Negative Automatic Thoughts Research Articles

Treatment of Misophonia with Cognitive Behaviour Therapy: A Case Report

IntroductionMisophonia is a condition characterized by extreme emotional reactions, such as irritation or anger, triggered by specific sounds. Despite its prevalence, there is a lack of evidence-based treatment methods for misophonia.Objectives This case report aims to explore the effectiveness of combining psychoeducation with Cognitive Behavioral Therapy (CBT) in the treatment of a misophonic patient. The focus is on reducing the patient’s emotional distress and improving their quality of life.Methods The patient is a 28-year-old woman employed as a salesperson in a busy city. Mouth smacking, gum chewing and clock ticking are the sounds that bother her the most. She has never used any medications or attempted any methods to alleviate her misophonia. Neither she, nor her family has a history of a psychiatric disorder.The therapeutic intervention spanned eight sessions, each lasting around half an hour. The first two sessions, a patient history was taken and Mısophonia Interview Scale (MIS) was conducted. MIS comprised the Misophonia Checklist (MCL), which involved reading fifty misophonic sounds to the patient one by one. She then rated her discomfort in response to each sound on a four-point Likert-type scale. From the MCL responses, a total severity score (Misophonia Total Score - MTS), was calculated. The treatment commenced with a psychoeducational component focused on enhancing the patient’s comprehension of misophonia. This phase aimed to elucidate the neurobiological underpinnings of the condition, common triggers, and the emotional reactions associated with it. Then, CBT was employed to identify and challenge the patient’s negative automatic thoughts (NATs) linked to her misophonia. Three sessions primarily concentrated on identifying and managing NATs associated with her misophonia. These sessions equipped the patient with the skills to recognize and confront NATs through structured discussions and practical assignments.The last three sessions centered on exposure therapy, with the goal of reducing emotional and physiological responses to triggers. Homework assignments during this phase encouraged the patient to independently practice exposure exercises.Results The initial MTS was 54, indicating significant distress. After the interventions, the final MTS decreased to 35 and the impact of misophonic symptoms on her life decreased from severe to moderate.Conclusions Misophonia is a challenging disorder to treat due to its limited evidence-based interventions. This case report demonstrates that a combination of psychoeducation and CBT methods may hold promise in managing misophonic symptoms. However, it is essential to acknowledge the need for further research in this area, as misophonia’s treatment strategies require more robust empirical support. This case highlights the potential benefits of psychoeducation and CBT, emphasizing the need to explore and develop effective treatments for this debilitating condition.Disclosure of InterestNone Declared

Assessment of preoperative anxiety and negative automatic thoughts in patients waiting for corneal transplantation

Introduction and aim. In patients waiting for organ transplantation, increased waiting time can increase anxiety by creating negative automatic thoughts. The aim of this study is to examine the relationship between corneal transplant recipients’ negative automatic thoughts and anxiety before organ transplantation. Material and methods. The population of this correlational descriptive study consisted of 108 patients waiting for cornea transplantation in the Eye Bank unit of a hospital in the south east region of Türkiye. The data were obtained from the patients presented to the ophthalmology clinic for transplantation between September and December 2022. A patient information form, the Negative Automatic Thoughts Scale, and the Trait Anxiety Scale were used to collect the data. Percentage distribution, arithmetic mean, logistic regression and correlation analysis were used in the data analysis. Results. It was determined that the mean score of the negative automatic thoughts of the transplant patients participating in the study was 100.69±47.83, and the trait anxiety mean score was 53.06±6.07. There was a positive relationship between neg ative automatic thoughts and trait anxiety at a moderate level, which was statistically significant (p<0.05, r=0.53). Conclusion. It was determined in the study that the patients’ negative automatic thoughts and trait anxiety were high, and their anxiety increased as the negative automatic thoughts increased.

