previously pleasurable activities, even though it requires an effort and may not immediately feel pleasant. The same
applies to feeling down and low moods more generally.
Another maladaptive way in which people respond to negative moods is to strike out, to react aggressively. This
pattern, like avoidance, is often exacerbated by substance use. Aggression can be reinforced by having the desired
immediate effect. In the long run, however, aggression rather consistently changes the person’s social environment in
ways that make negative emotionality worse rather than better.
In part, the problem here can be the lack of an important coping skill. Deficient social skills, for example, can
impede an individual from developing a reinforcing and supportive network of friends, which in turn decreases resistance
to depression. Social skill deficits can also perpetuate depression in adults. In these cases it is important for the person to
learn a new coping style, a new way of responding that promotes healthier moods and adjustment. If this appears to be the
case, it may be useful to include other CBI skill-building modules in treatment.
Finally, mood and depression are influenced by how the social environment responds to one's behavior. An
environment that provides very little positive reinforcement can foster negative mood and depression. In such situations,
no matter what the person does, very little reinforcement is forthcoming. A prolonged period of this may result in an
attitude of helplessness and pessimism, which itself feeds negative emotionality.
Ironically, some social settings strongly reward an individual for negative mood. Consider a woman with poor
social skills, who consequently has no close friends. Her everyday life is rather uneventful and empty. In time, she
becomes depressed and confides to several people that she is feeling suicidal and very down. Suddenly the church
community, of which she is a member, comes alive for her and rallies around her. The pastor calls regularly. Friends
begin telephoning and dropping in, often bringing food, helping with chores, or even sitting with her through the night.
What had been a largely inattentive group of people becomes, almost overnight, a warm and supportive community.
Amazed, she begins feeling better, and as she does, her friends go back to their previous business, leaving her alone again.
The “sensible” response to these contingencies is to become depressed again.
Change at this level involves rearranging the social environment, as much as possible, to reinforce healthy
behavior instead of unhealthy, disabled behavior. It is not enough just to stop reinforcing depression. Consider again the
woman just described. Suppose her friends had decided to abandon her in sickness and in health! Likely her depression
would not be lessened. Instead she needs to learn better social skills for forming personal and lasting relationships with
others. A key is to establish a social support network that provides ongoing reinforcement for healthy and adaptive
Still another possibility is to try new activities, new sources of potential enjoyment and reinforcement. There is a
tendency for adults to fall into predictable patterns of social and leisure activities. Substance dependence also commonly
involves a steady withdrawal from previously enjoyed people and activities. Some people are reluctant to try new skills
because they might not excel at them; consequently they do only what they are sure they can do well. Such limitations
unnecessarily restrict a person's possibilities. Exploring new activities, just for the fun of it, can lead to new and
rewarding relationships and involvements.
5.6j. Exploring Negative Mood States
Sometimes people have a difficult time naming or describing their own moods directly. They may describe their
thoughts rather than their feelings. For such clients, reflective listening may be fruitful, and you may be able to infer a
mood from the client’s more general description of STORC elements of a particular event. This is often done by
exploring a recent specific situation in which the person felt a negative emotion or mood.
THERAPIST: So – give me an example. When was the last time you felt a strong negative feeling?
CLIENT: Well, yesterday, when I was stuck in traffic, I thought all those people were jerks.
THERAPIST: You were in a traffic jam and you were feeling a strong mood. What name would you give that
CLIENT: I didn’t feel anything in particular; I just thought about what jerks people are, and how I wished I was
anywhere but there. I kind of wanted a drink.
THERAPIST: Interesting! So you’re not sure what to call your feeling, but it was pretty negative. It sounds, even
in your tone of voice right now, like you were a little irritated.
CLIENT: I guess you could call it irritated. And it was more than a little.
THERAPIST: We agree, then, that you got kind of angry in traffic yesterday. And that’s when you felt this urge
CLIENT: I suppose so. It’s strange to think about it that way. I just blamed it on the traffic. At least I didn’t
THERAPIST: What a good example! That’s not unusual, to think that your feeling is the direct result of what’s
happening out there. One of the things we are focusing on here, with this STORC approach, is how the situation
is only one small part of how negative moods happen.
CLIENT: I guess I was more irritated than I realized.
