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    Re:Affect resistant treatment
    JustBen · 01/30/04 at 10:46 ET

    I have an idea that may help you identify the problem, and it involves working with hot cognitions (i.e., those occuring in-session). Given the nature of this problem, you really need to dig into the nitty-gritty of things with as much precision as possible, and memories of things that happened during the week may be too vague.

    Stage 1
    When the client experiences a problem affect in-session:

  • Have her record the emotion and the level of intensity (say, from 1-100%)
  • Have her identify the causal thought
  • Immediately record her level of belief in that thought (using another 1-100% scale)
  • Instruct her to challenge the validity of that thought
  • Measure her level of belief in the original causal thought
  • Measure the intensity of her problem emotion again
    Note: Do not have the client develop an adaptive response until after you've completed every step in this stage.

    Step 2
    The next time the client experiences a problem affect in-session:

  • Have her record the emotion and the level of intensity
  • Have her identify the causal thought
  • Immediately record her level of belief in that thought
  • Instruct her to challenge the validity of that thought
  • This time, have her develop an adaptive response at this point
  • Measure her level of belief in the original causal thought
  • Measure the intensity of her problem emotion again

    The Rationale
    In the first stage, we're able to get some idea of just how well the client is able to challenge her thoughts. If her level of belief in the causal thought doesn't change - or doesn't change much - then we know that she's having trouble challenging the thought.

    In the second stage, we get a better idea of how skilled the client is at developing adaptive thoughts. If her belief level in the original causal thought drops, for example, but her affect stays the same, then the problem may lie in the adaptive thought she's developed.

    If neither of these stages reveals anything of substance (i.e., they point to neither an inability to challenge causal thoughts effectively nor a tendency to create inadequate adaptive thoughts) then it seems likely that you're still dealing with the wrong thoughts somehow. I realize this is a little confusing, so if you have any questions please fire away. Also, I've not yet used this technique, so comments from other professionals would be most useful.

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