认知行为疗法工作手册

CBTWORKSHEETPACKET

2020EDITION

JudithS.Beck,PhD

President,BeckInstituteforCognitiveBehaviorTherapy

ClinicalAssociateProfessorofPsychologyinPsychiatry,UniversityofPennsylvania

©JSBeck,PhD,1993,2012,2017Revised2020,JSBeck,PhD

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Introduction

Thepurchasersofthiscopyrightedworksheetpacketareherebygrantedpermissiontoreproducethroughphotocopyingtheactual(blank)formsfortheirownpersonalusewithclients.Torequestpermissionforanyotheruse,pleaseemailinfo@.

AmoredetaileddescriptionandfurtherexamplesofeachworksheetcanbefoundinBeck,J.S.CognitiveBehaviorTherapy:BasicsandBeyond,3rded.(2020),andBeck,J.S.CognitiveTherapyforChallengingProblems(2005).Asnotedinthesebooks,thedecisiontouseanygivenworksheetisbasedonthe

therapist’sconceptualizationoftheclient.Theworksheetsareinappropriateforsomeclients,especiallythosewhoarenotintellectuallyequippedtounderstandthem,whobecomeeasilyconfused,whodonotreadorwritewell,orwhohaveanaversiontofillingoutforms.Inreality,manyexperiencedcognitivetherapistsdonotusetheseformsastheyarepresentedhere;theyadaptthemtomeettheneedsoftheirindividualclients.

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TableofContents

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TraditionalCognitiveConceptualizationDiagram 3

Strength-BasedCognitiveConceptualizationDiagram 7

CaseWrite-Up 11

GraphforObjectiveScores 23

ActivityChart&PleasureandMasteryRatingScale 26

GradedTaskAssignment 33

IdentifyingThoughts 36

QuestionstoIdentifyAutomaticThoughts 38

ThoughtRecords 40

TestingYourThoughts 44

Advantage/DisadvantageAnalysis 48

ProblemSolving 51

CoreBeliefsAbouttheSelf 54

BeliefChange 57

PreparingforaTherapySession 60

SessionNotes 62

FeedbackForm 67

Self-TherapySession 69

GuidetoBoosterSessions 71

CBTResources 73

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(TRADITIONAL)COGNITIVECONCEPTUALIZATIONDIAGRAM

Instructions

The(Traditional)CognitiveConceptualizationDiagramallowsyoutoextractagreatdealofinformationaboutclients’mostcentralbeliefsandkeybehavioralpatterns;ithelpsyouunderstandtheconnectionsbetweenclients’childhoodexperiences,thedevelopmentofcorebeliefsabouttheself,worldandfuture,andthewaysinwhichclientscopewithandcompensatefortheirfixed,global,negativebeliefs.

Youshouldbegincompletingthecognitiveconceptualizationdiagrambetweensessionsassoonasyou

havecollectedpertinentdata.Thediagramisbasedonspecificinformationthatclientsprovide.Therefore,whenyoumakehypotheses,youshouldindicateso(withaquestionmark,forexample)andregardyour

hypothesesastentativeuntildirectlyconfirmedbytheclient.

Generally,itisbesttostartmidwaydownthepage,recordingproblematicsituationsthatarequitetypicalfortheclient.(Itisimportanttonotethatthreesituationsareinsufficienttounderstandthecomplexityofsomeclients.Youshouldaddadditionalboxesacrossthebottomofthediagram,particularlywhenclientshaveseveralcorebeliefs.)Choosesituationsinwhichclientsdisplayapatternofunhelpfulhebaviorortheclients’automaticthoughtsshowcommonthemes.Ifthereismorethanonetheme,makesureyouincludeasituationthatreflectsit.Ascertainingthemeaningofclients’automaticthoughtsacrossrepresentative

situationsshouldleadtohypothesesabouttheircorebeliefs.Usingthequestionsonthenextpage,youcanfillintherestofthediagram.