THERAPIST: And now you see it. Good for you! It’s pretty common for people to feel like drinking when they
get into a negative mood like that, and it sounds like for you, feeling angry is a particularly strong one. The point,
though, is that you have a lot to say about your own mood. You can, to a large extent, decide how you feel about
something. And as this experience shows, even if you do get into a negative mood, you don’t have to give in to
the urge to drink that goes with it. . . .
Another option is to use Form gg, which provides a broad list of feeling names. Show your client the list, and ask
which words might best describe how he or she felt in the situation being discussed.
After you have explained the STORC model, the next step is to have your client begin self-monitoring mood states.
Start by having your client complete one column of the mood monitoring sheet (Form hh), based on the most recent time
he or she experienced a negative feeling. In the top (Mood) box, begin with a general mood rating from -10 (very
negative feeling) to +10 (very positive feeling), for the client’s experienced mood level at that time.
Reference: Form gg
The Situation box is fairly easy to complete. First ask the client to describe the situation to you, and then have the
client make a brief note in the S box to indicate the external circumstances.
Sometimes people have initial difficulty with the Thoughts component, because they are unaware of any specific
thoughts that occurred in between the situation and the emotion. If this happens, go on to the O box, and then come back
to T and ask, “What might (or must) you have thought to get from here (S) to here (O)?” Emphasize again that feelings
are not automatic results of the situation, but rather result from thoughts that occur, often so quickly and automatically that
we are unaware of them.
In the O box, have the client fill in specific physical sensations as well as a name for the emotional state. How did
the person feel in this situation? Help the client to distinguish between thoughts and feelings. For example, when a
person says “I felt that ...” it is almost always a thought rather than an emotion (for example, “I felt that I was being
treated unfairly”). Listen for an implicit “that” in the statement: (“I felt I was being treated unfairly” is still the same
statement, and conveys a cognition, a mental interpretation rather than an emotion.) If there is a “that” in there, it’s not
For the R box, ask what the client said or did in response to the situation, thought, and feeling. How did the client
react? Have the client make a brief note about it.
Finally, in the C box, what happened as a result? How did others react, or what changed?
THERAPIST: Okay, now let’s try out keeping a mood diary on these sheets. What will be most helpful is if you
keep a record of times when you have a particularly positive or negative feeling. You don’t have to put every
feeling in the diary, or you could be at it all day, but when there is what seems like a significant feeling -
something especially positive or negative, write it down. As an example, think back to the last time this week
when you experienced a particularly negative feeling. When was that?
CLIENT: (Laughs). Just before I came in here. I had a big fight with one of my kids.
THERAPIST: Okay, fine. Now in this first box, I want just a rating of how good or bad you were feeling. It’s a
rating scale from minus ten (which is feeling about as bad as you can feel) to plus ten (which is feeling on top of
the world, about as good as you can feel). Where would you rate your mood in that situation?
CLIENT: During it? I was so mad I could hardly talk. Minus 8 or 9, maybe.
THERAPIST: So, a very negative feeling - almost as mad as you ever get.
CLIENT: Well, minus seven, maybe.
THERAPIST: Okay, write that down. Now what was going on just before this feeling happened? What was the
CLIENT: Toni, my 18 year-old, showed up with her navel pierced and bleeding. She decided to have one of her
friends pierce it to put in one of those rings. I was so mad.
THERAPIST: So she hadn’t discussed it with you, and just went ahead and did it.
Reference: Form hh
CLIENT: We had discussed it all right, and I had told her “No way.”
THERAPIST: All right. Just make a note in the Situation box there - maybe, “Toni came home with navel ring.”
Now what were you thinking to yourself when you saw her with the ring?
CLIENT: I thought, “How stupid can you be? That’s going to get infected. What were you thinking?”
THERAPIST: What else?
CLIENT: “You did this just to spite me. I told you ‘No,’ and you defied me.”
THERAPIST: Great! Write that in there. . . . . So then come the feelings. Really mad, you said.
CLIENT: Yup. Fried. I felt that I was about at the end of my rope with this kid.
THERAPIST: Put that in there: Really mad. Fried. That’s good! The last thing you said, though, goes up in the
CLIENT: Why is that?
