Cognitive Conceptualization Diagram

© 2011, Beck, J.S. Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). www.beckinstitute.org.

Cognitive Conceptualization Diagram

RELEVANT CHILDHOOD DATA

CORE BELIEF(S)

CONDITIONAL ASSUMPTIONS/ATTITUDES/RULES

COPING STRATEGIES

SITUATION #1

SITUATION #2

SITUATION #3

AUTOMATIC THOUGHT(S)



MEANING OF A.T.

MEANING OF A.T.

MEANING OF A.T.

EMOTION(S)

EMOTION(S)

EMOTION(S)

BEHAVIOR

BEHAVIOR

BEHAVIOR

From Creed, Reisweber, & Beck (2011). Cognitive therapy for adolescents in school settings. New York: Guilford Press.

Michele

Michele is a twelve-year old girl who arrives at her first session, wiping away

tears from her face as she sits in the waiting room. As you walk her to your office, she

responds to your gentle questions and chit-cat with single word answers. She tells you

that her name is Michele and she is in sixth grade, but shrugs to your other questions

and does not look at you as you walk down the hallway.

Michele is very slow to talk about herself, but over several meetings with you,

she reveals that she is deeply depressed. She tells you that she cries easily and often,

and has had trouble eating and sleeping. She tells you that she feels exhausted even in

the morning. In her saddest, darkest moments, Michele tells you that she thinks about

killing herself and sees it as the only way to escape from the difficult things in her life.

When she is feeling really down and frustrated, she sometimes cuts her upper thighs

with a razor blade or the sharp edge of a CD. These cuts are never deep enough to put

her life in any danger, but when she shows you the cuts, you can see that the cutting

has left scars.

Michele tells you that two things make her feel so sad that she wants to hurt

herself. First, from ages six to ten, her mother’s boyfriend sexually abused her. When

Michele told a friend about the abuse, the friend confided in an adult who ultimately

reported the abuse to Michele’s mother and the police. Michele’s mother accused her

of trying to steal her boyfriend and still blames her for the relationship ending. Michele

feels intensely sad that her mother does not believe she was sexually abused and that

she has so little sympathy for her feelings. Sometimes, Michele is so tormented by her

shame and unhappiness, that she thinks the only way out is to kill herself.

The second thing that Michele tells you that fuels her sadness is that she thinks

that she is “a fat pig” even though she is an average weight for her height. Michele goes

through cycles of restricting the amount she eats so that she can lose weight, and then

becomes so hungry that she binges. Following a binge, she is very critical of herself, and

thinks, “I’m going to be fat forever and no boy will give me a second look.” She thinks

she is weak because she cannot resist her cravings and hates herself. If she’s alone,

From Creed, Reisweber, & Beck (2011). Cognitive therapy for adolescents in school settings. New York: Guilford Press.

she’ll cut herself for some quick relief. Michel’s negative view of herself causes her to

seek sexual attention from boys to reassure herself that she is attractive. Sometimes,

Michele will have sex with a boy to reassure herself that he is interested in her.

However, after sex, the boy’s interest soon fades, and Michele feels deeply hurt and

thinks the boy left because she was fat. This fuels Michele’s determination to starve

herself again to become more attractive. These cycles of starvation and binging, plus

casual sex and rejection, leave her feeling sad, ashamed, and alone. Several of Michele’s

classes are with boys with whom she has had sex. Seeing the boys causes her to think

about her situation and she feels sad and she starts to cry. Once she starts crying, she

has a hard time stopping, so she hides in the bathroom until she regains control.

Copyright©2013 Michael A. Tompkins, Ph.D.

A and C

Instructions: In the A column, write down what happened just before C started _____Scared________________ (e.g., anger, sadness, hitting). In the C

column, rate the amount of _______Scared__________ (e.g., anger, sadness, hitting) with numbers 0 (lowest) to 10 (highest).

Activating situation

Consequence

0 (lowest) to 10 (highest)

I was taking my STAR test and kept making mistakes.

Scared (8)


A, B, C Form

Instructions: In the A column, write down what happened just before C started ________Scared_________ (e.g., sad, angry, scared). In the C column, rate the

amount of the feeling with numbers 0 (lowest) to 10 (highest). In the B column, write down what you were thinking just before the feeling started.

