# 21 - 15. Responding to Automatic Thoughts

# 01 - 15. Responding to Automatic Thoughts

# 15. Responding to Automatic Thoughts

T
he previous chapter demonstrated how to help clients evaluate 
important negative automatic thoughts and determine the effectiveness of their evaluation in session. But when these same thoughts 
arise in their minds during the week, clients may not remember their 
responses. They will also experience additional important automatic 
thoughts between sessions that you didn’t identify. You will find the 
answers to these questions in this chapter:
How do you help clients compose therapy notes to read 
between sessions?
How do you teach clients to use a worksheet to address other 
automatic thoughts between sessions?
What should you do if a worksheet isn’t helpful enough?
Make sure that clients have recorded robust responses in writing 
(on paper or an index card, in a therapy notebook, or on a smartphone) or in an audio format (using a recording device or an app) to 
automatic thoughts you’ve addressed in session. To respond to other 
automatic thoughts between sessions, you can teach clients how to use 
questions from the previous chapter (Figures 14.1 and 14.2). Or you 
can use the Testing Your Thoughts Worksheet (Figures 15.1 and 15.2) 
or a Thought Record (Figures 15.3 and 15.4) or another technique 
described later in this chapter.
RESPONDING TO 
AUTOMATIC THOUGHTS

COMPOSING THERAPY NOTES
Having evaluated an automatic thought with clients, you’ll ask them to 
summarize. You might pose one of the following questions:
“Can you summarize what we’ve just been talking about?”
“What do you think would be important for you to remember 
this week?”
“If the situation comes up again, what do you want to tell yourself?”
When clients express a strong summary, you might say, “That’s 
good. Would you like to write it down or would you like me to? I want 
to make sure you remember it this week.” You will most likely ask their 
preference in Sessions 1 and 2 and then assume their preference hasn’t 
changed unless they indicate it has. Abe and I evaluated his thought “I 
can’t do it” using Socratic questioning. Then I ask him to summarize.
Judith: Okay, Abe, if you think about filling out the insurance forms 
this week and again you have the thought “I can’t do it,” what do 
you want to remind yourself?
Abe: That it’s probably not true. My concentration was good enough 
to fill out a couple of job applications so I can probably at least get 
started on the forms.
Judith: That’s good. (Writes it down.) Anything else?
Abe: I could ask my son for help.
Judith: (writing) That’s important too. And how about that just getting 
started might be the hardest part?
Abe: Yeah, that’s good to remember.
To make sure that what Abe writes down will be most helpful, I first 
ask him to express his summary verbally. This gives me a chance to 
add to or suggest changes to his summary.
CLINICAL TIPS
When clients’ responses are superficial, confused, too brief, or too 
wordy, you might say: “Well, I think that’s close, but I wonder if it 
would be more helpful to remember it this way:             .” As 
above, if clients’ answers are reasonable but incomplete, you might 
ask, “Do you also want to remind yourself that             ?” If 
they agree, you or they can record the addition.
 
Responding to Automatic Thoughts

It’s desirable for clients to read their therapy notes each morning and pull them out, as needed, during the day. They tend to integrate responses into their thinking when they have rehearsed them 
repeatedly. Reading notes only when encountering difficult situations 
is usually less effective than reading them regularly in preparation for 
difficult situations. Below are some of Abe’s therapy notes. They contain responses to dysfunctional thinking and behavioral Action Plans 
items.
When I think “I’ll never get everything done,” I’ll remind myself:
    I should focus on what I need to do right now.
    I don’t have to do everything perfectly.
    I can ask for help. It’s not a sign of weakness.
Then I should figure out what’s easiest to do and set a timer for
10 minutes. At the end of 10 minutes, I can decide whether to keep
going or not.
 