THERAPIST: What you said, I think, is that you felt that you were at the end of your rope. That’s not a feeling
really, though it certainly leads to a feeling. It’s a thought flashing through your mind: “I’ve had it. I can’t do
this much longer.” Something like that, right?
CLIENT: Right, I see what you mean. That’s what I was thinking to myself, but I didn’t say it to her, thank
THERAPIST: Okay – you’re thinking, “I’m at the end of my rope. This kid intentionally disobeyed me, and did
something stupid.” And then you feel fried, angry. So what did you do?
CLIENT: I said something like, “How could you be so stupid? You’re grounded for a month.” I wasn’t thinking.
I couldn’t even see straight, I was so mad.
THERAPIST: Actually you were thinking - says so right there. And what you were thinking got you pretty hot.
CLIENT: Yeah, I see what you mean. Anyhow, I told her she was grounded, and she called me a name and ran
out of the house.
THERAPIST: All right. So in the R box there, just make a little note about what you said. There’s not a lot of
room, so just make it enough to remember what you did. . . . And then in the C box, make a note that Toni yelled
at you and ran out of the house.
CLIENT: Right then - I almost had a drink. I really felt like it.
THERAPIST: That sounds important. Let’s explore that a little, and keep going with this. The consequences -
what happened - become part of a new situation for you, and the process continues. So let’s do the next column.
The situation is that Toni just yelled at you and ran out of the house. That goes up there in the next S box. . . .
And you think to yourself, “I’d really love to have a drink.” What were you actually feeling at that point?
An important quality of discussion like this is that you and your client are standing back and reflecting on the flow of
events involved in feelings. Some of this discussion can even be fairly light-hearted, gaining some distance from what
was a significant emotional event.
Once your client seems comfortable with how to fill in the mood monitoring sheets, give the assignment of
keeping them as a diary between this session and the next, and to bring them back at the next session. (“Would you be
willing this week to keep these as a kind of diary . . . ?”) Give your client a supply of the forms, asking him or her to
complete at least three of them (that is, nine specific events). Make sure that is agreeable, and that the client understands
what you are asking him or her to do. Emphasize that you want the client to record situations in which either positive or
negative emotions occurred. Both are useful.
If time permits, you can continue with the next section, or postpone this until your client returns with completed
mood monitoring forms.
5.6l. Automatic Thoughts
Start this section with a discussion of how certain types of thoughts lead to negative emotions. Ask your client for
examples, to determine the extent to which he or she grasps the idea. Those with experience in AA may link this to the
concept of “Stinking thinking.” Use examples from the mood monitoring sheets to explore how thoughts are linked to
emotions. As your client begins to break his or her negative mood sequences down according to the STORC model, a
pattern of automatic thoughts that are mood magnifiers should emerge. You’re looking for patterns, for themes or
consistencies. These thoughts might be likened to weeds in the garden, with the analogy of plucking them out, one by
one, to allow room for what you want to grow.
Emphasize that emotions are transient - they tend to come and go. For an emotion like anger to persist, it has to
be fueled by thoughts. Going over and over certain thoughts is like putting logs in the fireplace. If you stop feeding the
fire, or pull out the wood, it eventually goes out.
Another important point, strange to some clients, is that we choose how we think about things. This is a crucial
point, because mood management involves changing thought patterns, pulling weeds, pulling fuel out of the fire.
The thought-changing process is a two-step process. First, learn to recognize the automatic thoughts, to catch
them as they go by. Second, learn to replace them with more balancing thoughts. Again, for clients with AA background
this will be familiar territory, though they may not have explored it in quite this way. “Resentment” is a common theme
in AA meetings, and serves as a very good example of how thoughts fuel negative feelings, which in turn can lead toward
As with all task assignments, when you have asked your client to keep mood monitoring records, give this priority
at the beginning of the next session. Ask for the records, lavishly praise the client for keeping them, and take time to go
over them together. Look particularly for consistencies in thought patterns that lead to negative emotions. Consider both
consistencies of content as well as distorted thought processes. Here are some common erroneous thought processes
described by David Burns (1990):
Filtering involves selective attention, looking only at certain elements of a situation while ignoring
Black and white thinking classifies reality into either/or categories without recognizing the many
degrees of difference.