Activating Situation

Belief

Consequence

0 (lowest) to 10 (highest)

I was taking my STAR test and kept

making mistakes.

I’m going to fail my STAR test and

my teacher will be really mad at me.

Scared (8)

From Using Homework in Psychotherapy: Strategies, Guidelines, and Forms by Michael A. Tompkins. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this book for personal use only (see copyright page for details).

My Anxiety and Fear Diary

Name: _________ Gwyn Moore ___________________ Date: _______________

Instructions: In the Situation column, record what you were doing just before you started feeling anxious or fearful. In the What did you do? and the What were

you thinking? columns record what you were doing and thinking and then record how frightened (How afraid were you?) you were feeling (0 to 10, where 10 is extreme fear).

Time

Situation

What did you do?

What were you thinking?

How afraid were you?

(0 – 10)

10:30 a.m.

My teacher asked the class a question.

I looked down and tried to disappear.

My teacher will ask me something I don’t know and the kids will think I’m really stupid.

7

Copyright©2013 Michael A. Tompkins

Catch It-Check It-Correct It

Catch It

What words/phrases/images went

through your mind just before or while

you were feeling anxious?

What is your worst fear?

What do these thoughts say and mean

about you and your life or your future?

What do these thoughts say and mean

about how others see/think about you?

I’m going to throw up because I feel a little sick to my stomach.

Check It

What are the primary Thinking Traps?

The crystal ball

A perfect disaster

Correct It

Pick a key thought and describe the

objective evidence that supports it. Is

this thought 100% accurate?

Does the thought contain any thinking

errors? Does this thought reflect

objective reality?

Develop an argument against the key

thought. Why is this key thought

inaccurate?

What are some alternative and more

balanced ways you can think about

this situation? Is there an alternative

thought more in line with the

evidence?

What would you say to a friend who

was in a similar situation? Is there a

more helpful way to think about the

situation?

I’ve made this prediction a ton of times and I’ve never been correct.

I’m likely tired because I’m not sleeping well because I’m worried about my exams.

Just because I feel sick doesn’t mean I’m going to throw up. I’ve been sick many times and I’ve only thrown up once, when I was six years old.


Thought Record

Situation

Feeling(s)

Automatic Thoughts

Other Response

Outcome

What event led to the

unpleasant situation?

What emotions

were you feeling?

What thoughts or images went

through your mind?

Is the thought completely true? Is

the thought helping you feel better

or work towards your goals?

What emotion do you

feel now? What will

you do now?

I got a C- on my math test.

Angry (70)

Sad (80)

“I can’t do math.”

“I am a total loser.”

“It’s not fair that I have to do math. What’s the point? I don’t need to know this stuff.”

“Math is harder for me than for some of the other kids, but a C- doesn’t mean that I can’t do math at all. No one is good at everything.”

“Just because I’m not a math star doesn’t mean I’m a loser. I do other things better than some of the kids. No one can be good at everything all the time.”

“I may not need much math when I graduate but I’ve got to get a decent math grade to graduate so that I can do the things I want some day.”

Not as sad (50)

I’m still angry but not as much (30)

I’ll ask Mr. Deacons for some help with the math. He’s an okay guy but he’s such a math geek. I’ve just got to keep my eye on the prize – graduate!

Michael A. Tompkins, Ph.D. 5435 College Avenue, Suite 100-2 Oakland, CA 94618-1590 (510) 652-4455 (tel) (510) 380-2988 (fax)

F.E.A.R.

Feeling nervous? (Are

you feeling nervous? How

can you tell?)

My stomach hurts and my heart is beating really fast.

Expecting bad things

to happen?

Someone will break into my new house like they did before.

Attitudes and

Actions (List some of the

possible things you could do

and think. Ask yourself

“what can I do to make this

situation less fearful?”

My mom and my therapist tell me my new house is in a safe

neighborhood.

I can turn on my radio so that I don’t hear sounds that scare me.

I could ask my new friends whether they are scare that bad people

will break into their houses.

Results and rewards

No one broke into my house last night and I was a little less

scared.

