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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 COGNITIVE DIARY CBT SELF-HELP app. Read: Understanding and Using the Cognitive Diary.

Doctor is Frustrated with Me

EVENT: I have a recurring infection and when I went to see my doctor for the third time she seemed irritated and said with a sigh “All I can do is write another prescription. Be sure you take it as prescribed.” I always do as she says but she seemed to accuse me anyway.

EMOTIONS: guilt, self-blame

DISTRESS RATING: 6—feeling bad

THOUGHTS: "She thinks I'm not following her advice and is angry with me for not getting rid of this infection. I feel guilty so I must be doing something wrong and I should be more careful in following her instructions."

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 guilt and self-blame?

The Cognitive Diary CBT Self-Help 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.

ANSWER:

Irrational Beliefs:
1) Mind-reading others. She is making an assumption that her doctor is irritated with her for not following her advice. However, the doctor did not say that. The doctor could have sighed because she was frustrated with the situation and not being able to help her patient. In which case, her instructions were not an accusation but just standard instructions.

2) Shoulds. She is placing a demand on herself that is unreasonable given that she indicated that she always complies with the doctor's instructions. How can she do any better?

3) Emotional Reasoning. She is blaming herself because she feels bad. In other words, she is determining that she must be at fault because she had a guilty reaction. If a person feels accused, sometimes they have an automatic guilty reaction even though they haven't done anything wrong. This reaction needs to be evaluated for its accuracy prior to acting on it.

How Can This Thinking Be Changed?
"I am making an assumption about my doctor's statement. She may not have been frustrated with me but with the situation. Even if she was frustrated with me I don't need to feel bad and put demands on myself because I haven't done anything wrong."

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