Thisdiagramisdesignedtohelpyouconceptualizeclients;itistooconfusingformostclients.Youcan,however,drawsimplifiedversionsofit.Insomecases,itmaybeappropriatetopresenttheclientwithablankdiagramtocompletewithyou.Again,itisgenerallybesttofoldthediagraminhalfandstartwiththelowerportion.Developingthediagramwithclientshelpsthemtounderstandwhytheyreact(oftendysfunctionally)incharacteristicwaysacrosssituations.

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(TRADITIONAL)COGNITIVECONCEPTUALIZATIONDIAGRAMQUESTIONS

SITUATION#1

Whatwastheproblematic

situation?

SITUATION#3

AUTOMATICTHOUGHT(S)

Whatwentthroughthe

client’smind?

AUTOMATICTHOUGHT(S)

MEANINGOFA.T.

Whatdidtheautomaticthoughtmeantothem?

MEANINGOFA.T.

EMOTION

Whatemotionwasassociatedwiththeautomaticthought?

EMOTION

BEHAVIOR

Whatdidtheclientdothen?

BEHAVIOR

Name:Date:Diagnosis:

RELEVANTLIFEHISTORYandPRECIPITANTS

Whichexperiencescontributedtothedevelopmentandmaintenanceofthecorebelief(s)?

COREBELIEF(S)(duringcurrentepisode)

Whataretheclient’smostcentraldysfunctionalbeliefsaboutthemself?

INTERMEDIATEBELIEFS:ASSUMPTIONS/ATTITUDES/RULES(duringcurrentepisode)

Whichassumptions,rulesandbeliefshelpthemcopewiththecorebelief?

COPINGSTRATEGIES(duringcurrentepisode)

Whichpatternsofdysfunctionalbehaviorsdotheyusetocopewiththebelief(s)?

SITUATION#2

AUTOMATICTHOUGHT(S)

MEANINGOFA.T.

EMOTION

BEHAVIOR

©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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(TRADITIONAL)COGNITIVECONCEPTUALIZATIONDIAGRAMEXAMPLE

SITUATION#1

Thinkingaboutbills

SITUATION#3

Memoryofbeingcriticizedbyboss

AUTOMATICTHOUGHT(S)

WhatifIrunoutofmoney?

AUTOMATICTHOUGHT(S)

Ishouldhavetriedharder.

MEANINGOFA.T.

I’mafailure.

MEANINGOFA.T.

I’mafailure.

EMOTION

Anxious

EMOTION

Sad

BEHAVIOR

Continuestositoncouch;ruminatesabouthisfailures

BEHAVIOR

Ruminatesaboutwhatafailurehewas

Name:Date:Diagnosis:

RELEVANTLIFEHISTORYandPRECIPITANTS

FatherleavesfamilywhenAbeis11yearsold.Heneverseeshimagain.Momis

overburdened,criticizeswhenhecan’tmeetherunrealisticexpectations.Precipitantstocurrentdisorder:Abestrugglesandthenloseshisjobandundergoesdivorce.

COREBELIEF(S)(duringcurrentepisode)

I’mincompetent/afailure.

INTERMEDIATEBELIEFS:ASSUMPTIONS/ATTITUDES/RULES(duringcurrentepisode)

It’simportanttoberesponsible,competent,reliableandhelpful.It’simportanttoworkhardandbeproductive.

DuringDepression:

(1)IfIavoidchallenges,I’llbeokay,butifItrytodohardthingsI’llfail.

(2)IfIavoidaskingforhelp,myincompetencewon’tshowbutifIdoaskforhelp,peoplewillseehowincompetentIam.

COPINGSTRATEGIES(duringcurrentepisode)

Avoidsaskingforhelpandavoidschallenges.

SITUATION#2

Thinkingofaskingsonforhelpinrevisingresume

AUTOMATICTHOUGHT(S)

Ishouldbeabletodothison

myown.

MEANINGOFA.T.

I’mafailure.

EMOTION

Sad

BEHAVIOR

Avoidsaskingsonforhelp

©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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(TRADITIONAL)COGNITIVECONCEPTUALIZATIONDIAGRAMWORKSHEET

Foraclick-and-fillversionofthisworksheet,pleasevisit:/diagram.

