This essay is an experiment. My hypothesis is that your life will improve if you participate. I assure you, I am not peddling woo. I am not providing you with misinformation and the kind of empty promise that you might hear from a Goop-like wellness product. Instead, I want to give you a scientifically supported, evidence-based tool to help with problem solving and managing uncomfortable emotions.
Straight to the point: the tool is called a Thought Record. As a clinical psychologist with expertise and extensive experience in helping people manage very complex and difficult mental health concerns, addiction, and other life challenges, I can tell you that this tool is a must-have. It will help you survive. It should be taught in schools. Everyone should know what it is and it should become embedded within popular culture.
A Thought Record is a tool that derives from Cognitive-Behavioral Therapy (CBT), which is one of the most well researched and scientifically supported mental health treatments in existence. When I explain to people what CBT is, they usually find it fairly intuitive and easy to understand. It is the implementation of CBT that is more challenging. The Thought Record is a way to apply CBT to everyday life situations.
In a Nutshell, What Is CBT?
CBT is the idea that we can understand our everyday life experiences by breaking them down into three interacting parts: thoughts, emotions and behaviors. That means that what we think about, how we feel and what we do are connected to one another. CBT involves challenging how we think and changing what we do in order to improve mental health. CBT is scientific: it means that your thoughts are not facts but rather hypotheses to be tested, challenged and critically evaluated.
It is also important to know that your thoughts do not just pop out of a vacuum but rather are often influenced by deeply held beliefs that you have about yourself, the world, other people, and the future. Sometimes people find it difficult to challenge their thoughts, so instead find it more helpful to focus on behavior change. In CBT, the way to change behavior is to do things that you might be avoiding that are pleasurable (but not self-destructive), effortful (but realistic), and anxiety-provoking (but manageable) despite having negative thoughts and despite experiencing uncomfortable emotions.
It means putting your shoes on and getting out the door despite not wanting to and feeling like garbage, so to speak. A well-trained CBT-therapist will collaborate with a person and use many different techniques to help a person challenge their thoughts and change their behaviors.
How Exactly Do I Use a Thought Record?
CBT is most often done with a well-trained therapist. But a Thought Record is a way to start to apply CBT on your own or in conjunction with a CBT therapist. A Thought Record is simply a sheet of paper with five columns: Situation, Emotions, Automatic Thoughts, Rational Responses, and Helpful Actions. Your cue for when to fill out a Thought Record is when you have an uncomfortable feeling. So, for example, if you are angry, anxious, sad or annoyed—go fill out a Thought Record. You can do it at the end of the day or in real-time as a situation is occurring.
Let's run through an example: Imagine that you are feeling angry because your friend, John Doe, was supposed to pick you up from work and it is now 30 minutes past the planned pick-up time.
The Situation column is the easiest. In a sentence, just write down what happened, or what is happening. You might simply write, "John Doe is 30 minutes late for picking me up from work." There is no interpretation involved—guessing what happened, what might happen or what someone might be thinking. This column is just objective: who, what, where, when.
The Emotions column is where you write down all of the emotions that you are experiencing and rate the intensity from 0 to 10. For example: "Angry = 8/10, Anxious = 6/10, Sad = 5/10."
In the next column, Automatic Thoughts, write down whatever automatically pops into your head when thinking about the situation. One helpful technique to help with this process is to ask yourself why you are feeling the particular emotions that you wrote in the Emotions column. For example, first ask yourself, "Why am I feeling angry?" and then answer the question in the Automatic Thoughts column: "I'm angry because John Doe doesn't care about me. If he cared, he'd be here." Continue this process with the other emotions: "I'm anxious because now I'm going to be late getting home and therefore will be late meeting my friends for dinner and then they will feel annoyed with me." "I'm sad because this is just another sign that my relationship with John Doe is deteriorating."
The next column, Rational Responses, is where you can challenge your thoughts in a helpful, realistic, balanced way. To help you do this, you can ask yourself questions that inspire critical thinking about the situation, such as:
- What's the evidence that my automatic thoughts are true and untrue?
- What's the worst, best, and most realistic thing that could happen?
- Could I live through it?
- What's another way to think about the situation?
- What's the bigger picture?
- How likely is it that this will actually happen?
- Am I thinking in all-or-nothing terms?
- What can I do to solve the problem?
- What difference will this make in a week or in 10 years?
- What's most important in life anyway?
In the Rational Responses column, you could also directly challenge the particular thoughts in your Automatic Thoughts column. For example, imagine you were to challenge this automatic thought: "I'm angry because John Doe doesn't care about me. If he cared, he'd be here." To challenge this thought, force your brain to generate helpful, realistic, balanced thoughts to counteract it; such as "I'm allowed to be angry, but maybe John Doe hit traffic or maybe he had a personal emergency or maybe he struggles with punctuality. Just because he's late doesn't mean that he doesn't care about our friendship." In the Rational Responses column, repeat this process for other automatic thoughts, using the questions above to help you.
The last column is Helpful Action. This column is versatile and can be used in three ways. First, you could use it to generate behaviors to help you problem-solve the situation. For example, you could write: "I'm going to call John Doe on his phone and if he doesn't answer, I'll e-mail him. If I don't hear from him in another 15 minutes, I will call a cab." Second, you could use the column to generate behaviors to help you manage the uncomfortable emotions from the Emotions column. For example, you could write: "Breathing exercises; phone a friend so that I can sort out my thoughts on what is happening and express my emotions; listen to music."
Third, this column can be used for generating what are called "behavioral experiments" to test the thoughts in the Rational Responses column. For example, to test out the rational response, "just because he's late doesn't mean that he doesn't care about our friendship," you could write in this column, "tomorrow I will have a conversation with him to express my concerns about the relationship and ask to hear his side of the story."
The way to think about the Thought Record is as your friend, not a chore. It is not a magic bullet that will cure all of your life woes. But it will help. It will help in the short term because it can help decrease the intensity of uncomfortable emotions so that you are better able to problem solve a situation. And it will help in the long term because with practice, your brain will get better and more efficient at challenging unhelpful thoughts, which will more quickly allow you to manage uncomfortable emotions and problem solve. Imagine for instance, how better equipped you would feel, and much sharper your brain would be, if you did a Thought Record for just five minutes every day for 365 days versus none at all for 365 days.
And so, that is my challenge to you. Conduct the experiment. Do a Thought Record for five minutes every day for one month, or six months, or a year, and see what happens. See if your mood improves. See if your life improves. If nothing changes, then you have lost 5 minutes daily, and I apologize. But I bet it will help. Research shows it helps. My many patients over the years have told me it helps.
Finally, here's the thing. I need to emphasize that using a Thought Record is not a substitute for therapy. If you are struggling with mental health or addiction concerns, then you should seek help from a professional. I detest this phrase but I will use it anyway:
It's 2019; seek help if you need it.