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CBT and Art Therapy: Using Art to Challenge Automatic Negative Thoughts

by Lauren Fallat, LPC LPAT ATR-BC


If you've ever struggled with anxiety, depression, or another mental health issue, you know that negative thoughts can be incredibly powerful and paralyzing. They are what we know as distorted thoughts that pop into our heads without any conscious effort on our part, and they tend to be negative, irrational, and exaggerated. Challenging automatic negative thoughts is essential for managing anxiety and depression. Automatic negative thoughts are often inaccurate and unhelpful thoughts that pop into our heads automatically. They can cause a great deal of distress, and they can interfere with our ability to think clearly and function effectively.


There are many different strategies for challenging automatic negative thoughts. In cognitive behavioral therapy, also known as CBT, the therapist will help the client to identify and dispute the negative thoughts as it is believed that this will then help the way you feel and act. One of the main goals of CBT is to challenge and change unhelpful thoughts that can contribute to anxiety and depression. The therapist may also teach the client behavioral techniques to help them avoid or cope with situations that trigger the negative thoughts.


The first step in challenging automatic negative thoughts is to become aware of them. This can be done by keeping a journal of your thoughts and feelings, or by recording them in a therapy session. Once you are aware of your thoughts, you can begin to challenge them. The second step is to question the evidence for and against your thoughts. Often, our automatic negative thoughts are based on irrational beliefs or assumptions. When you question the evidence for and against your thoughts, you can begin to see that they are not based in reality. The third step is to replace your negative thoughts with more positive ones. This can be done through cognitive restructuring or affirmations.


Art therapy is a form of therapy that uses creative expression as a means of exploring inner thoughts and feelings. Art therapy can be a very effective tool for challenging automatic negative thoughts, as it allows you to externalize your thoughts and feelings in a safe and supportive environment. Let’s explore one type of directive that can be used to navigate the different steps listed above.


For this directive, we will need drawing paper and a pencil and we can add in colors with any additional materials, such as colored pencils or markers. To begin, draw the outline of a human head. This can be a basic oval or the outline can be inspired by a google search of a basic head outline. For the next step, you will want to consider the automatic negative thoughts that may come into your mind. You might find that journaling these thoughts when they happen could be effective or writing down these negative thoughts when discussed in a session, as stated above. Some common automatic negative thoughts include “No one understands me”, “I am not good enough”, “I always fail”, “Why should I even try if I won’t be good at it”, “There must be something wrong with me”, and so on. Begin to write these thoughts down inside the head if they are your own.


If you can recall moments in your life where you were judged or criticized, then you can write those statements on the outside of the head outline. It can also be helpful to write what other people have said to you if you outwardly expressed these thoughts. Consider if people made attempts to console you, challenge you, invalidate you or encourage you when you’ve shared these thoughts.


Once you have written down your internalized thoughts as well as the external words and statements that you have heard over time from different people, you can then take another paper or draw on the back of the original one and create another head outline. This time, instead of writing the automatic negative thoughts inside the head, create thoughts that challenge or reframe (look at in a different and more empowering way) them. For instance, instead of writing “I am not good enough”, consider writing “At times I feel insecure and that is okay. I am consistently growing, learning and becoming exactly who I need to be and that is enough.” Do this for each of your statements and consider the emotions that surface for each one. On the outside of the head outline, you might consider writing statements that a trusted friend or confidant would say as comforting or effective in helping you shift your mindset.


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