The Effect of Mindfulness-based Psychoeducation on Negative Automatic Thoughts and Medication Adherence in Individuals with Cannabis Use Disorder: a Randomized Controlled Trial

AbstractThe aim of this study is to evaluate the effect of mindfulness-based psychoeducation on negative automatic thoughts and medication adherence in individuals with cannabis use disorder. The randomized controlled study was conducted between September 2021 and December 2022 in the psychiatry clinic of a university hospital in Turkey. The sample size of the study consisted of 60 individuals (30 experimental groups, 30 control groups). Descriptive Characteristics Form, Negative Automatic Thoughts Questionnaire, and Morisky Medication Adherence Scale were used to collect data. In the study, while eight sessions of mindfulness-based psychoeducation were given to the experimental group, no intervention was applied to the control group. Experimental group posttest negative automatic thoughts and medication adherence scale total mean scores were found to be statistically significant (p < 0.05). It was determined that the posttest negative automatic thoughts scale total score mean in the experimental group decreased compared to the control group, and the medication adherence scale total score mean increased compared to the control group. It was determined that mindfulness-based psychoeducation given to individuals with cannabis use disorder was effective in negative automatic thoughts and adherence to treatment.

The Effects of an Internet-based Cognitive Behavioral Therapy Program on Depression in Thai High School Students: A Quasiexperimental Study

Adolescents with depression often experience negative automatic thoughts, which contribute to the development of suicidal ideation. Internet-based cognitive behavioral therapy has now become a treatment to address negative automatic thoughts to prevent suicide. This quasi-experimental study aimed to assess the effects of an Internet-based Cognitive Behavioral Therapy Program on the depression of Thai adolescents. The participants consisted of 60 adolescent students with a deviation from their usual mood who were enrolled in public high schools in a province adjacent to Bangkok. The participants were conveniently selected, paired based on gender and grade point average, and randomly assigned into two groups. The experimental group received the program, while the control group received usual care (n = 30 each). Data collection instruments included a personal data form and the Healthrelated Self-report Scale. One-way repeated measures ANCOVA was used to compare the mean depression scores between the two groups while controlling for baseline depression scores. The results indicate that the participants’ depression scores decreased over time in both groups. However, a significant group effect suggests that being in the experimental group was associated with a greater decrease in depression scores both immediately after the intervention and at the two-week follow-up compared to the control group. These findings shed light on the potential benefits of implementing this Internet-based Cognitive Behavioral Therapy Program by school nurses, teachers, or primary care nurses to prevent extreme depression and suicidal ideation among adolescents. Further investigation with longer follow-up is recommended.

Emotional abuse mediated by negative automatic thoughts impacts functional connectivity during adolescence

BackgroundEmotional abuse during childhood and adolescence is thought to be associated with the brain; however, the neural mechanism underlying the cognitive process remains unknown. Therefore, we aimed to investigate the mediating effect of negative automatic thoughts on the relationship between emotional abuse and resting-state functional connectivity (rsFC) during adolescence. MethodOur community sample included 54 adolescents aged 13–17 years in the statistical analysis. Resting-state functional and structural magnetic resonance imaging (MRI) was performed, while emotional abuse and negative automatic thoughts were assessed using self-reported scales. A mediation analysis was used to assess the contributions of early traumatic events and negative automatic thoughts to resting functional connectivity. ResultHigher negative automatic thoughts were associated with lower connectivity in the context of greater emotional abuse (i.e., suppression effect). Thus, the relationships between emotional abuse and connectivity in the precuneus (pCun)-medial prefrontal cortex, parahippocampal cortex-extrastriate cortex, and temporal cortex-temporal pole were decreased by negative automatic thoughts. In contrast, functional connections in the pCun-pCun, pCun-precuneus/posterior cingulate cortex, and nucleus accumbens-somatomotor areas were strongly mediated when emotionally abused adolescents reported a high tendency for negative automatic thoughts. ConclusionNegative automatic thoughts strengthened the relationship between emotional abuse and rsFC. These findings highlight the underlying cognitive processing of the traumatic event-neural system, supporting the use of cognitive therapy for post-traumatic symptoms.

