Thought Diary in CBT

And according to CBT, these cognitions are not fixed – we can change them.

But for CBT strategies to step in and challenge our thinking, we need first to identify unhelpful and invalid thoughts.

Thought diaries provide a practical and easy way to capture our negative thought processes. This article explores what they are and how we use them, and provides templates to help therapists support their clients.

What Is a Thought Diary?

CBT helps clients form connections between their feelings, thoughts, behaviors, and physical symptoms (Anderson, Watson, & Davidson, 2008).

While there are several distinct approaches to CBT, they all center on the following principles (Dobson, 2013):

• Cognitive activity affects behavior.
• We can monitor and alter cognitive activity.
• Cognitive change can lead to desired behavioral change.

Cognitive techniques encourage the client to identify and challenge negative thoughts and find different ways of thinking (Anderson et al., 2008).

And it works. Indeed, for several clinical problems, it is the preferred treatment (Dobson, 2013).

How do we make clients central to their recovery?

A crucial aspect of CBT is giving clients homework, providing the opportunity to collect more information about the connection between thought and action.

One such activity is the completion of a thought diary. As therapists, we ask our clients to “step back from momentary experience and to observe and record it” (Dobson, 2013).

And it can have some very positive results.

In one study at a hospice offering palliative care and community service, one patient was quoted as saying, “the diary was helpful […] when I read it back to myself I can see the patterns of things that happened” (Dobson, 2013).

Not only is a thought diary valuable for ongoing review, but it highlights the need for interventions, such as replacing negative thoughts with alternative, positive ones and creating realistic goals.

In The CBT Handbook, Pamela Myles and Roz Shafran (2015) describe the importance of capturing such thinking. Our thoughts impact our feelings, behavior, and what happens to our bodies. Indeed, most of the problems we face are less a result of the event itself and more a response to its interpretation.

The thought diary helps by providing a way to capture thinking patterns (individual and collections of thoughts over time) and the opportunity to revisit and revise them. Many common patterns, referred to as thinking errors, lead to emotional problems and can be both limiting and upsetting; they include (Myles & Shafran, 2015):

• Overgeneralizing
  Applying the outcome of one specific event to many others in your life.
• Minimizing and maximizing
  Thinking things are worse than they are is often accompanied by underplaying strengths while focusing on weaknesses.
• Emotional reasoning
  We often judge situations according to our feelings.
• Selective abstraction
  Overly focusing on one aspect that may have gone wrong while ignoring all that has gone well.

If we identify when they happen and change how we think, we can reduce heightened emotions.

Think back over the last week. What events have triggered your anger, stress, and anxiety?

Using a thought diary can help.

How to Use a Thought Diary in CBT

Negative interpretations of events are often automatic, resulting in feelings of anxiety, depression, stress, and anger, and lowering our self-esteem (Myles & Shafran, 2015).

A thought diary does more than capture a single event, emotion, or thought; it records how we handle multiple situations over time.

Its strengths lie in highlighting consistent patterns of how we respond to both commonplace and exceptional events.

Capturing your thoughts in a thought diary

A thought diary can be simple, requiring only four columns to capture sufficient detail around unhelpful thinking, such as:

Column 1 – Date it happened
Column 2 – Situation
Column 3 – Emotion and a rating of emotional intensity
Column 4 – Thought and a rating of the strength of belief in the thought

To complete a thought diary, ask your client to:

1. Think back to a recent event that they found upsetting and describe it by answering the following questions:

• • When did it happen?
    Enter the date and approximate time (column 1).
  • What was the situation?
    What were you doing? Where were you? Who were you with? (column 2).
  • What emotion did you experience?
    Recognize the emotion; try and capture it in one word – happy, sad, or angry (column 3).
  • What were you thinking at that time?
    What thoughts were running through your mind during or immediately after the situation? (column 4). Such as, nobody likes me, I’m no good at this.

2. Return to column 3, the emotion. Consider your relationship with the emotion you felt at that time.

Rate the emotion (for example, how sad did you feel?), where 0% is not at all, 50% is moderate, and 100% is extreme.

Choose carefully, yet don’t overthink; this is your score, and there is no wrong value.

3. Return to column 4, the thought that went through your mind.

How much did you believe that thought? Give it a score between 0 and 100, where 0 is not at all, and 100 is complete.

Our mind is often awash with negative thoughts before, during, and after difficult situations. If you have listed several, then circle or put an X beside the most upsetting one.

Completing a thought diary can be a difficult exercise. Yet, it is incredibly worthwhile and provides a valuable starting point for capturing thoughts objectively, challenging them, and changing your negative thinking (Myles & Shafran, 2015).

Fill in the thought diary over a week as difficult emotions arise. The fresher your mind when captured, the more accurate the thought record will be.

But that is not the end in itself. After capturing unhelpful thoughts, it is essential to challenge and, where possible, replace them with something more worthwhile.

Evaluating your thoughts

So, how do you fix your thinking errors?

In The CBT handbook, Pamela Myles and Roz Shafran (2015) suggest a process they call evaluating interpretations. Weighing up “evidence for and against a given thought helps you judge whether it is valid or not.”