When I think “I’d rather stay inside,” I’ll tell myself that I’ve already
done the experiment of staying inside lots and lots of times and my
mood doesn’t get better. Chances are I’ll feel better if I do go out, to
get some sun, to exercise, or to do an errand.
It might feel as if I’m letting my kids down, but that’s all-or-­nothing
thinking. I’m not doing as much for them physically, like helping them
with yard work, as I did before I was depressed. But I’m still going to
my grandchildren’s soccer games and driving them when their parents
get stuck. I should call them right now and make plans to see them.
Cognitive Behavior Therapy: Basics and Beyond

When I want to ask Gabe for help looking online for a new job:
1. I’ll remind myself it’s just not a big deal. The worst that’ll happen
 
is he’ll say he’s too busy and then I can ask Kaitlyn instead.
2. Asking him to help is an experiment. Even if it doesn’t work this
 
time, it’s good practice for me.
3. If he says he’s too busy, he probably really is.
4. I should call him now and ask if I can come over today or
 
tomorrow or vice versa.
 
Strategies for When I’m Anxious
1. Read my therapy notes and/or do a Testing Your Thoughts
 
Worksheet.
2. Call Ethan and talk about sports.
3. Accept the anxiety. I don’t like the feeling, but it’s a normal
 
human emotion. I can do anything with anxiety that I can do
 
without anxiety. It will likely decrease once I turn my attention
 
to something else.
4. Practice the mindfulness exercise.
5. Go for a walk.
CLINICAL TIPS
On a practical note, you should keep copies of your clients’ therapy 
notes. You can photocopy them, take a picture of them and print 
them out, or use carbonless copy paper. You’ll refer to these therapy 
notes when planning the next session (usually immediately before 
that session), when reviewing clients’ Action Plans, and when reinforcing ideas you had discussed with clients in prior sessions. Also, 
you can provide clients with a photocopy of your notes if they lose 
their notes.
 
Responding to Automatic Thoughts

Audio‑Recorded Therapy Notes
Ensuring that clients have written therapy notes is ideal. They can 
carry around a notebook or index cards to read as needed, or they can 
read their therapy notes on their smartphone. But some clients can’t or 
don’t like to read. Or they find it’s more effective to listen to their notes. 
In any case, you can turn on an audio recorder or have clients use an 
app on their phones when developing responses to automatic thoughts; 
or you can note what the responses are and turn on the recorder for the 
last few minutes of a session, recording all responses at once. Recording and then having clients listen to an entire therapy session is often 
less useful. They are likely to review the recording only once during 
the week, instead of repeatedly listening to the most important points 
of the session. They may also have self-­critical thoughts as they listen.
When clients aren’t literate, you can ask them how they could 
remember what you’ve talked about. For example, could they draw 
a picture? Could they get someone to read the notes to them? Could 
they listen to an audio recording?
CLINICAL TIPS
To motivate clients to read their therapy notes, use the same techniques you’d use for any Action Plan item (Chapter 8), especially 
linking it to their aspirations, values, and goals. Be sure to ask about 
obstacles that could get in the way. If they’re not sure they’ll have 
enough time, ask them how long they think it will take to read their 
notes. If they overestimate, you might ask them to read the notes 
aloud in session while you time them, so they can see that it actually 
takes a much shorter amount of time (usually 20–60 seconds).
USING WORKSHEETS
The Testing Your Thoughts Worksheet (Figures 15.1 and 15.2) and 
the Thought Record (Figures 15.3 and 15.4), also known in an earlier 
version as the “Daily Record of Dysfunctional Thoughts” (Beck et al., 
1979), prompt clients to evaluate their automatic thoughts when they 
feel distressed or engage in unhelpful behavior. The worksheets elicit 
more information than just responding to the lists of Socratic questions in the previous chapter. It’s not necessary for clients to use these 
worksheets if thinking about these questions is helpful enough, but 
many clients find a worksheet organizes their thinking and responses 
better. The worksheets aren’t particularly useful for clients who are 
relatively low functioning, dislike writing, are unmotivated, or who 
have a low level of literacy.
Cognitive Behavior Therapy: Basics and Beyond

