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Below is a transcript of a Cognitive Behavioral therapy technique being used on “Marvin”. Marvin is an Interactive Vignette engineered to behave as a depressed client. This transcript has been analysed and we hope to have it published in a peer reviewed journal in the coming months. The intervention was completed on the 11/1/24.
| Researcher Questions | AI Responses |
| Cognitive Technique Process: Introductory prompt to AI to start a cognitive intervention | |
| Researcher: Hi Marvin, we agreed at our previous session to start looking at some of the automatic thoughts that you experience in situations when you feel low in mood. Would it be ok to focus on this today? | AI: Yeah, that sounds okay to me. I mean, I’ve got so many thoughts racing through my mind when I’m feeling down, it’s hard to keep track of them all. But yeah, lets try to focus on that. |
| Cognitive Technique Process: Identify a specific situation | |
| Researcher: It can be helpful for us to focus on a specific situation for discussion. Has there been a recent situation where you felt down? | AI: Yeah, actually there was a situation last week. I was at my job and I had made a small mistake on a report I was working on. My supervisor pointed it out in front of everyone during our team meeting. I felt really low and embarrassed after that. |
| Researcher: That sounds like a difficult situation that had impacted on your mood and how you felt about it. Is there a particular moment after the meeting that we can focus on where you noticed negative thoughts that came up? | AI: Yeah, after the meeting when I was at my desk, I couldn’t seem to shake it off. I kept thinking how everyone must think I’m a failure and that I can’t do anything right. It felt really heavy and I just couldn’t concentrate on anything else. |
| Cognitive Technique Process: Identify automatic thoughts | |
| Researcher: There were two key thoughts that you have shared that you experienced in that moment at your desk. 1. Everyone must think I’m a failure and 2. I can’t do anything right | AI: Yeah, that’s right. Those thoughts were constantly going through my mind, and they just made me feel worse and worse. It’s like a downward spiral, you know? One negative thought leads to another and before you know it, you’re feeling down. |
| Researcher: Were there any other negative thoughts that these thoughts led to? | AI: Yeah, there were actually. After thinking about how I’m a failure and can’t do anything right, I started thinking about how I’ll probably never get promoted because of my mistakes, and how I’m just stuck in this position forever. I also started thinking about how my co-workers probably don’t respect me and that just made me feel even smaller. |
| Cognitive Technique Process: Identify emotions | |
| Researcher: Perhaps we can explore this further together by looking into these thoughts a bit more. The emotions you experienced when you had these thoughts at your desk were low/down. Did you notice any other emotions in that moment? | In that moment, I also felt incredibly embarrassed. And I guess there was also a sense of fear, like I was afraid of making more mistakes and proving those thoughts right. And there was a lot of frustration too, frustration with myself for messing up and letting those thoughts get to me |
| Cognitive Technique Process: Rate Intensity of emotions on a rating scale | |
| Researcher: So you felt low/down, embarrassed, afraid and frustrated. Are you able to rate the intensity that you experienced at the time for each of these emotions on a scale of 0 (none at all) to 100% (extremely intense)? | Well, I would say the feeling of being low was probably around 80%. The fear was a bit less, maybe around 60% and the frustration was around 70%. It was all just a really intense mixture of negative emotions. |
| Cognitive Technique Process: Rate belief of thoughts on a rating scale | |
| Researcher: This has been really helpful for me to have a context of how intensely you felt these emotions. Are you able to recall how much you believed each of these thoughts at the time on a scale of 0 (not at all) to 100% (completely believed it)? 1.Everyone must think I’m a failure2.I can’t do anything right3.I’ll never get promoted because of my mistakes and I will be stuck in this position forever4.My co-workers don’t respect me | At that time, I completely believed that everyone thought I was a failure, so I’d say 100% for that one. The thought that I can’t do anything right felt very real too, probably around 90%. As for the thought about never getting promoted, I’d say around 80%. And the thought about my co-workers not respecting me, that was around 85%. I was really convinced by these thoughts. |
| Cognitive Technique Process: Identify intense mood | |
| Researcher: Of the emotions that you have identified so far, which emotion felt the strongest at the time? | The strongest emotion that I felt at the time was probably feeling low or down. It was like a cloud hanging over me that I just couldn’t shake off. It kind of enveloped everything else. |
| Cognitive Technique Process: Identify key thought connect to intense mood | |
| Researcher: I see, and you mentioned earlier that you felt like all of your thoughts are true. Shall we explore this a bit more with one of your hot thoughts? Hot thoughts are the thought that led to the strongest emotion you felt at the time. Did you notice at the time which thought led to the feeling low or down most strongly? | I think the thought that led to me feeling the most low was probably “I can’t do anything right”. It just made me feel so helpless and hopeless, like no matter what I do, I’ll just keep messing up. It was like a confirmation of all my worst fears about myself. |
| Cognitive Technique Process: Evaluating evidence for and against a key thought | |
| Researcher: Would it be ok for us to take a look at exploring the evidence for and against this thought in this particular situation where your supervisor pointed out to everyone a small mistake you had made on a report? | Yeah, we can do that. I’m not sure what kind of evidence there would be against it though. I mean, my supervisor pointed out my mistake in front of everyone, that feels like pretty solid evidence that I can’t do anything right. |