Resilience strengthening in youth with a chronic medical condition: a randomized controlled feasibility trial of a combined app and coaching program

Youth with a chronic medical condition (CMC) are often affected by comorbid mental disorders. Resilience-strengthening interventions can protect youth’s mental health, yet evidence-based programs remain scarce. To address this lack, this study aimed to evaluate the feasibility of a dual approach combining app-based resilience training and cognitive behavioral group coaching. Fifty-one youths with CMC treated at a German university children’s hospital aged 12–16 years were recruited. They were randomly assigned to a combined app game and coaching intervention or sole app gameplay. At pre-, post-intervention, and at a 2-month follow-up resilience, automatic negative thoughts and an app and coaching evaluation were assessed. Feasibility was defined as a recruitment rate of 70%, an 85% adherence rate for the REThink game, and 70% participation in both coaching sessions. Feasibility criteria were reached for coaching participation but not for recruitment or app adherence. While both the REThink game app and coaching intervention had high acceptance rates among youth with CMC, participants receiving additional coaching sessions showed higher satisfaction and adherence rates. Participants preferred remote to in-person meetings. The findings support a combination of a gamification app approach with online group coaching. Group coaching can improve adherence while online options increase accessibility. Future research should focus on testing in diverse participant samples, language, and age-adapted updates of the REThink game app. These findings provide guidance for increasing adherence in future intervention studies in youth with CMC cohorts.

The role of irrational beliefs in the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and disordered eating in two general student samples

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with disordered eating and negative mood. The purpose of this study was to examine whether irrational beliefs mediate this relationship along with previously reported mediators such as depression and impulsivity. Irrational beliefs trigger negative automatic thoughts which are believed, in cognitive behavior therapies, to be a source of psychopathology. Challenges brought about by symptoms of ADHD may lead to habitual emotion-eliciting thought patterns which, in turn, could lead to negative mood and disordered eating. Undergraduate students (N = 127) completed online questionnaires assessing ADHD symptoms and disordered eating and several potential mediators including irrational beliefs, depression, impulsivity, interoceptive accuracy, and reward responsiveness. The results, which were replicated in a second study (N = 254), indicated that irrational beliefs and depression mediated the relationship between ADHD symptoms and disordered eating. In the second study, impulsivity due to negative urgency was also a mediator. These findings support the theory that the symptoms of ADHD lead to enhancement of irrational beliefs, depression, and negative urgency which are linked to disordered eating.

Culturally Responsive CBT for Psychological and Physical Symptoms in Pakistani Youth: Role of Religious and Cultural Attunement

Cognitive Behavioral Therapy (CBT) is used widely throughout the world in diverse populations for successful treatment of a wide range of psychiatric and comorbid conditions. Over the years clinicians have been making efforts to culturally adapt CBT to various groups. This paper discusses the assessment and treatment of a young female from Pakistan with depression and anxiety with comorbid headache. After ruling out all organic causes, the treatment continued over 20 sessions with the initial phase consisting of introduction to CBT, risk assessment, and identification of treatment goals. Following this, the patient was helped in identifying automatic thoughts, feelings, and behaviors. Finally, tools such as thought substitutions, reappraisals, and positive diversions were used effectively to decrease automatic negative thoughts. A focus on the patient’s religio-cultural identity was maintained throughout. Understanding of contextual factors like religio-cultural values and family dynamics helped to bring about favorable therapy outcomes. A case conceptualization that cohesively addressed factors relating to ethnicity, class, and gender yielded a positive result in our case. Involvement of the family and psychoeducation regarding neurobiological causes also proved to be helpful. Such an approach can facilitate a culturally responsive application of CBT in Pakistani youth experiencing comorbid medical and psychiatric disorders.

Sexual functioning in patients with psoriasis: the role of body dissatisfaction and cognitive biases toward sexuality

Psoriasis is a chronic disease, involving skin and joints, characterized by inflamed lesions. Psoriasis negatively impacts the patients’ quality of life due to the physical, emotional, and social burden that accompanies this condition. Also, psoriasis is associated with a number of psychiatric comorbidities, including sexual dysfunctions. The present study investigates the variables associated with sexual functioning in psoriasis patients. One-hundred-three psoriasis patients and 101 matched control subjects took part in the present study. Each participant completed five self-report measures investigating the presence of depression, anxiety and stress symptoms, body image, quality of life, and sexual experience. Our results show that differences in sexual activity, but not in sexual functioning, emerged between groups. In men with psoriasis, more sexual difficulties were associated with more negative automatic thoughts about sexuality. In women, more sexual difficulties were associated with more negative automatic thoughts; anxiety, depression, and stress; severity of symptoms; comorbid disease; age; quality of life. Our findings expand the current knowledge about sexual functioning in psoriasis and shed light on specific cognitive, psychological, and demographic variables associated with sexual impairment in men and women with psoriasis.

