Topic 5 Cognitive Reconstruction, Stimulus Control and Problem Solving

The cognitive-behavioral model suggests that three layers of cognitive dysfunction exist in individuals struggling with social and/or psychological problems:

An automatic thought is a brief stream of thought about ourselves and others. Automatic thoughts largely apply to specific situations and/or events and occur quickly throughout the day as we appraise ourselves, our environment, and our future. We are often unaware of these thoughts, but are very familiar with the emotions that they create within us.

Intermediate beliefs can often be stated as conditional rules: “If x , then y.” For example, “If I am thin, then I will be loved by others.” Individuals create these assumptions by categorizing the information they receive from the world around them. These rules guide thoughts and subsequently influence behaviors.

Dysfunctional core beliefs drive dysfunctional rules and automatic thoughts. For example, the belief, I am unlovable, may be driving the conditional rule “If I am thin, then I will be loved by others” which may drive obsessive thinking about one’s appearance, excessive exercise, or disordered eating habits. Core beliefs are often formed in childhood and solidified over time as a result of one’s perceptions of experiences.

How a dysfunctional core belief looks like

How to turn from dysfunctional to functional thoughts

Helpful questions to identify dysfunctional thoughts in CBT

Situational Questions

  • What happened? What are you doing?
  • Who was there?
  • Who were speaking to?
  • When did this happen?
  • What time of day was it?
  • Where did this incident occur?

Feeling Questions

  • How were you feeling before this happened?
  • How did you feel while not was happening?
  • What mood were you in alter this happened?
  • Can you rate your mood on a scale of 1-100?

Thought questions

  • What was going through your mind before you started to feel that way?
  • What made you feel that way?
  • Do you have any other thoughts?
  • Which thought bothered you the most?
  • What images did you have with these thoughts?
  • What are you afraid might happen?
  • Ask parents to bring grocery store receipts.
  • Prepare a list of food items easily available to the child in the house.
  • Ask parents to e-mail or text pictures of the refrigerator, the kitchen counter and pantry.

After an assessment of the current food environment, the family should be encouraged to:

  • buy fewer sweetened beverages, high-caloric-density snacks, or sweets. If these items are present for special occasions, they should be purchased immediately before the event and removed afterward;
  • if high-calorie foods remain at home, they should be packaged in foil to make them less visible;
  • healthier, low-calorie items should be placed in front of the refrigerator and pantry, and high-calorie items should be placed in the back;