SITUATION#1

SITUATION#3

AUTOMATICTHOUGHT(S)

AUTOMATICTHOUGHT(S)

MEANINGOFA.T.

MEANINGOFA.T.

EMOTION

EMOTION

BEHAVIOR

BEHAVIOR

Name:Date:Diagnosis:

RELEVANTLIFEHISTORYandPRECIPITANTS

COREBELIEF(S)(duringcurrentepisode)

INTERMEDIATEBELIEFS:ASSUMPTIONS/ATTITUDES/RULES(duringcurrentepisode)

COPINGSTRATEGIES(duringcurrentepisode)

SITUATION#2

AUTOMATICTHOUGHT(S)

MEANINGOFA.T.

EMOTION

BEHAVIOR

©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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STRENGTH-BASEDCOGNITIVECONCEPTUALIZATIONDIAGRAM

Instructions

TheStrength-BasedCognitiveConceptualizationDiagram(SB-CCD)helpsorganizeclients’patternsofhelpfulcognitionsandbehavior.Itdepicts,amongotherthings,therelationshipamong:

•importantlifeeventsandadaptivecorebeliefs

•adaptivecorebeliefsandthemeaningoftheclient’sautomaticthoughts

•adaptivecorebeliefs,relatedintermediatebeliefsandadaptivecopingstrategies

•situations,adaptiveautomaticthoughtsandadaptivebehaviors.

You’llelicitrelevantdataattheevaluation(e.g.,whenyouaskclientstodescribethebestperiodintheirlife)forthetopofthediagramandadditionaldataforthewholediagramthroughouttreatment.The

SB-CCDistoocomplextopresenttomanyclients.Ifyoudo,showthemablankcopy.Youcanfillitouttogether,choosinghistorical(premorbid)situationsinwhichtheyhadadaptiveautomaticthoughtsandbehaviors,especiallyhowtheyadaptivelydealtwithchallengingsituations.And/oryoucanwaituntiltheclientsarecurrentlyperceivingthemselvesandtheirexperiencesmorerealisticallyandareengaginginhelpfulcopingstrategies.

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STRENGTH-BASEDCOGNITIVECONCEPTUALIZATIONDIAGRAMQUESTIONS

SITUATION#2

SITUATION#3

AUTOMATICTHOUGHT(S)

AUTOMATICTHOUGHT(S)

EMOTIONS

EMOTIONS

BEHAVIOR

BEHAVIOR

Name:Date:

RELEVANTLIFEHISTORY(includingaccomplishments,strengths,personalqualitiesandresourcespriortocurrentdifficulties)

Whatexperiencescontributedtothedevelopmentandmaintenanceoftheadaptivecorebelief(s)?Whathave

theclient’sstrengths,skills,personalandmaterialassets,andpositiverelationshipsbeenlike?Whataretheclient’sskills,strengthsandpositivequalities?Whatinternalandexternalresourcesdoestheclienthave?

ADAPTIVECOREBELIEFS(priortoonsetofcurrentdifficulties)

Whataretheclient’smostcentraladaptivebeliefsaboutthemself?others?theworld?

ADAPTIVEINTERMEDIATEBELIEFS:ASSUMPTIONS,RULES,ATTITUDES(priortoonsetofcurrentdifficulties)

Whatgeneralassumptions,rules,attitudesandvaluesdoestheclienthave?

ADAPTIVEPATTERNSOFBEHAVIOR(priortoonsetofcurrentdifficulties)

Whatadaptivecopingstrategiesandbehaviorsdoestheclientdisplay?

SITUATION#1

Whatwastheproblematic

situation?

AUTOMATICTHOUGHT(S)

Whatwentthroughtheclient’s

mind?

EMOTIONS

Whatemotionswereassociatedwiththeautomaticthought?

BEHAVIOR

Whatdidtheclientdothatwas

helpful?

©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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STRENGTH-BASEDCOGNITIVECONCEPTUALIZATIONDIAGRAMEXAMPLE

SITUATION#2

Fixingneighbor’scar

SITUATION#3

Surfingtheweb

AUTOMATICTHOUGHT(S)

Idon’tknowifIcangetitto

run.

