Often, when I suggest to my clients to use the Cognitive Diary to help change irrational thinking styles, they protest "But I know my thinking is wrong and how I should think. That doesn't make a difference. How will writing it down help?" Many people, even medical professionals, believe that cognitive therapy is about telling someone to think accurately. If that were the case, then we should all be thinking rationally because people are always telling one another how they should think.
However, several aspects of using the Cognitive Diary help people to actually learn how to change their thinking. The first is developing a rationale that you can believe more than the irrational thinking. The second is repeatedly using this rationale until it becomes automatic thinking. And the third is using different sensory modalities to help reinforce the thinking.
As I indicated most people who come into therapy know when their thinking is irrational but they say, "But that's what I feel!" This statement implies they don't believe they have control over their thinking even when they believe it is inaccurate. They are using feelings to validate the irrational beliefs.
Another subset of people may not understand that they are engaging in irrational thinking. These individuals will typically be a problem for others may not believe that they have a problem. A good example of this is someone who tends to blame others instead of taking responsibility for themselves: "If you would have told me I needed gas, I wouldn't have run out." One of the ways that they may arrive at therapy is if a spouse or boss tells them, "You need to make some changes." So for these individual, they need to learn why their thinking is irrational before they can take the further steps of changing it.
Once a person identifies an irrational thought, they need to develop a rational challenge to the thought. This rational challenge needs to be believable to the individual. For example, I frequently work with people who were abused as children and as a result have low self-esteem. They might believe "I am worthless." If I challenge this thought with "You are a good and valuable person" they are unlikely to accept this statement. By itself it is not believable. However, if I back the statement up with evidence such as "You do valuable volunteer work that helps people" or "You make sure you are available for your children and you protect them" they are much more likely to accept this. Then they may be able to develop a believable rationale such as "I am a worthwhile person because the evidence shows that I care deeply for others and treat them with respect."
The Cognitive Diary aids a person in this process by having them write about a specific event and fleshing out the different thoughts they have related to the event. The next step is to determine if any of this thinking is irrational. The interactive Cognitive Diary not only gives you additional reading about the different styles, it will also provide specific questions to help you determine how the thinking may be irrational. Your final step is to write a sentence or two that helps you refute the original irrational thinking.
However, just developing a believable rationale is not enough to change irrational thinking and feelings based upon this thinking. The most important part of cognitive therapy is frequent use of the rational challenges that a person develops. Without a repetition, cognitive therapy is likely to be ineffective. I once gave a talk to medical professionals and one psychiatrist stated "I've tried this cognitive therapy and it doesn't work." The first think I asked this doctor was "How often did the person challenge the thinking?" and was told that those instructions weren't given. Yet, repetition of the rational challenges is the most important component to changing thinking!
Frequently, we may "know" something at an intellectual level, but that doesn't mean it is an automatic process. For that to occur we need frequent practice. Just because I might intellectually understand the geometry of a pool table and how one ball angles off of another, it doesn't mean I can automatically shoot pool well without having had any practice. For some reason, when it comes to thinking people think they should just automatically change the thinking because they understand how it is inaccurate and that if it is not automatic, then it is not changeable. So it is important to think of the repetition as practice and that our thinking needs practice in order to change just as we need practice to learn any new skill.
The reason for this is that when we are learning new skills we create new pathways in the brain. In other words, as we practice or experience something our neurons (brain cells) create pathways connecting to other brain cells. The theory is that certain pathways in the brain become automatic as it connects with more and more neurons. So, if someone is learning to play golf, the more they practice the more this process occurs and they develop "muscle memory" for how to swing the club. This muscle memory becomes an automatic process so that they don't have to think about every movement like they did when they first started to learn.
Just as our brain develops automatic pathways for skills, it also develops these pathways for thinking. Unfortunately, some of these automatic pathways are the irrational ones that we don't want any more. We can't get rid of an automatic pathway that is already developed but the new automatic pathway can be reinforced enough so that it becomes stronger than the old one. And we do this through the repetition. For example, with our golf example above, let's say that the golfer originally learned to swing the club wrong and someone tells him a better way. At first, he may have to think a lot about his golf swing as he's playing so that he uses the new swing rather than the old one. However, with enough practice the new swing becomes more automatic and the preferred swing. However, the old swing is still in memory with an automatic pathway of its own so that if the golfer is under stress (an important tournament) he might be more likely to lapse into the old swing. When this happens with thinking, it may be necessary to use the Cognitive Diary again for awhile to reinforce the new rational automatic pathway.
Therefore, once a person uses the Cognitive Diary and has developed a believable rationale to challenge the irrational thinking, they need to keep a copy of that rationale handy and use it frequently. In addition, the Cognitive Diary needs to be used repeatedly with different events to help develop a variety of rationales for the common problems in thinking that the individual experiences.
Another important aspect of the Cognitive Diary is that writing, in a sense, gets us outside of our heads. Seeing something on paper (or the computer screen) allows us to gain a different perspective. In fact, frequently I'll have clients comment when they are explaining their self-talk to me "When I say it out loud, it doesn't make sense." So, when we use a different sensory modality such as writing or talking or reading we may be able to perceive our thinking in a different way and be able to challenge it more effectively. Sometimes I have clients tell me "I can tell someone else this but I don't think that way myself." For those individuals I might tell them to talk to themselves in front of a mirror because then they are also using the visual modality as if they are talking to someone else.
In addition to using different modalities to reinforce thinking, knowing that you are planning to record something on the Cognitive Diary forces you to be more aware of your thinking in general. Therefore, even for events that you don't write down, you are more likely to think them through and develop a believable rationale. This process helps to encourage the repetition discussed above.
1) Plan to use the Cognitive Diary daily. The more you use the diary the more quickly your thinking will change and the more you will reinforce the new automatic pathway. You don't need to write only about major events. In fact, writing about insignificant events will provide you with substantial practice to help change your thinking for the major events that occur less frequently. For example, an insignificant event can be "That grocery store clerk looked at me funny. She must think I'm ugly."
2) Follow the directions on the diary to help you think through the process of developing your believable rationale. If you have trouble with developing the rationale, either read more about the styles of irrational thinking and how to challenge them or ask people you know for input. In addition, if you have a therapist, you can print a copy of the diary and take into your session to obtain feedback.
3) The Cognitive Diary is printer-friendly so that you can print it out and keep a copy for future reference. Please be sure to either print or copy your final result to your computer as your responses are not saved on this site and you can't access them later (although I do hope to develop a feature that will allow you to log-in and be able to retrieve previous diaries you completed). I encourage my clients to keep a folder of all their diaries so that they can review them which aids with the repetition part of the process. In addition, you can develop a list of the rational challenges that you develop and read frequently to help develop the automatic pathway.
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Dr. Monica Frank