San Francisco Bay Area Center for Cognitive Therapy 5435 College Avenue Oakland, CA 94618-1590 (510) 652-4455 (tel) (510) 380-2988 (fax) www.sfbacct.com (webpage)

STOP

Trigger What were you doing when you started feeling scared? What happened?

Scared Am I feeling scared? Rate how scared you are from 0 (lowest) to 10 (highest).

Thought What was I thinking when I started to feel scared?

Other Thought

What could I think that would help? How could I handle the situation differently? Is there another way of looking at this? Are you missing something important? How do you feel after you tried the other thoughts? Rate how scared you are now from 0 (lowest) to 10 (highest).

Praise Congratulate yourself!

My dad is late picking me

up.

6

Something bad might

have happened to him

like it did to my brother.

He might have gotten

shot just like my

brother. Oh my God, I

bet he’s dead.

I never worried like this

when my dad was late before

my brother got shot, and

nothing ever happened to him.

My dad is always very

careful and he is coming

right from work to my school

and that is safe driving.

After what happened to my

brother, my dad told me he

would be extra careful and I

believe him.

I did a good

job of

coming up

with other

thoughts.

I’m getting

better at this

and soon I

won’t be so

scared

anymore.

San Francisco Bay Area Center for Cognitive Therapy • 5435 College Avenue • Oakland, CA 94618-1590 • (510) 652-4455 (tel) • (510) 380-2988 (fax) • www.sfbacct.com (webpage)

My Butterfly Thought Record Name __________________________________________________________________ Date _______________________________

Situation What were you doing when you started to feel bad? What happened?

Feeling What feelings did you notice (e.g., sad, angry)? Rate them from 0 (lowest) to 10 (highest)

Caterpillar Thought

Butterfly Thought

My mom asks me if I am going to Nora’s party.

Sad (8)

Probably no one will talk to me anyway, and I’ll have an awful time. There’s no use in me even going, I’ll have such a terrible time.

I don’t know for sure whether other kids will talk to me. Nora talks to me at school, and I know she’ll talk to me. Some of Nora’s friends already talk to me, so I can always talk to them if Nora is busy. I don’t know for sure whether I’ll have a terrible time. I can talk to my mom and Nora so that I can leave if I’m not having fun. Sometimes I think I won’t have fun and then I do, maybe this time will be like that.

San Francisco Bay Area Center for Cognitive Therapy • 5435 College Avenue • Oakland, CA 94618-1502 • (510) 652-4455 (tel) • (510) 652-3872 (fax) • www.sfbacct.com (webpage)

My Bullfrog Thought Record Name __________________________________________________________________ Date _______________________________

Situation What were you doing when you started to feel bad? What happened?

Feeling What feelings did you notice (e.g., sad, angry)? Rate them from 0 (lowest) to 10 (highest)

Tadpole Thought

Bullfrog Thought

I’m in bed and only my nightlight is on.

Scared (8)

Somebody will break into our house and get

me.

Our neighborhood is really safe and nobody

has every broken into any of my friends’

houses.

My mom and dad would hear something

way before anyone got into our house. My

dad’s a real light sleeper.


Time Machine

1

________

2

________

3

________

4

________

5

________

6

________

7

________

8

________

9

________

10

________ Could care

less

Definitely

not

important

Mildly

important

Almost

important

Important,

but not life

altering

Important,

but I have

bigger fish to fry

Important,

and I will

take it seriously

Very

important

Very, very

important

My life

and the

welfare of my world

as I know

it depends on this

My thought or belief: I can’t believe I said that. He must think I’m an idiot. I’ll never ask me out now.

How important is this to me right now? Very important. (8)

How important will this be in one hour? Very important still. I made a fool of myself! (8)

In one day? Still pretty important. I’ll have to face him at school. His friends might laugh at me. (6)

In one week? Important, but getting less important. People start to forget things after a week or so. (5)

In one year? It’s probably not that important. I’ll be a senior and too focused on college by then. (3)

In five years? It’s really not important! I’ll be finishing college in five years and probably won’t even remember this! (2)

In twenty years? This is definitely not important. I’ll be married with kids. If I even remember it, I might look back and laugh! (1-2)

My new way of thinking about it: Okay, it’s not that big of a deal. It feels really bad and important now, but it won’t be important in my future.

