Four Reasons Why Thought Records Do Not Always Work In Depression

How do thought records work in CBT?

The primary idea in cognitive behavioural therapy (CBT) is that our thoughts and behaviours can affect how we feel. By changing the way that we think or behave, we are able to effectively break through negative cycles that keep our anxiety or depression (or other symptoms) going.

One of the bread-and-butter techniques of CBT – especially the cognitive part of CBT – is the thought record. The thought record is a tool that CBT clinicians love to use with patients to help them jot down negative thoughts. By doing so, we can really evaluate these negative thoughts to see if they are as true as we think they are.

For example, a person might have the thought: “because I failed the exam, it means that I am worthless”. As you can see, this thought is a little bit on the catastrophic side and is known as a thinking error. These type of thinking errors (or cognitive distortions) are very common in people with depression. Some examples include: catastrophizing, mind-reading, emotional reasoning, discounting the positives, among others.

If you’re interested in learning more about thinking errors, check out this post on 9 common errors in depression!

But back to the thought record. After identifying a negative thought, we can evaluate both the truths of the thought and evidence that is against the thought to develop a balanced thought.

In the example above about feeling worthless after failing an exam, a balanced thought that the person might develop after using the thought record could be: “although I did fail the exam and that does affect how I feel about my academic self, there have been many times I have done well in exams and assignments. Moreover, I am competent in so many areas beyond academia: for example, I am a good son; I am doing well in my sports; and I am a good friend.”

The development of a more balanced and realistic thought to effectively replace strong negative thoughts can lead to reduced emotional distress over time. People begin to recognize that their negative thoughts don’t have as basis as they initially thought.

However, as effective as thought records can be, they don’t always work. In this post, I list 4 common reasons why thought records may fail us.

Reason #1: Not targeting the ‘hot’ thought

One big reason that thought records may not see as much mileage is when the thought that we write down is not the ‘hot’ thought. The hot thought refers to the specific cognition that really affects our well-being.

When we experience a stressful event, there can be many thoughts associated with it. Let’s go back to the thoughts about failing an exam. Some thoughts could be:

• “What will my mom think about this?”
• “My professor will consider me as a terrible student”
• “I’ll never become a lawyer after this”
• “I feel so darn worthless”

These are all possible thoughts that a person could write in their thought record.

Let’s say he focuses on the thought about how their mother will feel about this grade on the thought record. However, although the thought is a little anxiety-provoking, it is not the one that really affects him. Even if he does a beautiful job developing a balanced thought, it may give very little mileage in making him feel better.

Why? Because it’s not the hot thought!

It’s therefore important to write down all thoughts that you might experience and consider the thoughts that you resonate with the most – the ones that are tied to the strongest emotions. By focusing on the hot thought, the chances of a thought record being successful in improving how we feel is much higher.

Reason #2: Being too positive

Sometimes being too positive in response to negative thoughts can also impact our ability to benefit from the thought record. There have been instances where my patients have said “well, my thought says I am worthless, but I should just tell myself that I am perfect!”.

However, the issue here is that our brain is unlikely to believe this thought given that the failed exam is already evidence that the new thought (“I am perfect”) is not true.

These types of thoughts sometimes come from a place of frustration because people are upset about these negative thoughts and react by pushing towards the other extreme. Because of that, the negative emotions do not reduce; they may simply change from being upset and depressed to being frustrated and angry.

It is therefore important to honour the grain of truth in even our most negative of thoughts when completing a thought record.

Reason #3: Not grounding our balanced thoughts in facts

Along a similar vein with number two, thought records need to be grounded in facts in both evidence for and against a negative thought to be effective. Our brain is surprisingly good at recognizing when we are trying to trick it. And if the examples we give against a negative thought doesn’t pass our brain’s sniff test, then it’s not going to be useful.

With the example of a person failing an exam and feeling worthless, the balanced thought worked well because it was well-grounded in actual examples where the person was successful in both an academic sense and in other areas of his life. When we look for evidence then, we need to make sure that they are well-supported with tangible evidence that the negative thought is not completely true.

Reason #4: The thought record just doesn’t vibe with everybody

Dr. David Burns noted in his book When Panic Attacks that each CBT technique has maybe about a 10 percent chance of being particularly effective for each patient.

For some people, the thought record just doesn’t feel right for them. The idea of restructuring thoughts may not resonate with how they want to deal with their problems. Some people may prefer a more behavioural approach and others may prefer to change their relationship with thoughts instead.

In the latter case, a mindfulness approach may be more helpful because regular mindfulness training allows us to better notice when we are being particularly negative and simply let go. We acknowledge the existence of these thoughts but do not give power to them. We recognize thoughts are simply thoughts – it doesn’t mean they are true just because we think it. For some people, this approach feels much better than targeting thought. For others, they may prefer a combination of both approaches.

Therefore, just like an electrician may have several tools to support their work, it’s important for us to have a number of different clinical tools to allow us to choose the right tool for each problem. Be curious and experiment to see which techniques give you the best bang for your buck!

Conclusion

I hope this post was helpful in navigating some common problems with thought records!

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Best wishes,

P