Remember, thoughts may be 100% true or 0% true or somewhere in the middle. Just 
because you think something doesn’t necessarily mean it’s true.
1.  When you notice your mood getting worse, or you find yourself engaging 
in unhelpful behavior, ask yourself the questions on the reverse side of this 
worksheet and write down the answers. It will probably take about 5–10 minutes.
2.  Not all questions apply to all automatic thoughts.
3.  If you’d like, you can use the list below to identify cognitive distortions. You may 
find that more than one distortion applies.
4.  Spelling, handwriting, and grammar don’t count.
5.  It was worth doing this worksheet if your mood improves by 10% or more.
Cognitive Distortions
All-or-nothing thinking
Example: “If I’m not a total success, I’m a failure.”
Catastrophizing 
(fortune-telling)
Example: “I’ll be so upset, I won’t be able to function at 
all.”
Disqualifying or 
discounting the positive
Example: “I did that project well, but that doesn’t mean I’m 
competent; I just got lucky.”
Emotional reasoning
Example: “I know I do a lot of things okay at work, but I still 
feel like I’m a failure.”
Labeling
Examples: “I’m a loser”; “He’s no good.”
Magnification/
minimization
Example: “Getting a mediocre evaluation proves how 
inadequate I am. Getting high marks doesn’t mean I’m 
smart.”
Mental filter
Example: “Because I got one low rating on my evaluation 
[which also contained several high ratings], it means I’m 
doing a lousy job.”
Mind reading
Example: “He’s thinking that I don’t know the first thing 
about this project.”
Overgeneralization
Example: “Because I felt uncomfortable at the meeting, I 
don’t have what it takes to make friends.”
Personalization
Example: “The repairman was curt to me because I did 
something wrong.”
“Should” and “must” 
statements
Example: “It’s terrible that I made a mistake. I should 
always do my best.”
Tunnel vision
Example: “My son’s teacher can’t do anything right. He’s 
critical and insensitive and lousy at teaching.”
FIGURE 15.1.  Testing Your Thoughts Worksheet, side 1. Copyright © 2018 CBT 
Worksheet Packet. Beck Institute for Cognitive Behavior Therapy, Philadelphia, Pennsylvania.
 
Responding to Automatic Thoughts

1. What is the situation? You might be having thoughts about something that 
just happened in the environment or something that happened inside of 
you (an intense emotion, a painful sensation, an image, a daydream, a 
flashback, or a stream of thoughts—e.g., thinking about my future). 
I got a parking ticket. 
 
 
 
 
   
  2. What am I thinking or imagining? I’m so stupid. 
 
 
   
 
 
 
 
 
 
 
 
    
   
  3. What is the cognitive distortion? (optional) Labeling, overgeneralizing    
 
 
 
 
 
 
 
 
    
   
  4. What makes me think the thought is true? I shouldn’t have lost track    
 
of time. 
 
 
 
 
 
 
   
  5. What makes me think the thought is not true or not completely true? Other 
 
people get parking tickets. It doesn’t necessarily mean they’re stupid.   
  6. What’s another way to look at this? I just made a mistake. 
 
   
 
 
 
 
 
 
 
 
    
   
  7. If the worst happens, what could I do then? Just keep paying parking      
 
tickets, but it would be better to set an alarm on my phone so it 
   
 
doesn’t happen again. 
 
 
 
 
   
  8. What’s the best that could happen? I’ll never get a parking ticket again.   
 
 
 
 
 
 
 
 
    
   
  9. What will probably happen? I could get another ticket, but I’ll probably    
 
remember what happened this time and make sure I don’t. 
   
10. What will happen if I keep telling myself the same thought? I’ll keep being  
 
upset with myself. 
 
 
 
 
 
   
11. What could happen if I changed my thinking? I’d feel better. 
   
 
 
 
 
 
 
 
 
    
   
12. What would I tell my friend or family member [think of a specific person] 
Gabe 
 if this happened to him or her? It’s not that big a deal.    
 
So you forgot and made a mistake. You know how to avoid doing this    
 
in the future. 
 