Overgeneralization involves broad conclusions based on limited evidence, such as “making a mountain
out of a mole hill.”
Mind reading makes assumptions about what others are thinking and feeling, what motivated their
Catastrophizing assumes that the worst will happen.
Personalization is the error of seeing every experience as related to your own personal worth.
Blaming is holding other people responsible for your own pain.
Shoulds or Oughts can be rules that are rigid, not flexible enough to take into account human frailties.
Emotional reasoning is when feelings overrun reality-checking: if you feel it, it must be true.
Fallacy of external control is the perception that one has no power or responsibility for what happens in
his or her life.
Fallacy of omnipotent control is the opposite pattern: believing that you control (or are responsible for)
everything. This is another common theme discussed in AA meetings (see Kurtz, 1979).
Don’t bore clients by reciting this list. Rather, the list is meant to help you think clearly about what systematic, automatic
distortions may be occurring. With your client’s collaboration, identify the content or process errors in thinking that lead
to negative emotionality (Burns, 1990).
It would be inconsistent with the overall style of CBI to argue with your client about whether or not the client’s
thoughts and beliefs are correct. Instead, invite your client to consider how else it would be possible to view or interpret
the same situation. The point is not to say “you’re wrong,” but to show how different ways of thinking about things
actually lead to different realities (O, R, and C). No matter the situation, human beings always have the freedom to
choose how to think about and understand them. This, in turn, is the freedom to choose how one feels about life as well.
(For clients with AA experience, explore this in relation to the idea of serenity.)
5.6m. Challenging Toxic Thoughts
This leads naturally to the next step of challenging and finding antidotes to toxic thoughts - trying out new ways
of thinking and being. Once you have identified thought patterns that lead to negative emotions, work together to find
ways to challenge and replace those thoughts. Again, emphasize that this is a matter of choice. The client does not have
to think differently. (In fact, to say so would be to practice a distortion.) Rather your client can choose how to think (T)
about situations (S), and thus have some choice about how to feel (O) and act (R) as well, which in turn influences what
happens (C) in the client’s external world. It is also not your job to prescribe for your client the “correct” or “rational”
thoughts that he or she ought to have. It’s fine to suggest different possible interpretations if your client gets stuck, but
always first invite your client to suggest different ways of looking at things. Again, think of it as developing a menu of
options from which the client chooses.
There are at least two basic ways to intentionally challenge toxic thoughts. One is to think (T) differently - in
essence, talking to yourself. Another is to act (R) differently, to live as if different assumptions are already true. (In AA
this is sometimes described as “fake it till you make it.”). Just as negative moods can be magnified by either thoughts or
actions, they can also be counteracted in the same two ways.
This is where you can use Form ii - the Thought Replacement Worksheet. Often it is best introduced by working
through a specific example or two.
Reference: Form ii
THERAPIST: Okay – you have completed several of these sheets. What we’re going to focus on today is how
your thoughts affect your moods, and what you can do about that. Sound okay?
THERAPIST: Well – let’s see what you have here. (Looks over sheet.) I see that you had some pretty strong
negative moods on this sheet, with some urges to drink.
CLIENT: Yeah – that one night was especially tough.
THERAPIST: And I see some real mood magnifiers here.
CLIENT: I don’t know what you mean.
THERAPIST: Well – close your eyes for a minute, and imagine its Friday night again. You’re sitting in the chair
at home alone, channel surfing. What are you saying to yourself?
CLIENT: Here I am on a Friday night, watching television by myself. What a loser I am!
THERAPIST: A loser - and that kind of says, “It’s just how I am. It will never get better.” Does that sound right?
CLIENT: Uh huh.
THERAPIST: So how are you feeling? Can you feel it now?
CLIENT: Lonely. Depressed . . . discouraged.
THERAPIST: Exactly. If the problem is who you are - if this is something hopeless that can never change, then
of course you feel demoralized. It follows! The thought is a mood magnifier.
CLIENT: I can see that.
THERAPIST: Are you willing to try to pick some weeds here, clean out the garden a little?
CLIENT: How do I get rid of thinking that way?
THERAPIST: Well – let’s look at that thought that things will never get better. How accurate do you think that
is? Are you 100% sure that things will never get better?
