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Cognitive Diary Example


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The following is an example to help learn how to identify and change irrational thinking. It is best to read the articles defining the irrational styles of thinking prior to trying to identifying the styles in the example. It uses the format of the CBT Tools for Healthy Living app. Read: Understanding and Using the Cognitive Diary.

Fear of Having a Panic Attack While Flying

EVENT: I have to wait for the results from medical tests.

EMOTIONS: dread, uncertainty, hopelessness

DISTRESS RATING: 7--Feeling distressed, less in control

THOUGHTS: “I saw my doctor because I was not feeling normal and she thought I should get a thorough check-up. I think she thinks something is wrong but won't tell me. The technician looked at me with concern when I had the tests done. I'm sure there is something terribly wrong! I probably have cancer. What will I do? How will I take care of my family? I'm always so unlucky. If something bad can happen, it will happen to me.”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 3 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of dread, uncertainty, and hopelessness?

The CBT Tools for Healthy Living app helps you to determine some ways to challenge the irrational thinking. Once you have done that, it is important to read the rational challenges frequently until they automatically come to mind rather than the irrational thinking.


Irrational Beliefs:
1) Catastrophizing. In this situation, the person is anticipating the worst possible outcome regarding the tests. At this point he only has a vague sensation of something being wrong; he doesn't have serious symptoms. Yet, he is making an assumption that something is terribly wrong. In addition to that, he then catastrophizes even further into the future assuming that he won't be able to take care of his family.

Catastrophizing about something such as medical tests is likely only to increase anxiety unnecessarily. Most of the time the tests will show either nothing wrong or something that is easily treatable. Also, because medical tests are so often administered these days, it means that more and more abnormal findings are found when there is nothing wrong. Therefore, even if a test is positive, it is still important to wait for conclusive results before over-reacting. With catastrophic thinking, it is important to recognize that the worst case scenario is not likely to occur. And even if it does, you can deal with it then rather than using all your energy when nothing has happened.

Some people might think "If I don't react, aren't I in denial?" No, that is not the case. Denial is when you ignore obvious symptoms and just convince yourself that everything will be okay. If you are taking appropriate action and checking things out, you are not in denial.

2) Mind-Reading Others. Although there is no evidence for his assumption, he is creating evidence by engaging in mind-reading. He believes that both his doctor and the technician are withholding information from him. He takes a simple look from the technician as the evidence he needs to justify his catastrophic assumption.

However, the problem with interpreting looks, especially those of strangers, is that there is a high probability of being wrong. How someone looks could mean a lot of things. It could be even something personal that has occurred in that person's life. Without more experience with that person, it is not clear what a look means. So, with mind-reminding, it is important to remind yourself that you are likely to be wrong in your interpretation of other peopls's thoughts.

3) External Locus of Control. This person made a statement that he is "unlucky" and, as a result, believes that something bad is likely to happen to him. This is an external locus of control which is believing that you have no control over what occurs in your life.

With this type of belief, it is helpful to focus on how you do have control. For instance, he can focus on how he is taking care of himself by seeing the doctor and having the medical tests done. He can also recognize that if anything is wrong, he will take appropriate steps. These behaviors often decrease the likelihood of more serious problems.

How Can This Thinking Be Changed?
"Right now I don't have any information that there is a serious problem so I am not going to dwell on that. I can't interpret the looks of other people because they could mean many different things. Instead of feeling hopeless and unlucky, I can focus on what I am doing to help myself. People who take action when there is a problem are more likely to solve the problem or decrease serious outcomes. I will do what I can if anything does occur. But right now I am not going to worry about it."

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