CopyrightMichael A. Tompkins, 2013

What Do I Believe

I believe _______It’s all my fault that my Dad left_______

All things that may have been responsible for … %

My brother argues with my dad even more than I do.

10%

My dad couldn’t help support me and my mom and he felt really bad about that.

25%

My mom told that my dad could never settle down. He was a tumbleweed.

10%

My dad and mom were always arguing and this last year mom had enough and told him to leave several times.

10%

My dad had a drug problem and he was afraid the cops would find him.

40%

I argued with my dad sometimes because I was angry with him.

5%


I believe ___________ I’m a total loser _____________ .

100% 75% 50% 25% 0% Total Loser Total Winner Always in trouble at school, every teacher thinks he’s the worst and a minute doesn’t go buy that a teacher doesn’t criticize him. Kicked off baseball team and can’t even walk without stumbling, no kid will pick him for a team. His mom and dad are divorced, in fact, his parents left him and didn’t give him a thought. He smells bad, his clothes are rags. Gets Fs in every class, on every test, on every quiz, no points on anything.

Half the time he wins and half the time he loses a game. Half the time he gets a good grade and half the time he gets a bad grade. Half the time teachers praise him and half the time teachers correct him. Half the time he looks cool and half the time he looks tired and uncool. Half the time his mom and dad argue and half the time they are happy with each other.

Never gets in

trouble at school, not even

for scratching his nose.

Pitches or plays first base, or any

position he wants.

His mom and dad are

together and never argue or even disagree.

Gets As in everthing, even

stuff that’s really hard.

He dresses cool and all the girls, every single one of them, thinks he’s “the dude”.

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% James Alex Curt

Jack Austin

Zack Ted Ben Alec Jose Russ

Me Pete Todd

Jamal


I believe ___________ I’m selfish _____________ .

0% 25% 50% 75% 100% Selfless Selfish Never thinks about herself. She’s starving because she can’t bear to eat when she knows other people are hungry. Her clothes are rags because she won’t buy anything nice for herself and when she does she gives it away the moment someone compliments the outfit. Her grades are poor because she can’t bear the idea of doing better in school than any other kid. Kids don’t know who she is because she won’t speak because she always wants other kids to do better and speak more.

Half the time she thinks about herself and half the time she thinks about other people. Half the time she gives people things and half the time she accepts things from others. Half the time she shares things with people and half the time she doesn’t share because she has a reason. Half the time she spends money on herself and half the time she spends money on others. Half the time she waits her turn and half the time she goes first. Half the time she asks about you and half the time she doesn’t.

Never thinks about anyone but herself. Never gives

anyone anything.

Never shares anything no matter how small it is.

Only spends money on

herself. Never gives

gifts. Never waits her

turn because she only cares

about what she wants.

All she talks about is herself,

never asks about you or what you’re

doing. She never does anything nice

for anyone unless she

knows she can get something

back.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Alice Ann Jess

Beth Min

Anne Bev

Mary

May Me Sari Linda Lucy

Anya


Action Experiment

Belief Feeling embarrassed is horrible!

Step 1 What’s your prediction?

I won’t be able handle feeling embarrassed. I’ll just freak out. I’ll be paralyzed and unable to say a single word.

Step 2 How strongly do you believe your prediction is correct (0-100%)? 80%

Step 3 How could we test that out? Let’s design your experiment (what, when, where, with whom).

Make a little mistake in front of people. Tomorrow, I could stand on the corner of Haight and Ashbury and ask, “Excuse me, where is the corner of Haight and Ashbury, please?”

Step 4 Let’s practice the experiment and plan for any bumps.

If someone is confused, I’ll just tell them I’m new in town. If they ask me where I’m from, I’ll tell them Des Plaines, Illinois. My grandparents used to live there so I know kind of what it’s like. If they’re rude I’ll remind myself that I was very brave and it doesn’t matter what people think.

Step 5 Now, do the experiment. (when, where, with whom) I’ll try this today, in front of the book store. It’s not my neighborhood so I probably won’t know anyone.

Step 6 Describe what really happened.