The Impact of Stress Inoculation Management Training on Negative Automatic Thoughts, Psychological Distress, and Cognitive Fusion among Students Preparing for University Entrance Exam

Objective: One of the approaches that can lead to changes in reducing psychological distress, negative automatic thoughts, and cognitive fusion among students preparing for university entrance exam is stress inoculation management. Therefore, the purpose of this study is to investigate the effect of stress inoculation management training on negative automatic thoughts, psychological distress, and cognitive fusion among students preparing for university entrance exam. Methods and Materials: This research is an applied study in nature and quasi-experimental in implementation, using a pre-test and post-test design with a control group. The population consisted of all female students preparing for university entrance exam in Kermanshah in the year 2023. From this population, 60 participants were selected using a convenience sampling method into two experimental groups and one control group. The research tools included the Kessler Psychological Distress Scale (Kessler et al., 2003), the Negative Automatic Thoughts Questionnaire (Kendall & Hollon, 1980), and the Cognitive Fusion Questionnaire (Rachman & Shafran, 1996). Data analysis was performed using multivariate covariance analysis. Findings: The results indicated that the stress inoculation management intervention had a significant effect on the psychological distress of the students preparing for university entrance exam in the post-test phase (p<0.01). The intervention also significantly impacted negative automatic thoughts (p<0.01) and cognitive fusion (p<0.01) in the post-test evaluations. Conclusion: Stress inoculation management training is effective in impacting negative automatic thoughts, psychological distress, and cognitive fusion among students preparing for university entrance exam.

Comparison of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy on Negative Automatic Thoughts and Negative Affect in Depressed Women

Objective: The purpose of this study was to compare the effects of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) on negative automatic thoughts and negative affect in depressed women. Methods: The design of this study was applied and quasi-experimental, featuring pre-test and post-test stages with two experimental groups and one control group, followed by a two-month follow-up period. The study population included all women diagnosed with depression who visited a private counseling center in Tehran in 2023. A convenience sample of 30 participants was randomly assigned equally to the two experimental groups and one control group. The Watson and Tellegen (1985) Positive and Negative Affect Schedule (PANAS) and the Hollon and Kendall (1980) Automatic Thoughts Questionnaire (ATQ) were used for data collection. Data were analyzed using SPSS-26 software, applying three-way repeated measures analysis of variance (ANOVA) and Bonferroni post hoc tests. Findings: Results indicate significant differences between pre-test and post-test scores for both therapies in terms of negative affect and negative automatic thoughts (p < .01), demonstrating the significant efficacy of both treatment modalities. No significant differences were found between post-test and follow-up scores (p > .05). Analysis using the Bonferroni test shows no significant difference in the efficacy of the two approaches on problem-solving components (p > .05). Conclusion: Based on the findings, it can be concluded that both Cognitive Behavioral Therapy and Acceptance and Commitment Therapy are effective in reducing negative affect and negative automatic thoughts in depressed women, with no significant difference in the effectiveness of these therapeutic approaches.

교도소 수형자의 부정적 자동적 사고가 자살실행력에 미치는 영향

The purpose of this study was to examine whether the effect of prisoners' negative automatic thoughts on capability suicide through aggression is enhanced by cognitive fusion. Moderated mediation analysis was conducted by SPSS 25.0 and SPSS PROCESS Macro. The data of 500 prisoners were collected. The results of the study showed that there was a full mediation effect of aggression on the relationship between negative automatic thoughts and capability for suicide among prisoners. In addition, the aggression induced by negative automatic thoughts was further strengthened by cognitive fusion. Lastly, this study found that the mediation effect of aggression moderated by cognitive fusion was also significant from the moderated mediation model analysis. This finding suggests that the higher the level of cognitive fusion, the greater the impact of negative automatic thoughts on capability for suicide through aggression. The results in this study highlight the importance of psychological problems in interventions to prevent prisoner suicide and suggest meaningful information for theoretical intervention models in correctional psychology.