 
 
 
 
   
13. What would be good to do now? Get my mind off of this. Go for a walk.   
 
 
 
 
 
 
 
 
    
   
FIGURE 15.2.  Testing Your Thoughts Worksheet, side 2. Copyright © 2018 CBT 
Worksheet Packet. Beck Institute for Cognitive Behavior Therapy, Philadelphia, Pennsylvania.
Cognitive Behavior Therapy: Basics and Beyond

3.  Then fill in the rest of the columns. You can try to identify cognitive 
distortions from the list below. More than one distortion may apply. Make 
sure to use the questions at the bottom of the worksheet to compose the 
adaptive response.
4.  Spelling, handwriting, and grammar don’t count.
5.  It was worth doing this worksheet if your mood improves by 10% or more.
Spend just 5–10 minutes to complete the Thought Record. Note that not all questions will apply to every automatic thought. Here’s what to do.
Just because you think something doesn’t necessarily mean it’s true.
Catastrophizing (fortune-telling)
Example: “I’ll be so upset, I won’t be able to function at all.”
All-or-nothing thinking
Example: “If I’m not a total success, I’m a failure.”
Remember, thoughts may be 100% true or 0% true or somewhere in the middle.
1.  When you notice your mood getting worse, or you find yourself engaging 
in unhelpful behavior, ask yourself, “What’s going through my mind right 
now?” and as soon as possible, jot down the thought or mental image in 
the Automatic Thought(s) column.
2.  The situation may be external (something that just happened or something 
you just did) or internal (an intense emotion, a painful sensation, an image, 
daydream, flashback, or stream of thoughts—e.g., thinking about your 
future).
Cognitive Distortions
FIGURE 15.3.  Thought Record, side 1. Copyright © 2018 CBT Worksheet Packet. Beck Institute for Cognitive Behavior Therapy, 
Philadelphia, Pennsylvania.
Magnification/minimization
Example: “Getting a mediocre evaluation proves how inadequate I am. Getting high marks doesn’t mean I’m smart.”
Mental filter (selective abstraction)
Example: “Because I got one low rating on my evaluation [which also contained several high ratings], it means I’m 
doing a lousy job.”
Tunnel vision
Example: “My son’s teacher can’t do anything right. He’s critical and insensitive and lousy at teaching.”
Overgeneralization
Example: “Because I felt uncomfortable at the get-together, I don’t have what it takes to make friends.”
Disqualifying or discounting the positive
Example: “I did that project well, but that doesn’t mean I’m competent; I just got lucky.”
Emotional reasoning
Example: “I know I do a lot of things okay at work, but I still feel like I’m a failure.”
Personalization
Example: “The repairman was curt to me because I did something wrong.”
Mind reading
Example: “He’s thinking that I don’t know the first thing about this project.”
“Should” and “must” statements
Example: “It’s terrible that I made a mistake. I should always do my best.”
Labeling
Examples: “I’m a loser”; “He’s no good.”

1.  How much do you 
now believe each 
automatic thought?
2.  What emotion(s) 
do you feel now? 
How intense 
(0%–100%) is the 
emotion?
3.  What would be 
good to do?
1.  AT (50%)
2.  Anxious (50%)
3.  Practice
Date/
time
Situation
Automatic thought(s)
Emotion(s)
Adaptive response
Outcome
1.  (optional) What cognitive distortion did you make?
2.  Use questions below to compose a response to the 
automatic thought(s).
3.  How much do you believe each response?
1.  What emotion(s) 
(sad/anxious/
angry, etc.) did 
you feel (before, 
during, or after the 
event or unhelpful 
behavior)?
2. How intense 
(0%–100%) was 
the emotion?
1.  What thought(s) 
and/or image(s) 
went through your 
mind (before, 
during, or after the 
event or unhelpful 
behavior)?
2.  How much did 
you believe the 
thought(s)?
6/23
Thinking about the 
job interview
I’ll be so nervous, I 
won’t know what to 
say, and then I won’t 
get the job. (80%)
1.  What event 
(external or 
internal) is 
associated with 
the unpleasant 
emotion? Or 
what unhelpful 
behavior did you 
just engage in?
FIGURE 15.4.  Thought Record, side 2. Copyright © 2018 CBT Worksheet Packet. Beck Institute for Cognitive Behavior Therapy, 
Philadelphia, Pennsylvania.
Questions to help compose an alternative response: (1) What is the evidence that the automatic thought is true? Not true? (2) Is there an alternative 
explanation? (3) If the worst happened, how could I cope? What’s the best that could happen? What’s the most realistic outcome? (4) What’s the effect of my 
believing the automatic thought? What could be the effect of my changing my thinking? (5) If             [person’s name] was in this situation and had this 
thought, what would I tell him/her? (6) What would be good to do?
Anxious (75%)
(Fortune-telling)
I’m nervous now, but I can practice more with [my 
therapist]. When I was nervous in the past, like when I 
got a new boss, I didn’t have trouble talking. (80%)
If I don’t get the job, I can apply for other ones. The best 
outcome would be that the interviewer will offer me the 
job on the spot. The most realistic outcome is that I’ll 
have to apply for several jobs before I get one. (90%)
Thinking I won’t get the job just keeps me anxious. 
Realizing that it’s not the end of the world if I don’t get 
it makes me feel better. (100%)
I’d tell Gabe that it isn’t the end of the world if he’s 
nervous and doesn’t get the job. But the more he 
practices, probably the less nervous he’ll be. (100%)
I should practice what I want to say and then act as if 
I’m not nervous (100%)

