Be careful to choose a thought that is about the young person, as these thoughts tend to be more

powerful and prone to distortions based on young people’s beliefs about themselves, others and
the world. It is not a good idea to try to challenge a thought about another person at this stage (as
we don’t know the whole story), so avoid thoughts such as: ‘Sarah doesn’t like me.’
When you have identified a thought, explain to the young person that you will be looking for
evidence for and against it. Make two columns on a piece of paper, with one side evidence for
and the other side evidence against. Ask the young person to identify all the evidence for the
thought being true by explaining the reasons why they believe that thought to be true. Really try
to stretch the young person to tell you every reason – including such nebulous concepts as having
a ‘feeling’ – as well as their previous experiences linked with the thought. The aim is to get
everything down now to avoid later ‘yes . . . buts’. It is important that this stage is done
thoroughly so that the young person has a chance to say why this thought keeps recurring.
Although they may feel like they are re-experiencing the unwelcome emotion, it can be very
validating to hear it in this way.
In the second column (evidence against), instruct the young person to look for and record any
evidence that challenges their thought. Tell them that they are now thinking of evidence that goes
against the specific thought: for example, the idea that they are ‘useless at everything’. This is
often the hardest part of the exercise and may require more prompting. Ask what alternative
explanations there might be, ask them to think what someone else (who knows the young person)
might suggest as evidence against this thought.
After they have identified all the evidence against, spend some time reading both columns back
to the young person. Ask them what they make of the exercise and what they are thinking now.
Can they re-rate their belief in this thought now? Then ask if they can identify a more balanced
thought or alternative – less negative – interpretation of the same thought based on this exercise.
This is also an opportunity (if they have not done so earlier) to identify which type of thinking
bias(es) this thought might be.
Exercise: The thought record
Download Worksheet 26: The thought record and explain that this is a more advanced version
of the help triangle. It is divided into ten columns, with key symbols for most columns. The
advancement from the help triangle is in the strategy of challenging the NAT, as you have just
done in the previous exercise. After looking at the instructions and Katy’s example, start to fill in
the columns one by one, using the earlier example.
Explain to the young person that the thought record should be used when they next experience
an unpleasant mood or troubling thought. As you fill it in, discuss each column in turn.
• Situation. Where were you? What were you doing? When? With whom?
• Feelings. Use one word to describe each of your feelings at the time. Rate how strong each
was using the feelings scale (0–10).
• Thoughts. Describe any thoughts you noticed going through your mind. Highlight at least
one NAT from the example and write it in the column.
It might be useful to try to elicit further thoughts at this stage by exploring the meaning of the
thought with the young person. You could ask questions such as: ‘If that were true, what does that
mean to you/say about you?’
• Beliefs. Next, ask the young person to rate how much they believe that thought as a
percentage (100 per cent = believe it to be true without any doubt; 0 per cent = believe it is totally
untrue). The young person may describe believing it 100 per cent at the time but now being less
sure (for example, 80 per cent). This is useful information to support the tendency for high
negative emotion at the time to cause us to rationalise less and believe negative thoughts more.
Write down both levels of belief prior to looking at evidence for and against the thought. You can
use the belief scale to record the level of belief and download Worksheet 27: The belief scale).
• Balancing. The next step is for the young person to record evidence that they can see
supports their thoughts. After they have identified all the evidence against, ask them to work on
the steps 6–9.
 • Thinking distortions/bias. Looking back at their NATs, can the young person spot any
thinking biases/exaggerations in their thinking?
• Beliefs again. Now the young person should re-rate the percentage of their belief in each
thought. Have these changed?
• Alternative thoughts. Now that the young person is able to perceive their thought in a more
balanced way, they should try to come up with an alternative – more carefully considered or
balanced – thought.
• Feelings again. Finally, the young person should think about whether their feelings have
changed and record this.
It can sometimes be helpful to imagine someone (such as a best friend, sister or brother) and
think, ‘If they had this problem/thought, what would I say to them about what they were
thinking?’
Download Worksheet 28: Quick reference guide to help with completion of the thought record,
and see Katy’s thought record for an example (Table 6, and download Worksheet 29: Sample
thought record – Katy’s situation).
Download Worksheet 30: Help with challenging yourself.
 End of Session 6
• Homework: the young person should complete the thought record during the forthcoming
week with a real-life example, and have a go at challenging the thought. They can use Worksheet
28: Quick reference guide to help. Explain that thought identification and especially thought-
challenging take time and practice, so this is just a start. You do not expect them to be an expert
immediately: it takes at least two weeks for adults to start to understand the concept. They can
leave some columns blank if the task is becoming too difficult, and л with them during the next
session and try to fill in the gaps. The important thing is to try to identify an example during the
week when they have noticed a surge of emotion, to write down the situation, to break their
response into emotions, thoughts and behaviours, and to have a go at finding evidence for and
against a key NAT.
• Feedback.

