Practice Skills for Coping With Automatic Thoughts

The counselor and client practice self-talk:

C: Let’s practice self-talking in response to concerns about quitting. We’ll choose a general

concern about quitting to work on. Then you’ll do two things:

1. State the concern in your own words, using an “I” statement.

2. After stating the concern, follow it with a challenging statement. Again, use the pronoun “I” when making a challenging statement, and say it forcefully.

The counselor illustrates how to self-talk by focusing on a particular automatic thought that might trigger marijuana use (e.g., I guess I wasn’t as dependent on marijuana as I thought). The counselor states that thought and follows it with a challenging statement:

C: 1. Automatic thought. Quitting marijuana was easier than I thought. I must not have been dependent on it in the first place.

2. Challenge. I must be crazy. What am I saying? Quitting hasn’t been easy. I had the urge tosmoke all the time until the last few days. If I weren’t dependent on it, I could have quit long ago. I’m just missing the feeling of being high and starting to talk myself out of quitting. I think I’ll do something else.

When conducting the demonstration, the counselor makes eye contact, speaks clearly and confidently, and repeats the demonstration if necessary. After the counselor gives a few demonstrations, the client practices using any concerns he or she has. Other examples of automatic thoughts include I’m not feeling that much better now that I’ve quit or I bet I can smoke once in a while.

It is important to support the client’s phrasing of the automatic thoughts and the challenges. The counselor encourages the client to be specific (What do you mean by “No one cares whether I smoke or not?”), deliver responses as if the situation were real, and use the first person. If the client gives an unsatisfactory response, the counselor specifies the problem (e.g., not the first person, not specific in the challenge, not said in a forceful tone) and asks the client to try again. The counselor gives constructive feedback and avoids judgments or disapproval.

The following factors contribute to the client’s ability to formulate a positive response although not all need to be present all the time:

• Acknowledgment of negative or ambivalent feelings

• Reminder of the positive side (e.g., motivation and commitment, long-term positive outcomes, enhanced self-esteem, improved health)

• Specific positive alternatives

• Humor

• Absence of self-condemnation

• Self-reinforcement or self-appreciation.

Miguel (M): Sometimes, I just want to smoke. It’s easy to forget why I wanted to quit.

C: It gets easier with experience. You are changing a habit that was formed over many years and are finding it difficult at times. People need to remind themselves of how hard that can be. Let’s go over the skills that may help you and see whether you think they will work.