Effects of a Self-Guided Online Mindfulness and Self-Compassion Program (Mind-OP) in Reducing Negative Automatic Thoughts About Self: Randomized Active Controlled Trial

Effects of a Self-Guided Online Mindfulness and Self-Compassion Program (Mind-OP) in Reducing Negative Automatic Thoughts About Self: Randomized Active Controlled Trial

Associations between negative and positive automatic thoughts and clinical variables in patients with schizophrenia

This study investigated the relationships between negative and positive automatic thoughts and clinical variables in patients with schizophrenia. The participants included 36 patients with schizophrenia (male = 16; female = 20; age = 42.86 ± 9.40) who were outpatients in the Department of Psychiatry at Tokushima University Hospital. We used the Automatic Thoughts Questionnaire-Revised (ATQ-R), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Brief Assessment of Cognition in Schizophrenia (BACS) to assess negative and positive automatic thoughts, positive and negative symptoms, depressive symptoms, and neurocognition, respectively. Spearman rank correlation coefficients were calculated to determine the relationships between negative and positive automatic thoughts and clinical variables. No relationship was observed between negative and positive automatic thoughts. Negative automatic thoughts were related to depressive symptoms. Positive automatic thoughts were related to neurocognition. We therefore surmise that each automatic thought might have different clinical features and outcomes, and should therefore be treated accordingly.

Kognitiv atferdsterapi

Cognitive behavioural therapy (CBT) is a psychotherapeutic method focusing on the interaction between thoughts, behaviours, emotions and physiological factors in individuals. The central emphasis is on how people process the information they receive. It is assumed that the meaning or interpretation an individual has in each situation leads to uncomfortable emotions or inappropriate behaviours. Working systematically, the therapist first helps the patient see connections between their own behaviour, thoughts and feelings and to identify and explore negative automatic thoughts (NATs) and potential core beliefs. The therapist then encourages the patient to come up with alternative thoughts and test whether they result in less discomfort and better coping. The goal is for the patient to learn how to use CBT techniques by themself. The article describes a therapy process with a patient struggling with depression. Based on a case formulation that provides an overview of factors contributing to the development and maintenance of the patient's problems, the most central therapeutic interventions are described: establishing agreement on therapy goals, session structure, setting an agenda, mood checks, and homework assignments. The article also provides examples of how the therapist encourages cognitive restructuring through open-ended questions and guided discovery. Keywords: cognitive behavioural therapy, guided discovery, case formulation

Creating critical palliative hypnotic adjustments: temporality, hope, and meaning

ABSTRACT When cure is not possible, suffering often takes form as pain and distressing symptoms, death anxiety, existential distress, and meaninglessness. This paper describes important elements connecting palliative care principles with hypnotic approaches designed to provide support, palliate symptoms, foster hope, and address existential and spiritual distress. We offer a developmental process for and examples of hypnotic suggestions customized to simultaneously ameliorate physical symptoms and address profound distress arising from physical, social, psychological, existential, and spiritual challenges commonly encountered in terminal illness. This process necessarily requires use of the patient’s vernacular to hypnotically deepen inwardly focused attention in order to explore and access internal resources, reframe negative automatic thoughts, and create positive meanings for experiences that disinvite suffering. Effective delivery utilizes cognitive tools such as clinical and scientific principles, artistic forms such as poetry and haiku, and a thorough assessment of needs. This approach strategically addresses an overarching dimension of temporality through suggestions that sequentially address multiple sources of suffering that are layered throughout the various dimensions of self. This requires focus and presence in the present moment; it ultimately fosters a therapeutic relationship that can safely hold past painful experience as helpful new meanings emerge that build resiliency for that experience. This work benefits from inwardly focused concentration and a holding environment to identify and access helpful inner resources, which include an increasingly malleable relationship with temporal memories.

The Impacts of Religious Rational-Emotive Behavior Therapy (RREBT) on Mental Health: A Comparative Review

