Keeping a Tally in CBT

Copyright © Donald Robertson, 2011.  All rights reserved.

Sometimes, especially at the beginning of therapy, it can be useful to keep a tally or count of certain things in cognitive-behavioural therapy (CBT) as part of a process of self-monitoring and awareness training.  For example,

1. Affect, or feelings, might be counted by keeping tally of every time you become either angry, depressed, or anxious, etc.
2. Behaviour might be counted, e.g., the number of times you bite your fingernails, apologise, frown, etc.
3. Cognitions, or thoughts and images, might be counted, e.g., the number of times you worry about something bad happening or criticise yourself, etc.

Normally you would pick a specific type of thought, feeling, or action to keep a tally of, usually for at least 1-2 weeks.  When you try to spot and count every single occurrence you will also tend to find that you become more aware of the “early warning signs” and therefore more able to “nip habits in the bud” by catching thoughts, actions, or feelings and preventing them or making them less “automatic”.  Occurrences can be counted by keeping a simple written set of tally marks in your diary or notebook (usually four vertical lines with a stroke through on every fifth count) or by using a mechanical or electronic counter such as those used by doormen, golfers, or knitters.

Another benefit of keeping a count is that you may realise that you engage in the habit more frequently or less frequently than you assumed, which may be a significant insight.  There’s a common tendency for habits to reduce when self-monitored in this way, which may also be helpful in therapy.  Moreover, you may spot previously overlooked patterns in your behaviour and increase your awareness of the triggers, i.e., the events, people, times or places, in response to to which the habit tends to occur.  It will also naturally lead on to self-monitoring and recording more detailed information on the relationship between trigger events and your thoughts, actions and feelings, etc.  Hence, keeping a tally of negative thoughts has sometimes been used as a precursor to maintaining standard automatic thought records in cognitive therapy.  Keeping a count may also give you a simple way to measure your progress in treatment and you might make it an explicit aim to reduce the frequency of certain habits, e.g., “compulsively apologising” or having self-critical thoughts, by a certain date.

Another, slightly more demanding, way of using tallies as a form of self-monitoring involves keep count of two different things at the same time.  For example, someone who is depressed might keep a tally of how often they experience self-critical thoughts but also record the frequency of self-praise.  This can highlight where the use of self-criticism greatly outweighs the use of self-praise as way of thinking and might be seen as overuse of the “stick” approach and not enough use of the metaphorical “carrot”.  It can lead to useful cognitive therapy questions such as whether this ratio of criticism versus praise would be felt appropriate toward people you care about, or children, for instance.

Overall, this has proven to be a very simple and convenient way of monitoring and changing behaviour, which can also be used in preparation for a wide number of other therapy techniques.