AUTOMATICTHOUGHT(S)

I’dlikeabetterTVbutIhaveto

covermybills.

EMOTIONS

Neutral

EMOTIONS

Milddisappointment

BEHAVIOR

Keepstrying

BEHAVIOR

Doesn’torderTV

Name:Date:

RELEVANTLIFEHISTORY(includingaccomplishments,strengths,personalqualitiesandresourcespriortocurrentdifficulties)

PeopledescribedAbeas“agoodkid.”Somepositiveinteractionswithfamily,maternaluncleandcoaches

growingup.Tookfather’sabandonmentinstride.Triedhardwhengivenage-inappropriateresponsibilitiesat

homeatage11.Goodfriends,averagegrades,above-averageathlete,highschooldiploma.Stronglymotivated,

excellentworkhistory,manyinterpersonalandsupervisoryskills;reliable,productive,responsible.Goodproblem-solver,goodcommonsense.Hadmadeareasonableliving;alwaysbudgetedandsavedmoney.Likeable,a“goodfamilyman;”goodrelationshipswithchildren/grandchildren,acousin,twomalefriends;madeareasonableliving;alwaysbudgetedandsavedmoney.Stronglymotivated,goodsenseofhumor,likedbymostpeople.Seestwo

grownchildrenandfourgrandchildrenoften,helpsthemout,closerelationshipswiththem,acousinandseveralmalefriends.

ADAPTIVECOREBELIEFS(priortoonsetofcurrentdifficulties)

I’mresponsible,considerate,competent,self-reliant,helpful,agoodperson,likeable,resourceful.Mostpeople

areneutralorbenign.Theworldispotentiallyunpredictablebutrelativelysafeandstable.Icancope(ifbadthings

happen).

ADAPTIVEINTERMEDIATEBELIEFS:ASSUMPTIONS,RULES,ATTITUDES(priortoonsetofcurrentdifficulties)

Family,workandcommunityareimportant.It’simportanttoworkhard,beproductive,self-reliant,responsible,

andreliable,honorcommitments,considerothers’feelings,dotherightthing;dowhatIsayI’mgoingtodo.I

shouldfigurethingsoutformyself.IfIpersistonadifficulttask,I’llprobablysucceed.IfIperformhighly,itmeans

I’mcompetent;I’mokay.

ADAPTIVEPATTERNSOFBEHAVIOR(priortoonsetofcurrentdifficulties)

Setshighstandardsforhimself,workshard,triestoincreasehiscompetence,perseveresandsolvesproblemshimself;

iskindandconsideratetoothers,honorshiscommitments,doeswhatheseesas“therightthing,”helpsothers.

SITUATION#1

Thinkingaboutmeetingbuddiesforbreakfast

AUTOMATICTHOUGHT(S)

I’mreallytiredbutIdon’twant

todisappointthem.

EMOTIONS

Neutral

BEHAVIOR

Goestobreakfast

©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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STRENGTH-BASEDCOGNITIVECONCEPTUALIZATIONDIAGRAMWORKSHEET

SITUATION#2

SITUATION#3

AUTOMATICTHOUGHT(S)

AUTOMATICTHOUGHT(S)

EMOTIONS

EMOTIONS

BEHAVIOR

BEHAVIOR

Name:Date:

RELEVANTLIFEHISTORY(includingaccomplishments,strengths,personalqualitiesandresourcespriortocurrentdifficulties)

ADAPTIVECOREBELIEFS(priortoonsetofcurrentdifficulties)

ADAPTIVEINTERMEDIATEBELIEFS:ASSUMPTIONS,RULES,ATTITUDES(priortoonsetofcurrentdifficulties)

ADAPTIVEPATTERNSOFBEHAVIOR(priortoonsetofcurrentdifficulties)

SITUATION#1

AUTOMATICTHOUGHT(S)

EMOTIONS

BEHAVIOR

©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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CASEWRITE-UPEXAMPLE

TheCaseWrite-Upisaconceptualizationtooldesignedtohelpyouformulatecases.Itisnotdesignedforclientuse.