Steps include:

1. Review your (four-column) thought diary and choose an event that caused you distress.

If this is the first time you have tried this exercise, then start with a straightforward event.

• • Review the emotion and its intensity.
  • Review the thoughts and the extent to which you believed them.

These can be completed on a separate sheet of paper or in the nine-column extended thought diary in the later section.

2. Consider the ‘evidence for the most upsetting thought’:

• • Ask yourself, what is the evidence for your upsetting thought?
  • How did you conclude?
  • What % represents the strength of that belief and why?

3. Consider the ‘evidence against your most upsetting thought’:

• • If your score in the last column was under 100%, you must have some doubts. What is it?
  • What happened the last time you were in this situation?
  • Is there a different way of understanding the context and the event?
  • If the upsetting thought comes true, will it matter in years to come?

4. What alternative thoughts might you have?

• • What alternative thoughts might you have about the event to replace your original one? For example, a friend didn’t show up for lunch. Rather than think it is because they no longer like you, consider that they may have been delayed by work.
  • Identifying alternative thoughts does not require overly positive thinking, but being realistic.

5. Has your thinking changed?

• • Having weighed up the upsetting and alternative thoughts, it is worth re-rating the emotion and the belief in the original thought.
  • Has it changed?

6. What’s next?

• • If your thinking has changed, describe what you would now do if the situation reoccurred. Such as I’ll phone my friend or their office to see if everything is okay.

Try to perform the evaluation as soon after the event as possible.

Working through and challenging your thoughts (your own or your client’s) is vital to CBT and reducing distressing emotions. Writing down your thoughts and the answers to the questions maximizes its effect.

Thought Diaries for Depression and Anxiety

Mindfulness-based cognitive therapy combines CBT’s benefits with the increasingly popular mindfulness practice of living more consciously (Crane, 2017).

A mindfulness approach has been shown to help people with depression see thoughts as just that: thoughts. Thoughts are not who a person is nor the situation’s reality (Crane, 2017).

While developed as an approach for alleviating depression, it equally shares its benefits with those with stress and anxiety.

Performing mindful journaling can be one of the easiest ways to implement mindfulness into daily life and nonjudgmentally record and review thoughts.

Additionally, engaging in mindfulness while reviewing thoughts brings a gentle shift into focusing more on positive thoughts and images while decreasing negativity. Indeed, a 2010 study found that the mindful act of recording thoughts was helpful for relaxation, peace of mind, and improving focus and concentration (Khramtsova & Glasscock, 2010).

3 Examples of Thought Diaries

Psychologists Roz Shafran, from University College London, and Pam Myles, from the University of Reading, provide some great examples of thought-diary entries based on their clinical experiences (2015).

A few examples have been modified and included below.

Depression

Generalized anxiety

Stress

The three examples include emotional responses such as sadness, worry, anxiety, and stress. They are typical and can benefit from being restructured.

2 Templates and PDFs

The following worksheets are available to record and evaluate unhelpful thinking.

• This four-column Thought Diary is ideal for capturing the answers regarding the date, situation, emotion, and thought associated with an upsetting event.
• The nine-column Evaluating Your Thoughts Thought Diary helps you complete the process of evaluating thoughts.

Useful Worksheets

To improve your CBT skills, try out some of the following worksheets.

• Behavioral Experiments to Test Beliefs Worksheet – Use this worksheet to test negative automatic thoughts and reevaluate underlying beliefs and assumptions.
• Coping Styles Formulation – This CBT case conceptualization worksheet helps therapists and clients come to a shared understanding of the problem and develop more adaptive coping strategies.
• Graded Exposure Worksheet – This technique helps people confront and overcome their fears.
• Core Beliefs Suitcases – Select a virtual suitcase in this tool to reflect your beliefs about yourself and challenge core beliefs that may be wrong.

A Look at 3 Helpful Apps

Web-based and mobile CBT apps have proved successful in supporting people through behavioral change (Nes et al., 2012).

There are several mobile apps available for capturing unwanted and dysfunctional thoughts.

• The CBT Thought Diary is a valuable tool for capturing difficult or negative thoughts daily and is available on both the App Store and Google Play. The app provides mood tracking, helps identify cognitive distortions, and offers suggestions for reframing thoughts.
• CareClinic CBT Tracker and Diary helps you learn how to change your mindset while encouraging positive thoughts. Along with its built-in, CBT thought diary, it is possible to record emotional and psychological symptoms, treatments, and therapies. Available on the App Store and Google Play.
• Worry Watch: the Habit Tracker has been designed to help people who experience excessive worry and deep anxiety. It also includes a worry diary to help the user identify trigger points. The app is available on the App Store.

Conclusion

Thought diaries are incredibly powerful. While it may seem deceptively simple to catch our thoughts each day, through doing so, we become aware of unhelpful thinking patterns.

And according to CBT, how we make sense of an event decides how we feel (Myles & Shafran, 2015).

Once you are aware of your thinking in situations you find upsetting (your thinking errors), you can weigh up the evidence to judge whether they are valid or not. By replacing such thoughts with better alternatives, you can learn to behave and feel differently.

With such changes in place, it is possible to experience the impact of new types of thinking on your behavior and conversely understand how different behavior affects your thoughts and feelings.