Mental health affects how individuals deal with stress, communicate with others, and make wise decisions. Rational-emotive behavior therapy (REBT) principles can be integrated with patients’ religious beliefs and faith to address some mental health issues. The primary goal of this article is to assess the impacts of various forms of religious REBT (RREBT) on patients’ mental health. This research adopted a comparative, scoping literature review method. The findings show that various forms of RREBT exist, but the most frequently used approach is Christian REBT (CREBT), followed by Islamic REBT (IREBT) and Jewish REBT (JREBT). Three studies examined IREBT and reported its significant positive effects in treating posttraumatic stress disorder, negative self-esteem, and family distress and conflict. Only one study focused on JREBT, demonstrating that it effectively reduced family distress symptoms and marital conflict. The rest of the studies focused on CREBT, and their findings ranged from its significant positive effects in managing emotional distress, panic attacks, avoidance, deficiencies in social communication, binge eating, aggression, depressive symptoms, poor work-life balance, poor quality of family life to symptoms of family distress and marital conflict. These three forms of RREBT have been applied in one study to manage family distress symptoms and marital conflict among couples. Based on evidence from five studies, depression is the most commonly treated mental health disorder by RREBT counselors. Across all studies reviewed, changes in irrational cognitions, irrational beliefs, and automatic negative thoughts were the most common change processes. RREBT clinicians employing any of these approaches in their clinical practice and research are urged to highlight the therapeutic techniques that worked for their clients, how much time it took them to achieve the desired change as well as the mechanisms of change so that future therapists can be able to adapt their procedures for their clients.

Effect of Negative Automatic Thoughts on Medication Adherence in Individuals With Schizophrenia

This study aimed to determine the effect of negative automatic thoughts on medication adherence in individuals with schizophrenia. This was a cross-sectional study carried out in a community mental health center between October 2022 and December 2022. The study included 102 individuals with schizophrenia. Data was collected using the Descriptive Characteristics Form, Negative Automatic Thoughts Questionnaire (NAT-Q), and Morisky Medication Adherence Scale (MMAS). The individuals' total mean NAT-Q score was 106.34 ± 27.32. There was a strong negative correlation between NAT-Q and MMAS scores ( r = −0.822, P < 0.05). The study found that negative automatic thoughts predicted medication adherence by 67%. The negative automatic thoughts of the individuals were high and the medication adherence of half of the individuals was low. It was determined that the level of negative automatic thoughts of individuals with schizophrenia may negatively affect their medication adherence. [ Psychiatr Ann . 2023;53(11):518–524.]

Studi Kasus: Pengaruh Cognitive Behavior Therapy (CBT) pada Klien dengan Diagnosa Gangguan Afektif Bipolar

This study aims to explore how the cognitive behavioural therapy affected a client with bipolar affective disorder. Participant was a 25-years-old woman (SM) who is diagnosed with bipolar disorder specify current or most recent episode: manic, depressed (F31.6). Before beginning the therapy session, the participant completed a series of assessment, including interview (autoanamnesa and alloanamnesa), observation, graphic tests (BAUM, DAP, HTP Wartegg) and Sack’s Sentence Completion Test (SSCT) to evaluate the participant’s personality, and Standard Progressive Matrices (SPM) to assess cognitive ability. Therapy was conducted in 5 sessions (1 session each week) with additional daily task to track the thoughts and behaviors pattern. The result shows a decrease in depression scores (BDI-II) and also SUDS (Subjective Unit Disturbance Scale). Qualitatively, CBT helps the participant to select her own automatic negative thoughts and form more adaptive thinking pattern by her own. Participant also shows an increasing score in GAF (Global Assesment Functioning) after completing the whole therapy sessions

The Relationship between the Family Environment and Eating Disorder Symptoms in a Saudi Non-Clinical Sample of Students: A Moderated Mediated Model of Automatic Thoughts and Gender.

Eating disorders are a global burden and present personal, family, and societal costs. Most evidence in the literature is based on the relationship between a poor family environment and eating disorders, and the evidence of gender interaction in eating disorders is inconsistent. This study aimed to investigate the relationship between family environment and eating disorder symptoms, the mediating role of negative automatic thoughts, and the moderating role of gender using a non-clinical sample of students. A sample of 440 (70.9% females, aged 18-21) participated in this study. They completed the Eating Attitudes Test (EAT-26), the Automatic Thoughts Questionnaire (ATQ negative), and the Brief Family Relationship Scale (BFRS). PROCESS MACRO was used to study these relationships. The main findings revealed that family environment was negatively associated with eating disorder symptoms and that this relationship was mediated by automatic thoughts. Moreover, gender moderated those relationships, and more intensely in females. The results of this study indicate that the prevention of eating disorders should be directed at training individuals to challenge negative thoughts and encourage healthy individuals to be gender mindful.