PARTONE:INTAKEINFORMATION

IDENTIFYINGINFORMATIONATINTAKE:Age:56

GenderIdentityandSexualOrientation:Male,heterosexualCulturalHeritage:AmericanwithEuropeanheritage

Religious/SpiritualOrientation:BelongstotheUnitarianChurch;wasnotattendingchurchatintakeLivingEnvironment:Smallapartmentinlargecity,livesalone

EmploymentStatus:Unemployed

SocioeconomicStatus:Middleclass

CHIEFCOMPLAINT,MAJORSYMPTOMS,MENTALSTATUS,ANDDIAGNOSIS:

ChiefComplaint:Abesoughttreatmentforseveredepressivesymptomsandmoderateanxiety.MajorSymptoms

Emotional:Feelingsofdepression,anxiety,pessimismandsomeguilt;lackofpleasureandinterest

Cognitive:Troublemakingdecisions,troubleconcentrating

Behavioral:Avoidance(notcleaningupathome,lookingforajobordoingerrands),socialisolation(stoppedgoingtochurch,spentlesstimewithfamily,stoppedseeingfriends)

Physiological:Heavinessinbody,significantfatigue,lowlibido,difficultyrelaxing,decreasedappetite

MentalStatus:Abeappearedtobequitedepressed.Hisclothesweresomewhatwrinkled;hedidn’tstandorsitupstraightandmadelittleeyecontactanddidn’tsmilethroughouttheevaluation.Hismovementswerealittleslow.Hisspeechwasnormal.Heshowedlittleaffectotherthan

depression.Histhoughtprocesswasintact.Hissensorium,cognition,insightandjudgmentwerewithinnormallimits.Hewasabletofullyparticipateintreatment.

Diagnosis(fromtheDiagnosticandStatisticalManualorInternationalClassificationofDisease):

MajorDepressiveDisorder,singleepisode,severe,withanxiousdistress.NopersonalitydisorderbutmildOCPDfeatures.

CURRENTPSYCHIATRICMEDICATIONS,ADHERENCEANDSIDEEFFECTS;CONCURRENT

TREATMENT:Abewasnottakingpsychiatricmedicationandwasnotreceivinganytreatmentforhisdepression.

CURRENTSIGNIFICANTRELATIONSHIPS:AlthoughAbehadwithdrawnsomewhatfromhisfamily,his

relationshipwithhistwogrownchildrenandfourschool-agegrandchildrenweregood.He©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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sometimesvisitedthemorattendedhisgrandchildren’ssportingevents.Hehadagreatdealof

conflictwithhisex-wifeandhehadcompletelywithdrawnfromhistwomalefriends.Hewas

relativelyclosetoonecousinandlesssotoonebrother.Hesawandspoketohisotherbrotherandhismotherinfrequentlyanddidn’tfeelclosetothem.

PARTTWO:HISTORICALINFORMATION

BESTLIFETIMEFUNCTIONING(INCLUDINGSTRENGTHS,ASSETSANDRESOURCES):Abewasathis

bestwhenhefinishedhighschool,gotajob,andmovedintoanapartmentwithafriend.Thisperiodlastedforaboutsixyears.Hedidwellonthejob,gotalongwellwithhissupervisorandco-workers,socializedoftenwithgoodfriends,exercisedandkepthimselfingoodshape,andstartedsaving

moneyforthefuture.Hewasagoodproblem-solver,resourcefulandresilient.Hewasrespectfultoothersandpleasanttobearound,oftenhelpingfamilyandfriendswithoutbeingasked.Hewashard-working,bothatworkandaroundthehouse.Hesawhimselfascompetent,incontrol,reliableandresponsible.Heviewedothersandhisworldasbasicallybenign.Hisfutureseemedbrighttohim.Healsofunctionedhighlyafterthistime,thoughhehadmorestressinhislifeafterhemarriedandhadchildren.

