Consistent with the theory underpinning Cognitive Restructuring, DBT proposes that certain styles of unhelpful thinking leave a person cognitively vulnerable to overwhelming emotions.
Several exercises can be tried to help reduce the power of unhelpful thinking styles.
‘Identify Trigger Thoughts’ – also known as Automatic Thoughts, these tend to come into our heads automatically whenever we feel emotionally distressed (e.g. ‘I can’t do anything right’; ‘No ones ever going to love me’). A list of common Trigger Thoughts can be provided to choose from, or clients can formulate their own.
‘Thought and Emotion Defusion’ – this exercise is used to build the skills of “unhooking” from unhelpful thoughts and overwhelming emotions. This is a Mindfulness skill. A variation is offered for the purpose of Emotion Regulation.
Begin the exercise by focusing on one of your Trigger Thoughts. Recall a recent distressing event in which your Trigger Thoughts arose. Notice how you feel emotionally and physically. Then begin the Thought Defusion exercise as usual. Memories, emotions and thoughts from the event will arise. imagine them floating on clouds in the sky or upon leaves in a stream. Do this exercise as often as possible.
‘Use Coping Thoughts’ – These are statements that remind you of your strengths, past successes, and some commonly held truths (e.g. ‘I can think different thoughts if I want to’, I’m strong enough to handle what is happening to me now’, ‘My feelings are like a wave that comes and goes’). Clients are shown a list to choose from, or can create their own.
‘Balancing Your Thoughts and Feelings’ – this technique counters the unhelpful thinking style of ‘filtering’, in which the person systematically fails to consider evidence that is inconsistent with their Trigger Thought. Instruction aimed at understanding the problem of filtering can be provided by exploring some case studies of characters demonstrating pronounced filtering. The supervised practice of the balancing technique essentially involves working with the client to identify and assess the evidence for and against the Trigger Thought. DBT endorses a slightly modified version of the Thought Record Sheet which is a widely used structured worksheet that is used to record: (i) What happened? (ii) As a result, what did you think and feel? (iii) What evidence supports how you think and feel? (iv) What evidence contradicts who you think and feel? (v) What is a more accurate and fair way to think and feel about this situation? (vi) What can you do to cope with this situation in a healthy way?.