CLINICAL TIPS
Both worksheets contain similar questions, but the Testing Your 
Thoughts Worksheet has an easier readability level, and its more 
structured format is simpler and easier to complete. As you read in 
the previous chapter, first, you’ll identify an important automatic 
thought and use one of the lists of questions with the client. If the 
intensity of the client’s automatic thoughts and emotions decrease, 
you can then demonstrate how to write the answers and other information on one of the two worksheets. Note that you could pull out 
a worksheet immediately after identifying an important automatic 
thought. But if the evaluation of the thought is ineffective, clients 
may believe the worksheet won’t be helpful to them.
In the following section, Abe and I have used the list of Socratic 
questions from the Testing Your Thoughts Worksheet to evaluate his 
thought “Gabe won’t want to go with me,” and he feels better. Next, I 
introduce that worksheet.
Judith: Good. Now I’d like to show you a worksheet [Figures 15.1 and 
15.2] that I think will help you at home. It’s called Testing Your 
Thoughts. It’s just an organized way of writing down what we just 
did. Okay?
Abe: Sure.
Judith: (showing it to Abe) It may take some practice for you to get 
really good at it. So, expect to make some mistakes along the way. 
These mistakes will actually be useful—­we’ll see what was confusing, so I can prepare you better the next time. Okay?
Abe: Yeah.
Judith: (showing side 1 to Abe) Here at the top, it reminds you that your 
thoughts might or might not be true. Then it tells you when to use 
it. (Reads aloud.) “When you notice your mood getting worse, or 
you find yourself engaging in unhelpful behavior, ask yourself the 
questions on the reverse side of this worksheet and write down 
the answers.” I think it’ll take you about 5 minutes to do it, maybe 
a little more. It also lets you know that not every question may 
apply, that spelling, handwriting, and grammar don’t count, that 
if you feel 10% better, it was worth doing, and it also lists cognitive 
distortions.
Abe: Okay.
Judith: (turning to the other side) This side is self-­explanatory. You just 
read a question, and if seems to apply, you write the answer next 
to it. Do you have any questions?
 