CLIENT: Not really – but I do think that there’s a good chance things won’t improve.
THERAPIST: What are the odds you would give yourself, in your head? 50/50? There’s a 50% chance that
things will get better?
CLIENT: No, I’d say there’s a 10% chance that things will improve.
THERAPIST: Now there is a bad mood magnifier! The doctor only gives you a 10% chance of having a life.
You gonna take the doctor’s word for it?
CLIENT: Maybe I should get a second opinion (laughs).
THERAPIST: Yes! A second opinion. That’s good! Choose yourself a better doctor.
CLIENT: It would be nice.
THERAPIST: Your tone of voice sounds a little hesitant.
CLIENT: Yeah – I don’t know about this.
THERAPIST: You’re not too sure you can do this - maybe a 10% chance?
THERAPIST: I agree. It’s not easy. Here - let’s take a look at that thought about things never getting any better.
I’m going to use this new sheet here. (Takes out the Thought Replacement work sheet.)
CLIENT: Okay. How do you want to look at it?
THERAPIST: Well, you said that your mood was really negative on Friday night. How did you feel on Saturday
CLIENT: Okay, I guess. Yeah – I had some stuff to do, and I hadn’t had anything to drink, so I was feeling a little
THERAPIST: So – you were improved the next day?
CLIENT: Well, yeah – somewhat – but I wasn’t totally happy or anything.
THERAPIST: Not perfect – and that’s a point well taken. We’re not looking for total perfection here – we’re just
looking for what moves your mood one way or the other. What if you had drunk on Friday night?
CLIENT: Would have been much worse. Okay – I see where you’re headed with this. I have some choice about
THERAPIST: So let’s try a little mind experiment here. This is your initial thought on Friday night - hopeless -
I’m writing it in the Automatic Thought box. And we know where that one leads - you felt lonely, depressed,
discouraged. I’m writing that in here.
THERAPIST: Now, just use your imagination. What else could you have said to yourself, sitting there at the
television, besides, “I’m a loser, and I’m always going to be a loser.”
CLIENT: Something like, “I may feel miserable right now, as if I was never going to feel better, but chances are I
will feel better tomorrow.”
THERAPIST: All right! That’s a much more balanced thought. Good work! I’m writing that in here, in the
Thought Replacement box. And what do you suppose your feeling would have been if you had said that to
CLIENT: A little more peaceful, maybe.
THERAPIST: Peaceful. Okay. I’ll put that in here. You get the idea?
CLIENT: Uh huh. I think so.
THERAPIST: Okay. Now you try one. Here’s the sheet. Let’s look back at your mood diary for this week and
find another place where you had negative feelings. How about this one. “Upset,” it says. And under Thoughts
you have “Unfair.” What’s the mood magnifier there? . . . .
Thought Replacement Worksheet (Example)
Replacement Thought (Antidote)
I’m a real loser. It’s
never going to change.
I’m always going to be
I’m feeling lonely right
now, but I’ll probably
feel better in the
morning. What else
could I be doing besides
sitting here watching
I’d really like to have a
drink. I’d feel better. If I
don’t have a drink this
feeling is just going to
get stronger and
Wait a minute. I’ve
already tried that. If I
drink now I’ll feel a
whole lot worse. Who
am I kidding?
In the same way, examine what the client does in negative mood situations (R), and how this may
be a mood magnifier. Similarly, explore what else the client could have done instead. As with thought
substitution, the idea is to emphasize choice. Some common examples of behaviors that may serve to
reinforce negative moods are: withdrawing, arguing, sulking, drinking, driving aggressively, smoking,
overeating, and criticizing or blaming.
As before, it is not your job to confront, criticize, or correct your client’s behavior. Instead, invite
the client to consider with you, as a mental experiment, what else she or he could have done, and what
different consequences might have followed. A problem-solving approach works well in this context,
with therapist and the client working together to generate a list of different response options that could
have different effects on moods.
THERAPIST: Now a piece we haven’t talked about yet is how what you do can also be a mood
magnifier. Looking back at your Friday night, you say you were watching TV alone and eating
chips. And doing that, you felt lonely, discouraged, depressed. Now what are some other
possibilities. What else could you have done when you were feeling that way?
Documents you may be interested
Documents you may be interested