Part 9. Thought records.

Cerebral cortex Cognitive behavioural therapy (CBT) assumes that those who are reasonably reasonable most of the time have more pleasant emotional lives. “The wise man is always happy—keeping an eye on his logic,” wrote Cicero, the prefeminist philosopher. Today even the Dalai Lama favours rationality: “My experience is that [mental peace] is obtained mainly through reasoning. Meditation does not help much.”2 In Greco-Roman times you might have recommended charioteer training to your overly emotional patients. The ancients believed that a wild horse represented emotion and that a vigorous charioteer represented rationality (Figure 1). Socrates, Plato, Aristotle, and other early cognitive therapists made people eudemonic (happy) largely by making them more rational. Modern times One of CBT’s tested tools for increasing rationality is called the thought record. There are many styles of thought records with varying complexities; however, in my experience, the return on investment is highest with the 3-column version. The simplest thought record is a pen-and-paper exercise in which patients write down what they’re feeling, what they’re thinking, and the cognitive illusions1 that might be contaminating their thinking. (Table 1 provides examples of thought records.) Although some patients lack the requisite self-awareness and self-help follow-through, many patients can comply and are helped a great deal.