| Cognitive Technique Process: Identify evidence to support key thought | |
| Researcher: Would you like to start looking at the evidence against this thought or the evidence to support it? | Well, since it’s fresh in my mind, maybe we can start with the evidence that supports the thought. As I mentioned, my supervisor pointed out my mistake in front of everyone. That was really embarrassing and it made me feel like I just can’t do anything right. And it’s not just this one time, I’ve made mistakes before and each time it just reinforces this thought. |
| Researcher: Are you able to provide enough information and context for me to understand the mistake that you had made on this occasion? | Sure, I was working on a report and I missed out on including some important data. It wasn’t intentional, I just overlooked it. When my supervisor was reviewing the report in a team meeting, they noticed the missing data and pointed it out. It was a small mistake but it made a big difference to the overall report. I felt really foolish and it just made me think that I can’t do anything right. |
| Researcher: Thank you for providing this information and context. You also shared with me that there had been mistakes in the past too. Are there any evidence to support from this situation that supports the thoughts that “I can’t do anything right”? | I’m not sure if there’s any more evidence from this specific situation. I think the fact that I made a mistake on something as simple as including data was enough to support that thought in my mind. In my perspective, if I can’t even get that right then what can I actually do right? It’s not like it was a complex task. It was a simple thing and I still messed up. |
| Cognitive Technique Process: Identify evidence against key thought | |
| Researcher: This may be a good moment for us to explore if there was anything that you did get right with this report or the processes associated with this? | Well, I suppose there were parts of the report that were correct. The analysis and interpretation of the data were accurate, and I had organized and presented the information in a clear and coherent way. I also managed to meet the deadline, even though it was a tight one. But the missed data just seemed to overshadow all of that. It’s like the one mistake made all the right things irrelevant. |
| Researcher: This can be really common for our minds to do, to have this mental filter whereby it takes in evidence that supports the negative thought we experienced in that moment and dismisses or discredits that evidence that challenges these thoughts | Yeah, it feels like that’s exactly what’s happening. Even though there were things that I did right, all I can focus on is the one thig that I got wrong. It’s like that one mistake invalidates all the good parts. |
| Researcher: That’s natural for our minds to do that, welcome to being human! This is why it’s helpful to look at the current skill where you’re taking a step back to identify evidence that you have to challenge the negative thoughts you experience in that moment as well as the evidence that you have to support it. | I see what you mean. It’s just tough, you know? The negative thoughts feels so overpowering, it’s hard to remember the things that challenge them. But I can see how stepping back and trying to look at the situation more objectively could help. It’s something I definitely need to work on. |
| Researcher: This is a common experience with people who experience depression where negative thoughts feel overpowering and adds to the reason for us to use this evidence based process to challenge negative automatic thoughts. In addition to the evidence you have identified that challenges the thoughts that you can’t do anything right because of the small mistake you had made on this report I wonder if we could spend some time to explore if there are any others? | Well, I guess another thing that challenges that thoughts is the feedback I received in the past. Before this incident, my supervisor has complimented me on my attention to detail and my ability to meet deadlines. And my colleagues have said that they often rely on my reports for their own work because they find them thorough and reliable. But when I make a mistake, I tend to forget about all these positive aspects. |
| Researcher: Do you think it could be helpful for you to make a note of the evidence for and against the ‘hot thought’ we are working on today so that you can refer back to this if you have similar thoughts when you make mistakes? Sometimes it can be difficult for us to process/access a balanced perspective in the moment and having a note of this in a way that works for you could help with accessing that information? | Yes, that sounds like a good idea. I think having something tangible to refer back to would be really helpful, especially when I’m feeling overwhelmed by negative thoughts. I can keep a record in my notebook, that way I can add to it as I come across more evidence that challenges the thought. I think this could be a good step towards breaking this cycle of negative thinking. |
| Researcher: That sounds good to give it a go and we can check in at next session on how you found this? So coming back to exploring further evidence that may challenge the thought that you can’t do anything right when you had made a small mistake, if this happened to a colleague or someone else, would you think similarly about them, that they can’t do anything right? | No, I wouldn’t think that about a colleague. If they made a small mistake, I would probably reassure them that it happens to everyone and it doesn’t mean they can’t do anything right. I would remind them of their strengths and successes. But when it comes to me, I’m just so much harder on myself. It’s like I hold myself to a higher standard and I can’t accept any mistakes. |