Responding to Automatic Thoughts

Abe: No, I think I understand.
Judith: What do you think? Is it okay if we take another automatic 
thought and see if you can use the worksheet?
Abe: Yeah.
Make sure that clients can successfully complete one of the worksheets in session before you suggest it as an Action Plan assignment. 
For some clients, it’s better to introduce the Thought Record in two 
stages. In one session, you might teach clients to fill in the first four 
columns and ask them to do the same at home when they’re feeling 
upset. If it goes well, you can then teach them to use the final two columns at the following session.
WHEN A WORKSHEET ISN’T HELPFUL ENOUGH
As with any technique in CBT, it’s important not to overemphasize 
the importance of worksheets. Most clients, at some point, find that 
completing a particular worksheet did not provide much relief. If you 
emphasize its general usefulness and “stuck points” as an opportunity for learning, you help clients avoid automatic thoughts critical of 
themselves, the therapy, the worksheet, or you.
As described in the previous chapter, evaluation of an automatic 
thought (with or without a worksheet) may be less than optimal if clients fail to respond to their most upsetting thoughts or images, if their 
automatic thought is a core belief, if their evaluation and response are 
superficial, if they discount their response, or if the automatic thought 
is part of a dysfunctional thought process.
CLINICAL TIPS
If you’re not highly confident that clients will be able to use a list 
of questions or a worksheet effectively at home, ask them to predict 
what might happen.
Judith: If you have trouble evaluating your thoughts this week, how 
are you likely to feel?
Maria: Frustrated, I guess.
Judith: What’s likely to go through your mind?
Maria: I don’t know. I’ll probably just quit.
Judith: Can you imagine looking at the sheet of paper and not 
being able to figure out what to do?
Cognitive Behavior Therapy: Basics and Beyond

Maria: Yeah.
Judith: What’s going through your mind as you look at the paper?
Maria: “I should be able to do this. I’m so stupid.”
Judith: It’s good you told me that. Do you think it would help to 
have a reminder that it’s just a skill you’ll get better at? And that 
I can help you at the next session?
Maria: Yes. (Records it in the therapy notes.)
Judith: Do you think this response will help enough? Or do you 
think we should put off this Action Plan item until we have 
more time to practice together?
Maria: No, I think I can try it.
Judith: Okay, now if you do get frustrated and have automatic 
thoughts, be sure to jot them down. Okay?
Here I make the Action Plan into a no-lose proposition: Either 
Maria does it successfully, or we’ll collaboratively work on it at the 
next session. If frustrated, she either reads her therapy notes (and 
probably feels better) or keeps track of her thoughts so we can 
address them together.
 
Finally, as described in the previous chapter (p. 256), clients may 
be able to take a shortcut without the structure of a list of Socratic 
questions or a worksheet—­but be careful that their responses aren’t 
superficial. You can use two formats. One, described on pages 256–
257, takes the following form: “When I think             , I should 
remind myself             .” Another form is the two-­column technique (automatic thoughts and responses), shown below.
 
Automatic thought
Response
“I want to skip the reunion.”
“It’s better for me to go. I could 
reconnect with people. And 
someone might have a lead for 
a job.”
“If I tell Rita I don’t want to 
change the holiday plan, she’ll 
get angry.”
“If this doesn’t get her angry, 
something else will. I should 
do what’s good for me—not 
accommodate her all the time.”
 
Responding to Automatic Thoughts

SUMMARY
There are two major ways that clients respond to their unhelpful 
thinking between sessions. They can read their therapy notes, if you’ve 
previously evaluated the thought with them in session. Or they can use 
a list of Socratic questions or a worksheet to evaluate new automatic 
thoughts. It’s better to use the questions on a worksheet verbally with 
clients. If you successfully help clients evaluate an automatic thought, 
then you can show them how to use a worksheet that contains the same 
questions. When a worksheet isn’t sufficiently helpful, conceptualize 
the difficulty so you’ll know what to do.
REFLECTION QUES TIONS
What problems could arise in introducing a worksheet to a client? 
What can you do when a worksheet isn’t helpful enough? How can you 
reduce the likelihood that clients might become self-­critical if they can’t 
successfully complete a worksheet?
PRACTICE EXERCISE
Identify an automatic thought that could interfere with your doing a Thought 
Record yourself. Then evaluate and respond to this thought using a Thought 
Record. Next, identify one of your dysfunctional thoughts about any situation, and use the Testing Your Thoughts Worksheet. Also, do a role play in 
which you introduce a client to one of the worksheets. Remember, start 
by helping the client successfully evaluate an automatic thought verbally, 
using the questions on the worksheet. Then pull out the worksheet and 
show the client how to fill it in.
Cognitive Behavior Therapy: Basics and Beyond