Most people didn’t even blink. They just smiled and told me I was standing at the corner. One lady smiled and asked if I was kidding but when I told her that I was from out of town, she told me and even chatted with me. I felt embarrassed at first but not ask embarrassed as I thought I was going to feel. I was able to talk, like when the lady asked where I was from and I told her the little white lie we made up about that.

Step 7 Now, let’s talk about it. Were you surprised? What did you learn? Why do you think your prediction didn’t come true?

I thought I would be much more embarrassed than I really was. I guess learned that being afraid of embarrassment isn’t a good reason not to do something. I also learned that everyone makes mistakes and feels embarrassed sometimes and it’s not the end of the world.

Step 7 Now, how strongly do you believe your prediction is correct (0-100%)?

40%

Step 8 How are you thinking about it now? Would it help to try it again? What could we do differently?

I’d try it again but maybe I could try it with someone I know a little, like the book store owner. Maybe I could ask for a magazine that is sitting on the rack right next to the cash register. If that’s easy, after she tells me that the magazine is right in front of me, I could ask her, “Where?” Now that sounds embarrassing.


My Pluses and Minuses Worksheet

Problem I want to think through: ___ Whether I should try a medicine for my anxiety or not. _____

+ + + Pluses + + +

- - - Minuses - - --

My mom told me Stephanie tried a medicine for her worry and it really helped, so maybe it would help me too.

It might not work. (But, I won’t know that until I try it).

I’m working really hard in my therapy, and it’s helping, but some days I’m miserable. Maybe, like my therapist said, a little medicine might make therapy a bit easier for me too.

I might have some side effects. (But most teens do, and they might not be too bad).

Sometimes, I feel like the anxiety is wearing me down. Maybe a medicine would help me feel less worn down.

If my friends find out I’m taking a medicine, they might think I’m some sort of mental case. (But, Jenny took medicine for a while to help with her focusing problem and none of us thought she was weird).

It’s a hassle to take medicine and one more thing my parents have to remind me to do. (However, maybe I could work out a way to remember on my own).

Now I’d have to admit that I really have a problem with anxiety if I try medicine. (But I’m learning that a lot of teens struggle with anxiety and if the medicine works, why don’t try).

My plan or decision is: I’ve decided to give medicine a try and see how I feel. I can always change my mind if it’s not helping __ .

My Daily Activity Schedule

Name ___________________ Jessica _________________________________ Date ______ May 5 ________________

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

9:00-10:00 am

Shower. Fun (2) Proud (3)



10:00-11:00 am

Walked dog. Fun (4) Proud (5)



11:00-12:00 pm

Watched TV Fun (4) Proud (5)

Watched Youtubes. Fun (4) Proud (5)

12:00-1:00 pm

Made/ate lunch Fun (2) Proud (4)

Lunch with mom Fun (3) Proud (2)

Made/ate lunch Fun (2) Proud (4)

Lunch alone Fun (2) Proud (2)

Lunch with mom Fun (5) Proud (2)

Overall Mood (0-10)

4

5

2

2

6

Fun or Proud Activity Scheduling Form

Fun or Proud Activity Day of Week

Su Mo Tu We Th Fr Sa

Watch some funny YouTube videos (F) √ √ √

Wrote some Fan Fiction (P) √ √ √

Went to 7-11 for a soda (F) √

Texted with my best friend for 10 minutes (F) √ √ √ √

Gave mom a hug (F) √ √ √ √

Road my bike to the park and back for 20 minutes (F) √ √

Downloaded music and listened to the new tunes (F) √ √ √ √

Went to Melissa’s house for lunch (F) √

Went to the dog park to walk Milton (P) √ √

Bought a new magazine and read for 30 minutes (F) √ √ √

Total Events 4 5 2 3 2 4 7

Overall Mood (0-10) 3 4 2 3 3 3 5



Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

9:00-10:00 am

Shower. Eat breakfast Fun = Proud =







10:00-11:00 am

Walked dog. Fun = Proud =

Ride to and from park (10”) Fun = Proud =

Walk dog. Fun = Proud =





11:00-12:00 pm

Listen to music (30”) Fun = Proud =

Watch my favorite TV shows (60”) Fun = Proud =

Watch funny YouTubes (60”) Fun = Proud =

Listen to music and dance (30”) Fun = Proud =

12:00-1:00 pm

Lunch Fun = Proud =

Lunch, then ice cream with Amy Fun = Proud =

Lunch with mom Fun = Proud =

Made new lunch food Fun = Proud =

Lunch Fun = Proud =

Lunch with mom Fun = Proud =

Lunch with Melissa Fun = Proud =

Overall Mood (0-10)