HANDOUT FOR THE YOUNG PERSON: SESSION 6

How to break the cycle of thoughts and negative feelings
Sometimes we muddle up thoughts with facts and we might accept them without question. The
expression ‘looking through rose-tinted spectacles’ is used to describe someone who always sees
things in a hopeful or cheerful way, even when they are bad. This is a kind of thought distortion
or bias because it is unrealistic or extreme. The person sees the situation from only one
viewpoint; they do not see the negative aspects.
Thought distortions or thought biases are common and unhelpful ways of thinking.Everyone
makes these distortions, but when they happen regularly they can make you feel bad and affect
your decisions about things and how you behave. A useful strategy is to learn to analyse these
thoughts and challenge them, both to test out if they are true and to help you feel better.
There are many different types of thinking bias, but the five main ones are listed below:
• Black-and-white thinking. Looking at things in an ‘all-or-nothing’ way: for example,
someone who sees things as either wonderful or terrible, total success or complete failure, with
nothing in between.
• Jumping to conclusions. Thinking that you know how someone else thinks or feels (‘mind-
reading’) or thinking that you know what will happen (‘fortune-telling’): for example, not sitting
a test because you ‘know’ you will fail or thinking that someone no longer likes you because they
did not say hello.
• Over-generalising. Blowing things out of proportion. You can often spot these when there
is an ‘always’, ‘never’, ‘everyone’ or ‘no one’ in the thought: for example, getting a bad grade
and thinking, ‘Everyone else is better than me. I am never any good at anything.’
• Should/must/ought. Giving yourself a hard time: ‘I must do better’, ‘I should be better’, ‘I
ought to have known better’. These thoughts are often linked with overgeneralisations: ‘I should
always . . .’, etc.
• Blaming yourself. When you feel responsible for things that are not your fault or that are
beyond your control: ‘My dad left because of my behaviour’, ‘It is my fault that I got beaten up’,
etc.
Thought-challenging
Thinking biases can make us experience some unpleasant feelings, such as sadness, anger, etc.
Sometimes we are so self-critical that we start to accept these thoughts as true facts. Checking out
such thoughts, and challenging them to test whether they are true, can help to stop them going
round and round in our heads. If we don’t challenge them, we can end up feeling worse.
Challenging your thoughts is not just about thinking positively about life; it is about having
balanced thinking, which involves looking for evidence to support and challenge your thoughts.
Completing the thought record
• Situation. Where were you? What were you doing? When? With whom?
 • Feelings. Use one word to describe each of your feelings at the time. Rate how strong each
one is using the feelings scale (0–10).
• Thoughts. Describe any thoughts you noticed going through your mind. Highlight at least
one negative automatic thought (NAT) from the example and write it in the column. If it were
true, what does it mean to you/say about you?
• Beliefs. Rate how much you believe that thought as a percentage (with 100 per cent =
believe it to be true without a doubt and 0 per cent = believe it is totally untrue).
• Balancing. The next step is to write down all the evidence that supports your thought. Then,
look for and record any evidence that goes against the thought.
• Thinking distortions. Look back at your NATs. Can you spot any thinking biases/
exaggerations in the thinking, etc.?
• Beliefs again. Now re-rate the percentage of your belief in each thought. Has it changed?
• Alternative thoughts. Now that you are seeing your thought in a more balanced way, try to
come up with an alternative – more carefully considered or balanced – thought.
• Feelings again. Think about whether your feelings have changed and record this.
It can sometimes help to imagine someone (a best friend, sister or brother) and think, ‘If they
had the same problem/thought, what would I say to them about how they were thinking?’

Session 7
This session continues to focus on Module 11. However, if you find that this does not fill the
session, then Module 12 can be incorporated. Module 12 is the formulation, and it is linked with
the eliciting of core beliefs and rules for living covered in Module 11.