HISTORYOFPRESENTILLNESS:Abedevelopeddepressiveandanxioussymptoms2½yearsago.Hissymptomsgraduallyworsenedandturnedintoamajordepressiveepisodeabout2yearsago.Sincethattime,symptomsofdepressionandanxietyhaveremainedconsistentlyelevatedwithoutany

periodsofremission.

HISTORYOFPSYCHIATRIC,PSYCHOLOGICALORSUBSTANCEUSEPROBLEMSANDIMPACTON

FUNCTIONING:Abebecamequiteanxiousabout2½yearsagowhenhissupervisorchanged

hisjobresponsibilitiesandprovidedhimwithinadequatetraining.Hebegantoperceivehimself

asfailingonthejobandbecamedepressed.Hisdepressionincreasedsignificantlywhenhelost

hisjobsixmonthslater.Hewithdrewintohimselfandstoppedmanyactivities:helpingaroundthehouse,doingyardworkanderrands,seeinghisfriends.Hiswifethenbecamehighlycriticalandhisdepressionbecamesevere.Hehadnothadanyproblemswithalcoholorothersubstances.

HISTORYOFPSYCHIATRIC,PSYCHOLOGICALORSUBSTANCEABUSETREATMENT,TYPE,LEVEL

OFCAREANDRESPONSE:Abeandhiswifehadthreejointoutpatientmaritalcounselingsessionswithasocialworkerabout2yearsago;Abereporteditdidnothelp.Hereportednootherprevioustreatment.

PERSONAL,SOCIAL,EDUCATIONALANDVOCATIONALHISTORY:Abewastheoldestofthreesons.HisfatherabandonedthefamilywhenAbewaselevenyearsold,andheneversawhisfatheragain.Hismotherthendevelopedunrealisticallyhighexpectationsforhim,criticizinghimseverelyfornotconsistentlygettinghisyoungerbrotherstodohomeworkandfornotcleaninguptheirapartment

whileshewasatwork.Hehadsomeconflictwithhisyoungerbrotherswhodidn’tlikehim“bossing”©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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themaround.Abealwayshadafewgoodfriendsatschoolorintheneighborhood.Afterhisfatherleft,hedevelopedacloserrelationshipwithhismaternaluncleandlaterwithseveralofhiscoaches.Abewasanaveragestudentandaverygoodathlete.Hishighestlevelofeducationwasahigh

schooldiploma.Abestartedworkingintheconstructionindustryinhighschoolandhadjustafewjobsintheindustrybetweengraduationandwhenhebecamedepressed.Heworkedhiswayupincustomerserviceuntilhebecameasupervisor.Hegotalongwellwithhisbosses,supervisorsandco-workersandhadalwaysreceivedexcellentevaluationsuntilhismostrecentsupervisor.

MEDICALHISTORYANDLIMITATIONS:Abehadafewsports-relatedinjuriesinhighschoolbut

nothingmajor.Hishealthwasrelativelygood,exceptformoderatelyhighbloodpressure,whichhedevelopedinhislateforties.Hedidn’thaveanyphysicallimitations.

CURRENTNON-PSYCHIATRICMEDICATIONS,TREATMENT,ADHERENCEANDSIDEEFFECTS:AbewastakingVasotec,10mg,2xperdaywithfulladherencetotreathighbloodpressure.Hehadnosignificantsideeffects.Hewasnotreceivinganyothertreatment.

PARTTHREE:THECOGNITIVECONCEPTUALIZATIONDIAGRAM

Seepage5ofthisworksheetpacket.

PARTFOUR:THECASECONCEPTUALIZATIONSUMMARY

HISTORYOFCURRENTILLNESS,PRECIPITANTSANDLIFESTRESSORS:ThefirstoccurrenceofAbe’s

psychiatricsymptomsbegan2½yearsagowhenAbebegantodisplaymilddepressiveandanxioussymptoms.Theprecipitantwasdifficultyatwork;hisnewsupervisorhadsignificantlychangedhisjobresponsibilities,andAbeexperiencedgreatdifficultyinperforminghisjobcompetently.Hebegantowithdrawfromotherpeople,includinghiswife,andstartedspendingmuchofthetimewhenhewashomesittingonthecouch.Hissymptomssteadilyworsenedandincreasedverysignificantlywhen

helosthisjobandhiswifedivorcedhim,abouttwoyearsago.Hisfunctioningsteadilydeclined

afterthat.Atintake,hewasspendingmostofhistimesittingonthecouch,watchingtelevision,andsurfingtheweb.