4

5

2

2

6

From Using Homework in Psychotherapy: Strategies, Guidelines, and Forms by Michael A. Tompkins. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this book for personal use only (see copyright page for details).



Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Morning

Help mom make pancakes.

Ride to school with Bethany.

Ride to school with Julie.

Afternoon

Go to park with Julie and mom.

Meet with Dr. Tompkins.

Evening

Call Julie to chat.

Call Bethany to chat.

Bedtime

Read stories with mom.

Read stories with mom.

Copyright2013 Michael A. Tompkins

Solving Problems

Step 1. How am I feeling?

__Sad and angry _____________________________________________________

Step 2. What is the problem?

__ My mom and day are fighting all the time _____________

Step 3. Now I’m going to stop

and think of as many solutions to my problem as I can, and write them down. Then I’m going to think about the benefits and consequences of each solution and write those down.

Solutions Benefits Consequences

Run away from home.

My parents would be really sorry and make-up.

I would miss my brothers and sisters. I would be found and punished. I would be cold and hungry.

Get out of the house and go hang out with my friends.

I would have a good time. I wouldn’t have to hear them fight.

My parents might be angry with me and punish me for going to my friends house.

Go to my room and turn my radio up real loud.

I might get in trouble if I play my radio too loud.

I might not have to hear them fight. I wouldn’t have to go anywhere.

Talk to my Ms. Jansen about how I’m feeling.

I like Ms. Jansen and she might make me feel better.

Ms. Jansen might tell my parents and they’ll be mad at me. Ms. Jansen might be mad at me for bothering her.

Step 4. Now I’ll choose the best solution and try that one first.

__Get out of the house and go hang out with one of my friends.

Step 5. If I try the first solution and it doesn’t work, I’ll try this solution next.

__ Talk to Ms. Jansen about how I’m feeling. ___________

Step 6. Great job!! I want to remember how to solve this problem in the future. I’ll write my plan for solving this problem in the future here.

When my parents are fighting, I’ll go hang out with one of my friends and if I can’t hang out with one of my friends I’ll go to my room and listen to music. ____

Michael A. Tompkins, Ph.D. • 5435 College Avenue, Suite 100-2 • Oakland, CA 94618-1590

510.652.4455 x12 (tel) • 510.380.2988 • (fax) [email protected] (email)

Youth Handout

Ways to Feel Better Right Now

Instructions: Below is a list of ways children help themselves feel better when they are feeling stressed, upset, or scared.

Circle the ones you like the best and will use when you want to feel better right now. On lines, 23-25, write your own ways

to feel better right now.

1. Stop whatever you are doing, close your eyes, and take 10 slow, deep breaths.

2. Visualize your “safe place.”

3. Go to a quiet room and read a good book.

4. Listen to your favorite music.

5. Pray, meditate, or focus on your special relaxation phrase.

6. Listen to, watch, or read something funny.

7. Go outside and take a walk in a safe area.

8. Run in place for 5 minutes.

9. Call a friend.

10. Talk to a parent or other adult who understands and listens.

11. Write in your journal.

12. Volunteer.

13. Sing aloud.

14. Dance.

15. Tell yourself that things will get better.

16. Take a warm bath.

17. Make something with your hands – knit, sew, crochet woodwork, paint, and build a model.

18. Tell yourself five good things about yourself.

19. Talk about your feelings.

20. Tell someone you love him or her.

21. Play with your pet.

22. Do something to help someone else.

23.

_______________________________________________________________________________________ .

24.

_______________________________________________________________________________________ .

25.

_______________________________________________________________________________________ .

Adapted from Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and

adolescents. New York: Guilford Press.

Cognitive Conceptualization Diagram

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