Session 7: Cribsheet for the therapist

• Formulation.
• Core beliefs and rules for living.
Module 12: Beyond the help triangle:
core beliefs and rules for living
Aim
If the young person is more insightful, very depressed or older, with wellestablished patterns of
behaviour and recurring NATs, it can be useful to identify their core beliefs.
Agenda
• Bridge from last session.
• Homework review: thought record. Review this and spend time working on it if the young
person has encountered problems. Encourage them to keep going with this over the next few
weeks.
• Any issues raised by the young person.
• Main session topic.
• Homework plan.
• Feedback.

Main session topic

Explain to the young person that there are three different levels of interpretation when anyone
encounters a situation. First, there are the automatic thoughts (discussed in the last session),
which usually appear as verbal statements (or images) in our heads. The second level includes
‘rules for living’ or conditional assumptions. These are much less obvious than automatic
thoughts and we can figure them out only by looking closely at our actions. Look at Katy’s
example.

CONDITIONAL ASSUMPTIONS: KATY

 ‘A girl in the year above me disagreed with my opinion during the discussion we had after
school. I immediately felt bad and thought, “They don’t like me and they think I’m stupid.”’ In
this case, Katy’s assumption might be either:
• if people disagree with me, then they don’t like me
or
• other people’s opinions are more important than mine.

You can see how these assumptions consist of more than mere statements; they involve beliefs
about how certain situations have meaning to the person. Assumptions often occur as ‘if . . . then’
statements and sound like general rules. This will make more sense later, after core beliefs are
explained.
Ask the young person to hold on to this as a concept but reassure them that you will be
explaining in more detail after focusing on core beliefs – the third and deepest level of cognition.

Core beliefs
Core beliefs are seemingly unquestionable opinions about ourselves, others or the world.
Explain to the young person that when we are growing up, we develop these beliefs on the basis
of both our actual experiences and our perception of our experiences. Greenberger and Padesky
refer to the theory that young babies start to make sense of their world by organising their
experiences into familiar patterns.(1) These patterns that develop, which are seen as rules and
beliefs about the world around them, are not necessarily reflections of the ‘true’ environment but
instead the consequence of an underdeveloped mental ability in the young child that is rather rigid
and inflexible. As we grow up, most of the ‘rules’ we have developed during our childhood
become more fluid and flexible as we see exceptions and alternative explanations. However,
some of our childhood beliefs stay absolute even into adulthood.
When we think the same thoughts about ourselves over and over again, and repetitively judge
what we do, those thoughts and beliefs grow stronger and more fixed. As well as this, when early
life experiences recur or are extremely traumatic, we can become convinced that this will
continue to happen. This perception can start to rule our lives because the thoughts are often
extremely negative and become too strong and plausible to challenge.
The second reinforcer of such beliefs is the information-processing bias that follows. In other
words, any new evidence that contradicts the beliefs tends to be ignored or dismissed as
unimportant and untrue, as it does not fit with our perception of reality; essentially, it is filtered
out.
Core beliefs tend not to be in our heads all the time (or ever). Rather, they seem to be held
below consciousness and manifest only occasionally as short, brief statements: for example, ‘I am
lovable’ or ‘I am worthless’. If beliefs are negative – for example, ‘I’m a failure’ – they often
make you feel bad and can filter the way you see the world. If a person thinks that negative things
are going to happen because of a flaw in them, then this can set them up to fail. A good example
is if someone believes that no one will ever love them (they feel unlovable), they may reject any
signs of affection from parents, friends or boy/girlfriends and feel that none of these people really
cares, or that they have an ulterior motive for expressing affection. This might stop people from
showing affection, and the belief that the person is unlovable will be strengthened.
Part of the information-processing bias is that anything that supports the negative core belief,
however trivial, is seized upon as ‘proof’ of its veracity. As well as this, because core beliefs help
us to make sense of our world at a young age, it may never occur to us to evaluate whether there
are more useful ways to understand our current experiences. Instead, as adolescents (and into
adulthood), a person might act, think and feel as if these beliefs are 100 per cent true.

CASSIE’S CORE BELIEFS

• Everything I do must be perfect.
• I always get things wrong – I’m a failure.
 • I’m unlovable.

Exercise: Core beliefs

Look at Cassie’s core beliefs and ask the young person which dangers/ difficulties she might
experience by holding on to them. (For example, by believing that everything she does must be
perfect, she might avoid trying new things because of a fear of failure; or she might judge herself
harshly whenever she doesn’t obtain a top grade at school.)