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When Automatic Thoughts Are True: Choosing An Apprioriate Strategy

Jessica Greil-Burkhart

Created on February 3, 2026

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Transcript

When Automatic Thoughts Are True: Choosing An Apprioriate Strategy

The thought appears to be true. What now?

start

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Problem Solve

This is a problem-solving moment. When a threat or concern is realistic and action is possible, CBT shifts from restructuring to planning. • Generating options • Weighing pros and cons • Coping ahead • Action planning • Resource use

Go back and try "no" to see the next steps

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Meaning-Making

Even when a thought is true, the belief attached to it may be distorted or incomplete. • Examining conclusions about self, future, or world • Cognitive continuums • Identifying core beliefs • Revising rigid rules or assumptions Example beliefs to target: “This means I’m a failure” “This will never get better” “I can’t handle this”

Go back and try "no" to see the next steps

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Acceptance & Values

This is not a disputation problem. Continued debating will likely increase suffering. • Acceptance of reality • Reducing struggle with what cannot be changed • Values clarification • Acting in meaningful ways despite discomfort

Go back and try "no" to see the next steps

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Emotional Regulation & Coping Skills

When distress is too high, cognitive work will not stick. Regulation comes first. • Grounding • Distress tolerance • Self-soothing • Mindfulness • DBT skills

Go back and try "no" to see the next steps

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Practice, Rehearsal, and Behavioral Follow Through

When thoughts are true and insight is present, change requires repetition and real-world practice. Clinical focus: • Coping cards • Behavioral experiments • Daily routines • Anchoring skills to triggers • Troubleshooting thoughts about practice itself Examples of homework-blocking thoughts: “I’ll do this wrong” “This will take too much time” “If I think about this, I’ll feel worse”

Go back and try "no" to see the next steps

Reassess the Target

If the client has insight, is practicing, and the situation is accurate, yet distress or impairment persists, this is a signal to pause and reassess what level of intervention is needed. At this point, the issue is often not the automatic thought itself. Common possibilities include: • A deeper schema driving repeated activation • An avoidance pattern maintaining distress • Environmental or systemic barriers • Comorbid issues (trauma, substance use, medical factors) • Mismatch between intervention and clinical need

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Key Takeaway

When automatic thoughts are true, effective clinicians choose between: • Problem solving • Meaning-making • Acceptance and values • Emotion regulation • Practice and rehearsal The skill is knowing which one fits the moment. Continue with the Learning Lab

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