tested. They form an automatic protocol for
interpreting situations and are usually based on demands or imperatives. Rules are often formed in childhood where they may have made perfect sense,
but provide over-rigid and often unrealistic standards in later life. Examples include:
I must always work hard.

People cant be trusted.
I should always be strong.
There is no point trying.
I will ultimately fail.
I should not be anxious.
Dysfunctional Assumptions
Dysfunctional assumptions are learned suppositions that over time form a reflexive way of interpreting and applying meaning in different situations. They
are usually conditional statements that provide a bridge between core beliefs and negative thoughts and act as an automatic formula for interpreting or
reacting to situations. Examples include:
If I am criticised, then it proves I am no good.

When things go wrong, I cant cope.
If I dont put in 100% all the time, then it proves I am a failure.
If people ignore me, it means I am no good.
If I cant think of something interesting to say, people will think I am boring.
If I always work hard, I will be a success.
Core Beliefs
Core beliefs are fundamental, absolute and generalized beliefs that we hold about ourselves, other people, the world and the future. Inaccurate and
negative core beliefs profoundly affect our self-concept and vulnerability to mood disturbance. Core beliefs typically centre around themes of Lovability,
adequacy and helplessness. Common examples include:
I am not good enough.

I am unlovable.
I am incompetent / stupid.
I am a bad person.
I am a failure.
I am worthless.
31
Compensatory Strategies
Although not strictly cognitions, compensatory strategies form the link between our thoughts and the action or behaviours we take. These strategies
basically tell us how to behave when our negative cognitions are activated. Examples include:
Over prepare / apply perfectionist standards.

Attend to the problem by worrying about it.
Seek approval, ask for reassurance or people please.
Blame, criticise or attack.
Continuously check or examine things to reduce uncertainty.
Procrastinate, avoid or withdraw.
The above explanation briefly illustrates how different layers of cognition are organised or structured. This is a way of presenting the overall architecture
or structure of our thinking processes. The following section focuses on the types of thinking processes that operate at each of these levels and draws out
some common thinking errors.
32
Appendix 20. Cognitive Errors

We are evolved to use a number of cognitive filters, processes and short-cuts to handle the multitude of stimuli, signals and demands made by our
environment. These common cognitive processes are subject to distortions or processing errors when we are exposed to maladaptive learning, are
placed under pressure or experience distress. The following categories are not exhaustive, however they provide some common examples of how we can
trip into thinking errors that maintain negative emotions and unwanted behaviours. Use these categories to determine which thinking errors contribute to
your emotional distress.
Mental Filter
We take the negative details and magnify them while filtering out all positive aspects of the situation. For example, we may pick out a single unpleasant
detail and dwell on it exclusively so that our idea of reality becomes darkened or distorted.
Polarized / Dichotomous / Black and White Thinking

In polarized thinking, things are either black-or-white. We have to be perfect or we are a failure: there is no middle ground. We place people or
situations in either/or categories, with no shades of grey, allowing for the complexity of most people and situations. If our performance falls short of
perfect, we see ourselves as a complete failure.
Overgeneralization
We come to a general conclusion based on a single incident or a single piece of evidence. If something bad happens only once, we expect it to always
happen in future. We may see a single, unpleasant event as part of a never-ending pattern of defeat.
Jumping to Conclusions
Without individuals saying so, we just know what they are feeling and why they act the way they do. In particular, we are able to determine how people
are feeling toward us. For example, we may conclude that someone is reacting negatively toward us but we do not actually find out if they are correct.
Another example is where we anticipate that things will turn out wrong and we are completely convinced that our prediction is already an established fact.
33
Catastrophizing
We expect disaster to strike, no matter what. This is also referred to as magnifying or minimizing. We hear about a problem and use what if questions
(e.g., What if tragedy strikes? What if something terrible happens to me?). For example, we might exaggerate the importance of insignificant events
(such as our own mistake, or someone elses achievement). We may inappropriately shrink the magnitude of significant events until they appear
inconsequential, for example, our own desirable qualities or someone elses imperfections.
Personalisation
We believe that everything others do or say is some kind of direct personal reaction. We also compare ourselves to others trying to determine who is
brighter, better looking, wittier, etc. When we engage in personalization, we may also see ourselves as the cause of some unhealthy external event that
we were not actually responsible for. For example, We were late for dinner and caused our friend to overcook the meal. If I had only pushed my partner
to leave on time, this would not have happened.
Blaming
We hold other people responsible for our pain, or default to blaming ourselves for every problem. We assume that every problem has to be personally
attributed to ourselves or someone else.
Shoulds / Musts / Demands

