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MickyD

Thought Records and Adaptive Thinking for Acne

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I was reading some posts in this forum and wondering if people who feel bad about their acne had tried writing a thought record. It takes about 15 minutes and you might find it helpful. I found it very liberating to write down my feelings and look at them from another angle.

Here is what you do.

Thought Records

Adaptive thinking is about identifying negative thoughts and feelings and recognising them for what they are. If you can take your negative thoughts, write them down and find an answer to each thought, then you can overcome these thoughts and the negative effects they may have on your self esteem.

Throughout the day, you will find yourself having many negative automatic thoughts. You may not even recognise you are having them but they have a severe negative impact on your emotions. These thoughts are automatic and trained in to your brain just like the thoughts and skills involved in learning to ride a bike or drive a car. At first cycling and driving are difficult but after years of practice you no longer need to think so hard as you have trained your brain to perform these tasks automatically.

In relationship to acne you may have automatic thoughts like:

"The person I am talking to is repulsed by me."

"I will never be able to meet anyone."

"My skin will never look good."

"I don't want to deal with people face to face in my job."

These negative thoughts will often involve some kind of avoidance. People avoid things because they make them feel worse or already expect a certain outcome to the situation. However, the avoidance leads to more negative feelings such as depression and anxiety. This leads to a vicious circle of worse and worse emotions. To break the circle, it is important to identify these negative thoughts and become aware of when they happen and what causes them. Then you can learn to think about these things in adaptive ways.

Thought records are designed to allow you identify, slow and restructure negative thoughts. They consist of a table with 5 columns. The headings for the columns are:

  • Time and Situation
  • Automatic Thoughts (what was going through your head?)
  • Mood and Intensity of Mood
  • Thinking Errors (match thoughts from list)
  • Rational Reponse

To start with, think of a distressing incident in the past week. In the first colum, "Time and Situation", write when and where the incident took place, who you were with and what happened. This should be one or two sentences.

In the second column, "Automatic Thoughts", write what you were thinking. What were you saying to yourself about the incident? What did you say to yourself about you, other people and your role in the situation? What did you worry might happen? What is the worst that could have happened? What does this mean about how the other person thinks about you? It is important to write your thoughts here and keep them separated from your feelings.

In the third column, "Mood and Intensity", simply write each of the moods you experienced followed in brackets by how strongly you felt this emotion on a scale of 0-100, where 100 is the most intense. Examples of mood include happy, angry, frustrated, repulsed, anxious, depressed, shocked.

In the column "Thinking Errors", you identify the type of thought you have listed. Each thought may be fall into several catergories so write all those that you feel apply. By identifying the type of thought we can understand why we have these thoughts and can see how they affect our behavoiur and emotions. Remember that not all negative thoughts represent thinking errors but there may be thinking errors associated with a thought even if it is appropriate to the situation.

List of Thinking Errors - from Hope, Heimberg, Juster and Turk (2000)

  • All-or-nothing thinking: You are seeing things in black and white catergories.
  • Overgeneralization: You see a single negative event as part of a never ending pattern.
  • Mental filter: You pick out a single negative detail and dwell on it exclusively, overlooking other positive aspects of the situation.
  • Disqualifying the positive: You reject positive experiences by insisting that they "don't count" for some reason. In this way, you can maintain a negative belief that is contradicted by your everyday experiences.
  • Jumping to conclusions: You make a negative interpretation even though there are no facts that convincingly support your conclusion.

    1. Mind reading: You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out.
    2. Fortune telling: You anticipate that things will turn out badly, and you feel that your prediction is a predetermined fact.
  • Magnification/minimization: You exaggerate the importance of things or inappropriately shrink things until they appear tiny (for example, your own desirable qualities or another's imperfections).
  • Catastrophizing: You attribute extreme and horrible consequences to the outcomes of events.
  • Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, so it must be true."
  • "Should" statements: You try to motivate yourself with "shoulds" and "shouldn'ts" as if you need to be punished before you can be expected to do anything.
  • Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing an error, you attach a negative label to yourself or others.
  • Personalization: You see negative events as indicative of some negative charateristic of yourself or others, or you take responsablility for events that were not your doing.
  • Maladpative thinking: You focus on one thought that may be true but over which you have no control. Excessively focussing on one thought can be a form of self criticism and can distract you from an important task or from attempting new behaviours.

The fifth column, "Rational Reponse", is about correcting the negative thought and finding more helpful thoughts to replace them. In the book this section contains a fairly long story about two little league baseball coaches. Coach A is a bullying nasty coach who tells his players "I can't believe you missed that ball! Miss another like that and you are on the bench!" Coach B is very supportive and says "Well you missed that one but it doesn't matter. Fly balls always look further away than they are." He is supportive and full of advice for the future. This is what you are trying to do. Change yourself from a negative Coach A to being a supportive Coach B when you are thinking. The questions to ask yourself are:

  • What is the evidence that this thought is true?
  • Is there an alternative explantion?
  • What is the worst thing that can happen? Has the situation unreasonably grown in imporatance?
  • What would a good coach say in this situation?
  • Have I done what I can to control it? If I were to do anything else, would this help or hinder the situation?
  • Am I worrying excessively about this?
  • What would a good friend say to me about this situation? What would I say to a good friend about this situation if he were going through it?
  • Why is this statement a thinking error?

Adapted from Safren, Sprich, Perlman and Otto (2005)

I really hope this helps. If you have any trouble with it, feel free to ask in this thread and I will try and help you with it. I think you will find it easiest to take a sheet of paper and turn it on its side to fit the five columns in. I hope you have luck with it, if you try it out. You should consider seting aside time each week or each month to go over the excercise again. I found it worked great for me.

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