From book Emotion Regulation in Psychotherapy - 149

Emotionally Intelligent Thought Record:

The therapist may ask the following questions in session, while referencing the Emotionally Intelligent Thought Record:Step 1: What is going on around you, in your environment, right now? Where are you? Who is with you? What are you doing? What are you noticing in the environment that is affecting you?Step 2: Sometimes our response to something in our environment can be felt in the body, like butterflies in the stomach, for example. Bringing our attention, as best as we can, to these sensations can be helpful. Developing awareness and sensitivity to these experiences can take practice, so if you dont notice anything in particular, just allow yourself that experience, while taking a moment or two to give yourself some time to observe whatever may be present. In this situation, what physical sensations do you notice yourself experiencing in your body? Where in your body do you feel such sensations? What are the qualities of such sensations?Step 3: Labeling our emotions using feeling words can be helpful. What feeling word would best describe and label this emotion that you are feeling in this moment? How intensely would you say you are feeling this emotion? If you were to rate this emotion on a scale of 0100, with 100 being the most intense feeling you could have and 0 being no presence of this feeling at all, what would that rating be?Step 4: What thoughts are going through your mind in this situation? Ask yourself, What is going through my mind right now? What is my mind telling me? What is popping into your head in this situation? What does this situation say about you? What does this situation suggest about your future? As best as you can, notice the flow of thoughts that unfold in your mind in this situation. What are some of the thoughts that are arriving?Step 5: We have learned to try to get rid of, or get away from, things that seem threatening or unpleasant. This makes a lot of sense. But attempts to suppress or eliminate distressing thoughts and feelings sometimes makes them that much stronger. So, for a moment, take this opportunity to learn to stay with your experience, just as it is. Following the flow of your breath in this moment, as much as you can, make space for whatever unfolds before your mind.Step 6: Now that you have noticed, and allowed yourself to more fully experience, the sensations, emotions, and thoughts that have shown up in this situation, how might you best respond in this moment? Adopting a mindful, emotionally intelligent attitude, you can recognize that these thoughts and feelings are events in the mind, and not reality itself. Working with your therapist, you can learn many ways to respond to distressing thoughts and feelings. Here are a few questions to ask yourself that you can practice over the course of the coming week:What are the costs and benefits to me of believing these thoughts? | |How might I act if I really believed this? | |How might I act if I didnt believe this? | |What might I say to a friend who was facing this situation? | |What needs are involved in this event, and how can I best take care of myself now? | |Can I mindfully observe these events in my mind, choose a course of action, and act | |in a way that will serve my aims?

Step 7: Ask yourself the following questions:How can I best pursue my own aims and values in this situation? | |Is there a problem here that I need to solve in order to live my life in a meaningful | | and valued way? How can I interact with others in this situation in an effective way that suits my aims | |and values?Does this situation call for a behavioral response? Does any action need to be | |taken?Is doing nothing an option? | |How can I take care of myself best in this situation? | |

ExampleTherapist: Youve described several situations this past week when your fear of vomit was very troubling. It seemed to be on your mind a lot during your childrens playdates, didnt it?Patient: It really did. A lot of the children at the nursery school have been sick with the flu lately, and I just couldnt stop worrying that one of the kids would come home with a stomach virus. It really freaked me out.Therapist: And if one of them did come home with a stomach virus, what did you fear might happen?Patient: Well, I was afraid they would throw up, of course. Then I would have to deal with it, which would freak me out, and I just dont know if I could handle it.Therapist:I know that this thought, I dont know if I could handle it, has shown up along with a lot of anxiety in the past.Patient:It sure has, but I think its true. What kind of a mother cant deal with her own children throwing up?Therapist:So when this thought shows up, it brings friends and it means business, doesnt it? So now it seems that youre having the thought that you are somehow defective as a mother.Patient:Of course I am! Why would we even be having this discussion if I werent.Therapist:You know, a lot seems to be coming up for you in this very moment, so I would like to use this part of our session as an opportunity to practice a new way of working with these thoughts and feelings.Patient:What do you mean?Therapist:As part of our agenda for the session today, you might remember that we discussed introducing a new self- therapy practice exercise. Why dont we take a look at that self- therapy exercise right now and rehearse it together in this session. Would that be all right?Patient:Sure. I am looking for just about anything to take this feeling away today.Therapist:Well, Im not so sure we are aiming to take any feelings away just now. In fact, part of our work is going to be allowing some of these feelings and thoughts to stay here, in the room, as we work together. Do you remember our earlier mindfulness work?Patient:Yes, sure. Im still practicing the mindfulness of the breath exercise each morning. Just for 15 minutes, though. Are you going to be asking me to just accept these feelings?Therapist:You are right, accepting feelings is part of it, but there is more that we can do. Sometimes acceptance is passive, just letting things take their course. But sometimes acceptance can be very active. It can involve seeing things clearly as they are, while deeply engaging with what matters most to us in our lives.Patient:Yes, I remember that, and its been a little bit helpful when I pick up the kids.Therapist:So, this willingness to feel things more fully hasbeen helpful?Patient:I said a little bit! (laughing) but . . . yeah, it has been helping.Therapist:All right, so here we are, in this office, at 2:00 in the afternoon, and we are discussing your fear of your children vomiting.Patient:Yes, and I hate even thinking about it.Therapist:That makes sense. So, could you briefly describe the situation you are in that is activating these thoughts and fears about vomit, please?Patient:Im sitting with my therapist, and we are talking about my fear of vomit. Its two in the afternoon, and later I will have to pick up my kids from nursery school.Therapist:So, as weve seen, sometimes the first place to look, in order to bring our awareness more fully to our experience, is to check in with what sensations are showing up in the body.Patient:Like in the body scan exercise?Therapist:Like that, yes. This time, though, we are checking in on our experience in real time so that we can train our awareness to really be with our experience in this moment, as we live our lives. So, bringing your attention, as best as you can, to the presence of sensation in the body in this moment, what physical sensations do you notice yourself experiencing in your body?Patient:I feel like my breath is short, like there is pressure on my chest.Therapist:Good. You were able to notice that fairly rapidly. Now, without trying to change or alter that experience, would you be willing to just allow yourself to stay with this feeling of shortness of breath, and this feeling of pressure on your chest, as we proceed with this exercise?

Patient:Yes, I can do that. Its not like its going to go away anyway! (Laughs.)Therapist:(laughing with the patient) Thats a pretty keen observation there. Now, taking a moment to truly make space for and allow this experience, what feeling word would best describe and label this emotion that you are feeling in this moment?Patient:Feeling word? You mean like a name of an emotion?Therapist:Yes, thats it exactly.Patient:Well, then it would be anxiety. This definitely feels like anxiety, or maybe you could also even call this fear.Therapist:Good, you were able to label that experience quite clearly, werent you?