We hold rigid rules about how people should or should not behave, or how things must or must not turn out. People who break the rules make us angry or
hurt and we often feel personally guilty or a failure when we violate these rules ourselves. For example, I really should exercise. I should not be so lazy.
They cannot or must not treat me this way.
Emotional Reasoning
We believe that what we feel must be true. If we feel stupid and boring, then in fact we must be stupid and boring. We assume that our unhealthy
emotions reflect the way things are in reality. For example, I feel it, therefore it must be true.
34
Control Fallacies
If we feel externally controlled, we see ourselves as a helpless victim of fate. For example, I cannot help it if the quality of the work is poor, my boss
demanded I work overtime on it. The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For
example, Why arent you happy? Is it because of something I did?
Fairness Fallacies
We feel resentful because we think we can decide what is fair, but other people wont agree with us. As our parents tell us, you should always be fair.
The problem with this is that we then turn this around to demand that we should always feel fairly treated ourselves. People who go through life applying
a measuring rule to judge fairness often feel negative and resentful because of what they see as a breach of the standards they demand. Feeling
negative and resentful does not change whether something is or is not fair.
Change Fallacies
We expect that other people will change to suit us if we just pressurise, cajole or manipulate them enough. We believe that we need to change people
because our hopes for happiness seem to depend entirely on them.
Reward Fallacies
We expect our sacrifice and self-denial to ultimately pay off and be acknowledged, as if someone is keeping score. We feel bitter if we are not recognised
or rewarded.
Global Labelling
We generalize individual qualities or characteristics into a negative global judgment. These are extreme forms of generalizing, and are also referred to as
labelling and mislabelling." For example, using a label (stupid, useless driver) to describe behaviour and then imputing all the meanings the label
carries.
35
Always Being Right

We are continuously attempting to demonstrate or prove that our opinions and actions are correct. Being wrong is absolutely unthinkable and we will go to
any lengths to demonstrate that we are right and others are wrong. Winning the argument becomes more important than the original point or the impact it
has on the situation.
Each of the above cognitive errors or patterns of negative thinking, are commonly found in our day to day experiences. These errors become a problem
when they are systematically applied and form an unhelpful way of thinking about and reacting to challenges.
The purpose of cognitive work in CBT, is to identify, assess and where appropriate alter the nature and pattern of thinking, so that we can experience a
healthier emotional reaction, feel physically better and act in a way that is consistent with our goals and values.
Always ask yourself:

What do I notice about my thoughts - step back and just observe what's happening? How does thinking this way help me? What's a more realistic
interpretation? Are these just thoughts? Am I really defined by my thoughts? Tolerate the uncertainty and discomfort - make the NATs less relevant. Shift
my focus on to helpful and rational things.
36
Appendix 21. Relapse Prevention Plan

Use this template to capture the key learning points from the CBT process and identify action required to limit and manage potential future setbacks.
1. What have I learnt about the old problem?
2. What are my high risk situations?
3. What are the key signs? - (Thoughts / Feelings / Behaviours / Symptoms)
4. What can I do to maintain momentum and build on my gains?
5. What action will I take in case of a relapse?
37

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Section 1. The Problem........................................................................................................................................................

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Appendix 17. ABC Form.................................................................................................................................................... 25

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It provides a source of information and an explanation of the different stages of therapy.

What is Cognitive Behavioural Therapy?

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Section 1. The Problem

What triggers the problem?

How frequently / intensely do you experience the problem?

How does this affect your work / social / personal life?

When you experience the problem, how do you feel emotionally?

When you experience the problem, how do you feel physically?

When you experience the problem, what do you do or avoid

What makes the problem worse?

What makes the problem better?

What do you think caused or predisposed you to the problem in

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Section 2. Personal Strengths / Resources

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Section 3. Reasons for Change

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Section 4. Personal Goals

Short-term Goals (1-4 weeks)

Medium-term Goals (2-5

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Longer-term Goals (6-12

Section 5. Personal Values

Value & Description

1. Accepting: to be open to and accepting of myself and other people.

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Section 6. Session Learning Points

What did we cover?

What did I learn?

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Appendix 1. Cross Sectional Assessment

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Appendix 2. Background Factors

What Did I Learn?

How Did This Shape My Beliefs?

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Appendix 3. Anxiety / Depression Maintenance Cycle

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Appendix 4. COGS A Maintenance Cycle

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Appendix 5. Cognitive Conceptualisation Diagram

Cognitive Conceptualisation Diagram Judith Beck (1993)

Relevant Childhood Data

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