Abnormal Psychology

Foundations of Treatment 127

Leon, for example, has irrational, dysfunctional thoughts about being evaluated,

and he expects to feel embarrassed and humiliated. Thus, he avoids interacting with

others. His thoughts and beliefs lead to his avoidant behaviors—and his thoughts,

beliefs, and behaviors, in turn, lead to his depression. With cognitive therapy, Leon

would have an opportunity to reassess whether his automatic thoughts and beliefs

are realistic and, if not, learn to substitute more realistic ones that will make social

interactions less anxiety-provoking. Leon should then be more likely to participate

in social situations, which in turn may reduce his depression. In general, then, cog-

nitive therapy promotes more rational and realistic thoughts and beliefs, which in

turn alter the patient’s behavior, which should then lead the symptoms to subside.

Avoidance: Even

though I want

some, I don’t

get coffee

from cafeteria.

Avoidance: Problem

arises at work and I

should talk to a

colleague about it

but I don’t – I avoid

it. I send an email

instead even though

that will take longer

to resolve problem.

Avoidance and

social isolation.

9 am

Time of day Problematic

behavior

Context: Where the behavior

occurred

10:15 am

noon

Sitting at desk at work,

hard to fully wake up.

Checking over some

documents at work.

Eat my lunch at my

desk rather than

eat with others.

Wanted coffee, but worried

that someone else will be

in the food area and I'll

feel uncomfortable

around them. Then started

to feel depressed and

hopeless about my

situation and my life.

Realized that a coworker

made a mistake, but the

thought of talking to her

made me anxious. Sad

and angry that I can’t

make this phone call.

Thought about eating

with others, but became

anxious about their

looking at me or talking

to me. Then felt very sad

about my life.

What event triggered the behavior

(thoughts, feelings, interactions

with others)?

Name: LeonLeon Day: MondayMonday Date: Oct 10Oct 10

Figure 4.2

4.2 • A Daily Self-Monitoring Log Leon’s self-monitoring log (from a time when he worked the day shift)

suggests that his depressed and hopeless feelings follow the anxiety he experiences after simply thinking about

possible social interactions, which he then avoids. Treatment might focus on his social anxiety and avoidance at the

outset; as those lessen, so should his depression.