John Suler's Teaching Clinical Psychology

The Way I think

(samples of cognitive therapy techniques)

For this exercise I ask students to take out a piece of paper and write at the top of it, "The Way I Think." I then pose to them, one by one, the series of questions listed below. It helps to present the questions in a visual format, as in an LCD projection. On their papers, students write out their responses to each question. I pause for a few minutes between each question so students have time to complete their responses. Each question illustrates a different type of cognitive therapy technique. After we complete the exercise, we go back over the questions and discuss the intended purpose of that technique and their reactions to it.

cognitive therapy

1. I often worry that I _________ (fill in the blank)

I then say and write on the board...

2. If this worry of yours was indeed true, what does it mean to you and why does it bother you so much?

Students then write their response. After they finish, I repeat the question, "If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?" Once they finish writing, I AGAIN repeat the question, ""If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?" Repeating this question helps uncover various layers or clusters of beliefs that may be "irrational," "faulty," or "pathogenic" (the term varying according to the specific theory).

I then say, "Look back over the various things you wrote so far and answer this question:"

3. What's the worst thing that could possibly happen? What do you fear most of all?
This question uncovers possible catastrophizing.

4. When you think of the worst thing that could happen, do you really think that it's likely to happen? If so, how could you learn to cope with it?

The first question attempts to stimulate more rational, realistic thinking. The second encourages cognitive adapting to the situation. I then say, "Look back over the worrisome thoughts that you have written about so far, and answer this question:"

5. What do I (perhaps "secretly") get out of thinking like this? How does it work to my advantage?

This question encourages the student to look at what might be called the "secondary gain," "ambivalence," or "conflict" related to those worrisome beliefs.

6. Persuade a Friend

Here I tell the students to carry on a dialogue - in writing - with a friend. "Pretend that your friend has some of the same worrisome beliefs that you do. Look back over the things you wrote for questions 1-3. Pick out one of those statements and write it down, as if your friend just said it. Now skip a line, and write a response to your friend's statement. In that repose, be a compassionate, rational, and realistic thinker. After you write your response, skip a line and have your friend reply. Maybe your friend is a bit stuck in his/her thinking. Then skip a line, and respond again to your friend. Keep this conversation going for 10 lines or so.

This exercise encourages students to identify with and develop the rational, compassionate side of themselves.

7. Positive imagery antidotes

I ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...

I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antidote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind.

8. I accept myself even though I __________
(do not use the word "am")

I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labeling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.

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