Drawing Out Thoughts, Cognitive Distortions and the Six-Column Record

Alison suggests acting on cues such as grimacing during step-ups or tears, naming what you notice and asking what is going through the patient's mind. Repeating "and then what" untangles surface thoughts down to the worst case scenario, which people often then see as unlikely. The thoughts are then examined together, looking for evidence for and against them. Prompts include how likely it is, what happened in the past, what the patient would tell a friend, whether it is fact or opinion and whether the reaction is in proportion. The clinician guides the conversation and adds expert knowledge with permission, but lets patients challenge their own thoughts, since dismissing a belief, for example about scan findings, breaks rapport. Common distortions include all-or-nothing thinking, overgeneralizing, mental filtering, disqualifying positives, jumping to conclusions, catastrophizing, minimizing, emotional reasoning and should or must statements. The six-column record covers the situation, emotions, physical sensations, thoughts and images, evidence for and against, and a more helpful response, with prompts for each column.