The process of cognitive therapy: The first dysfunctional thought changes less than the last one

An observant cognitive therapy patient reported that the first dysfunctional thought elicited and treated in homework sessions was more resistant to change than later distorted thoughts. To determine whether this was due to the fact that this thought was elicited first, or to the fact that it was treated first, systematic data were collected from 9 patients in 48 sessions of cognitive therapy. In half of these sessions, dysfunctional thoughts were treated in the order they were elicited; in half of the sessions, they were treated in the reverse order. Results showed that the first dysfunctional thought elicited changed least; there was no effect of order of treatment. Several possible explanations of this finding are offered.