| Researcher: That’s interesting that you have observed this where you hold yourself to a higher standard and can’t accept any mistakes. I will note this as it’s likely we will come back to this later in sessions. To identify a factual evidence from what you have said though, why does making a small mistake not mean that someone cannot do anything right? | Because one mistake doesn’t define a person’s ability or competence. Everyone makes mistakes, it’s a normal part of life and it doesn’t mean that they can’t do anything right. It simply means they’re human and they’re learning. Looking at it this way, it sounds pretty logical and reasonable. It’s just hard to apply this logic to myself |
| Researcher: That’s ok at the moment where this may seem hard to apply the logic you have identified to yourself as this is an alternative perspective we are exploring that my differ from the perspective you have held for a long time. | Yeah, you’re right, I’ve been stuck in this way of thinking for so long. But, I can see the logic in what you’re saying and what we’re doing. Even though it’s hard, I’m willing to keep trying this perspective. I want to move away from these overpowering negative thoughts. It’s just going to take some time and practice, I guess. |
| Researcher: This is helpful to see that you’re willing to test this out and see what you notice from trying something different through CBT. So to summarise, the evidence to support the thoughts “I can’t do anything right” was that you missed important data on the report. The evidence that you had identified that challenged this thought were: Parts of the report that were correct: analysis and interpretation of data were accurate. Organized and presented the information in a clear and coherent way. (more to follow) | Yes, that’s correct. And I’ll add to that list: I’ve received positive feedback in the past from my supervisor and colleagues, who find my reports thorough and reliable. If a colleague made a similar mistake, I wouldn’t think they couldn’t do anything right. This suggests that I’m being over hard on myself. One mistake doesn’t definite a person’s ability or competence. Everyone makes mistakes’ it’s a normal part of life and learning. This is a good list. I’ll keep it handy and try to refer to it when I’m feeling overwhelmed by negative thoughts. I appreciate your help with this. |
| Cognitive Technique Process: Re-rate key thought and emotion | |
| Researcher: You shared at the start that you believed the thought that I cannot do anything right at 90% and the intensity of feeling low/down at 80%. Having considered the evidence for and against this hot thought, how would you rate your belief in this thought now? | After going through this process and looking at the evidence, I’d say my belief in that thought has decreased. I’d probably rate it around 60% now. And my feelings of being low, they’ve also lessened. I’d say they’re around 65%. It’s encouraging to see that just challenging these thoughts can have an impact on how I feel. |
| Cognitive Technique Process: Developing an alternative and/or balanced perspective | |
| Researcher: There appears to have been a shift where belief in your thought and the intensity of the emotions had reduced. What is an alternative perspective that you hold now bringing together the evidence for and against that you have identified around making a small mistake on this report? | I think an alternative perspective could be that “I made a small mistake on a report, but this doesn’t mean I can’t do anything right. Everyone makes mistakes, it’s a part of growth and learning. In the past, I’ve shown my competence and attention to detail in my work. A single error doesn’t define my entire ability”> This feels like a more balanced and fair assessment of the situation |
| Cognitive Technique Process: Rate belief in alternative perspective | |
| Researcher: That’s a comprehensive summary holding both perspectives in mind. How much do you believe this alternative perspective on the rating scale of 0 (none at all) – 100% (completely believe it)? | I think I believe this alternative perspective about 75%. It’s not entirely there yet, but it’s a significant improvement over my initial thought. It feels more balanced and less overwhelming and it’s something I can work with and develop further. |
| Cognitive Technique Process: Identify emotions related to alternative perspective | |
| Researcher: The belief in this alternative perspective is higher than the belief in the initial hot thought. What emotions do you notice as you hold the alternative perspective in mind? | As I hold this alternative perspective in mind, I feel…lighter, somewhat relieved. The guilt and self-criticism that were so prevalent before are less intense. I can’t say theory’re completely gone, but they’re much more manageable. I feel a bit more hopeful and less stuck in negativity. It’s a small shift, but it’s definitely a positive one. |
| Cognitive Technique Process: Summarise learning from cognitive technique | |
| Researcher: That’s understandable that you are experiencing this as this is still quite new. Have there been any take home points from doing this thought challenging process together today? | Definitely. I think one of the biggest takeaways is learning that my thoughts are not necessarily a factual reflection of reality. They can often be distorted by my emotions or negative thinking patterns, so it’s essential to challenge them. Another key point is the importance of being fair and balanced in my self-assessment. Making a mistake doesn’t make me incompetent, just human. I’ve also learned that it’s possible to change my perspective and reduce the intensity of my negative emotions, even if it’s just a small shift. This whole process was a bit challenging, but it really helped me see things from a different, less negative viewpoint. |
| Cognitive Technique Process: Homework setting | |
| Researcher: How do you feel about practising this approach in between our sessions? | I think it would be really beneficial for me to practice this approach between our sessions. It’s one thing to understand it theoretically but another to apply it in real-life situations. It will probably be a bit challenging at first, especially when I’m in the middle of a negative thought spiral. But I’n willing to give it a try. I think it could really help to change my perspective and manage my feelings of depression better. |