MAINTAININGFACTORS:Highlynegativeinterpretationsofhisexperience,attentionalbias(noticingeverythinghewasn’tdoingorwasn’tdoingwell),lackofstructureinhisday,continuing

unemployment,avoidanceandinactivity,socialwithdrawal,tendencytostayinhisapartmentandnotgoout,increasedself-criticism,deteriorationofproblem-solvingskills,negativememories,

ruminationoverperceivedcurrentandpastfailures,andworryaboutthefuture.

VALUESANDASPIRATIONS:Family,autonomyandproductivitywereveryimportanttoAbe.Heaspiredtorebuildhislife,torecapturehissenseofcompetenceandabilitytogetthingsdone,togetbackto

work,tobecomefinanciallystable,tore-engageinactivitieshehadabandonedandtogivebackto©2018.AdaptedfromJ.Beck(2020)CognitiveBehaviorTherapy:BasicsandBeyond,3rdedition.

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others.

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NARRATIVESUMMARY,INCORPORATINGHISTORICALINFORMATION,PRECIPITANTS,MAINTAININGFACTORSANDCOGNITIVECONCEPTUALIZATIONDIAGRAMINFORMATION:Formostofhis

life,Abedemonstratedmanystrengths,positivequalitiesandinternalresources.Formanyyears

hehadhadasuccessfulworkhistory,marriageandfamily.Hehadalwaysaspiredtobeagood

person,someonewhowascompetentandreliableandhelpfultoothers.Hevaluedhardwork

andcommitment.Hisstronglyheldvaluesledtoadaptivebehavioralpatternsofholdinghigh,but

realistic,expectationsforhimself,workinghard,solvinghisproblemsindependentlyandbeing

responsible.Hiscorrespondingintermediatebeliefswere,“IfIhavehighexpectationsandworkhard,I’llbeokay.Ishouldsolveproblemsmyself.Ishouldberesponsible.”Hiscorebeliefsabouttheself

werethathewasreasonablyeffectiveandcompetent,likeableandworthwhile.Hesawotherpeopleandhisworldasbasicallyneutralorbenign.Hisautomaticthoughts,forthemostpart,wererealisticandadaptive.

ButthemeaningAbeputtocertainadversechildhoodexperiencesmadehimvulnerable

tohavinghisnegativebeliefsactivatedlaterinlife.HisfatherleftthefamilypermanentlywhenAbe

was11yearsold,whichledhimtobelievethathisworldwasatleastsomewhatunpredictable.His

mothercriticizedhimforfailingtoreachherunreasonablyhighexpectations.Notrealizingher

standardswereunreasonable,Abebegantoseehimselfasnotfullycompetent.Butthesetwobeliefsweren’trocksolid.Abebelievedthatmuchofhisworldwasstillrelativelypredictableandthathewascompetentinotherways,especiallyinsports.

Asanadult,whenAbebegantostruggleonthejob,hebecameanxious,fearingthat

hewouldn’tbeabletoliveuptohisdeeplyheldvaluesofbeingresponsible,competent,and

productive.Theanxietyledtoworry,whichcauseddifficultiesinconcentrationandproblem-solving,andhisworksuffered.Hestartedtoviewhimselfandhisexperiencesinahighlynegativewayand

developedsymptomsofdepression.Hiscorebeliefofincompetence/failurebecameactivatedandhebegantoseehimselfassomewhathelplessandoutofcontrol.Hisnegativeassumptions

surfaced:“IfItrytodohardthings,I’llfail.”“IfIaskforhelp,peoplewillseehowincompetentI

am.”So,hebegantoengageindysfunctionalcopingstrategies,prima