Cognitive Therapy

The variety of techniques for eliciting thoughts and feelings during the session is very large and we can do little more than highlight one or two aspects in this summary. Direct questioning is one approach, and we have illustrated this in talking of the way in which a therapist attempts to engage the patient at the beginning of therapy. The above descriptions also illustrate another approach: using times when the patient appears upset to ask what went through their mind just then. This was a technique that Salkovskis used at the beginning of the therapy session he describes. But a technique which emerges very clearly in some of the case descriptions in this book is the introduction of behavioural experiments within the session to simulate real-life circumstances. For example, Greenberg uses the hyperventilation technique to examine the patient's thoughts and feelings about their own bodily symptoms. After hyperventilation for two minutes the patient reported discomfort: sweating, drowsiness, stinging, apprehension. He also reported the fear that he was going to faint. This in turn reminds him of the feeling that he gets outside the therapeutic situation in which he finds himself asking the question, 'Can I get help?' or 'I'm all alone here, could I get to…?' and 'If I died what would happen?' and 'Well, who would care?'

In Channon and Wardle's description of their patient with an eating disorder (Chapter 6), they demonstrate the use of a behavioural experiment (eating a small piece of chocolate) to elicit automatic dysfunctional thoughts. The patient was asked to list her thoughts at four stages: (1) before the food is presented; (2) in the presence of food, before eating; (3) during eating, and (4) after eating. The statements that