Several people have asked for a comprehensive list of CBT techniques. What is CBT in psychology? CBT refers to cognitive behavioral therapy. CBT is a very popular form of therapy because it has been proven to be effective for a large number of people suffering from anxiety, depression, and other mental illnesses.
This article is meant to help provide a brief introduction to CBT as well as some resources on where you can get cognitive behavioral therapy. I also link to a brief CBT manual and some worksheets for therapists (which other people might be interested in as well). Finally, I provide the much-anticipated list of CBT techniques at the end of the article.
What is cognitive behavioral therapy?
CBT, a combination of cognitive and behavioral therapies (surprise! hence the name), is used to treat mood and anxiety disorders. Fundamentally, CBT rests on the notion that since it is hard to directly alter emotions, we can instead target emotions indirectly by changing the way people think and behave. As you can imagine, there are many CBT techniques that can achieve this and I will provide a list of CBT techniques (the main ones) further down in this article.
Who can CBT help?
Cognitive behavioral therapy is helpful for a wide range of problems, but is not suitable for every type of problem. In the manual, “A Therapist’s Guide to Brief CBT” on page 8, there is an excellent chart that goes over what disorders are more suited to CBT.
According to that chart, the following are well-suited to CBT:
- Assertiveness issues
- Exercise motivation
- Social Isolation
- New Diagnosis of COPD
- Coping with Chemotherapy
- Caregiver Burden
In addition, the chart suggests the following MAY or may not benefit from CBT:
- Specific phobias
- Crisis intervention
Finally, the chart suggests that the following are NOT suitable for CBT, at least short-term CBT. I think it might be arguable, but here they are:
- Alcohol Dependence
- Paranoid Personality Disorder
- Chronic PTSD
- Somatoform Disorder
So, that gives you an idea of what can and cannot be helped with CBT.
How is cognitive behavioural therapy administered?
Before I provide a list of CBT techniques, I would like to consider how CBT is administered. You can do cognitive behavioral therapy through a counsellor, psychologist or other mental health professional. They might give you CBT within the session, but also as homework exercises to work on between sessions.
Alternately, you can do CBT on your own with the guidance of a book. There are several good books on CBT. My personal favorite is The Feeling Good Handbook by David Burns (affiliate link).
As well, there are smart phone and tablet apps for CBT. Also, there are some well-reviewed on-line CBT programs. I have heard good things about two in particular (both of which are, as of the time of this writing, free of charge):
Lastly, if you are a therapist or a real do-it-yourselfer, here is a link to some CBT handouts that you can use to work through your problems.
List of CBT Techniques
CBT is more than just a list of CBT techniques. It is really a way of thinking, and I would like to discuss that a little before I list any techniques. The way of thinking is basically this: when you have a mood disorder such as anxiety or depression, one of the main problems come from cognitive distortions. I put a link to a Wikipedia article there, but, honestly, it does not explain it as well as the Burns book above.
What is a cognitive distortion?
Briefly, cognitive distortions are just errors in the way we think. For example, one cognitive distortion is “mind reading”. In this one, we assume we know what another person is thinking or feeling about us, based on their non-verbal behaviour. This one can be a tricky one for some people because sometimes people are sensitive and good at picking up on non-verbal cues.
However, the types of things we learn from CBT are: 1. If that person has something negative to say, they are going to have to outright say it — we will not be held “hostage” to passive-aggressive non-verbal attacks if that is even what they are really doing. 2. We might be right that we are getting a negative non-verbal cue from someone, but we may be wrong in attributing it to ourselves — for example, maybe someone has a brother who is dying of cancer and they are thinking about that while they are trying to talk to us.
CBT techniques are more than just a list of cognitive distortions
This is why it is hard to make a list of CBT techniques. One can make a list of CBT distortions (as Wikipedia did), but the techniques — well, there are many ways to wake ourselves up from the distorted belief systems that we are living in. Another example: suppose that my car won’t start and I have to be somewhere important by a certain time. Because my car won’t start, I miss the meeting and therefore miss an important opportunity. I start to feel bad about myself. Maybe I left my headlights on and caused the car to not start. I might call myself “stupid” or “a loser”. That is called “labeling”. With cognitive therapy, I would come to realize that even if I did make a mistake, that is a normal part of being human. I am not stupid or a loser just because I make a mistake.
Part of how emotional disorders build is by this process of catastrophizing (is that a word?). What I mean by that is that little things might go wrong and we assume more things will go wrong or that things always go wrong for us, that we are unworthy, that we are somehow lacking. We take an event — probably an unpleasant event — and ascribe it with a personal meaning. In fact we allow the event to define our sense of self-worth. When I put it like that, it sounds a little crazy, doesn’t it? However, people do that all the time.
So, the list of CBT techniques is:
- Journaling or in some way keeping a record of your moods and/or thoughts, especially noting the time, the extent of the mood or thought, and what led to it. This is the “data gathering” phase.
- Unraveling cognitive distortions. With or without the help of a professional, figuring out which cognitive distortions you make most frequently and learning how not to do them. Here, we identify and challenge “automatic” thoughts.
- Cognitive restructuring. Once you have identified a rule or assumption that you have been making about the world and your place in it, you can begin to explore the origins, advantages, and disadvantages of this. For example, you might think that in order to be successful in life, you have to run five miles per day, but then you get injured and you cannot run five miles a day anymore. You feel bad about yourself because, besides not getting the endorphins from the regular exercise, you had the belief (that you were previously barely aware of) that running five miles a day made you a “good” person. Time for some cognitive restructuring, meaning it is time to think about what being a “good” person really means to you.
- Exposure and response prevention. This is an excellent technique for people with OCD (obsessive compulsive disorder). It involves being around whatever normally elicits a compulsive behavior, but refraining from engaging in the compulsive behavior and then writing about how that makes you feel. Here is the worksheet about it.
- Another form of exposure is called interoceptive exposure. This is exposure to bodily sensations and it is particularly important in treating panic and anxiety. You can find a worksheet about it here.
- Nightmare exposure and rescripting is pretty much what it sounds like. It is a fairly specific technique for people who are having bad dreams. Here is the worksheet.
- Play the script until the end. This is quite a cool technique because a lot of people get crippled at some point in time by fear or anxiety. In this technique, we examine what would happen if the worst case scenario really happens. To me this is a very important technique because it creates sort of a rehearsal in a person’s mind that tells them that no matter what happens and what goes wrong, they will, ultimately, be okay. The handout for this exercise is here.
- Progressive muscle relaxation (PMR). This is hardly unique to CBT, but it is an excellent technique nonetheless. For those who have not heard of it, you relax one muscle group at a time. This is a way to relax your whole body. I am including a link to the worksheet, but the ideal way to do this is if you can find an audio recording of someone guiding you through PMR because then you can just relax, lie on a yoga mat or something like that, and do the exercise very effectively.
- Relaxed breathing. Again, this is not unique to CBT — in fact it has more in common with mindfulness — but it is a great technique once mastered. If you have tried this in the past and it has not worked for you, I encourage you to keep trying. It literally took me years before I even began to understand how to slow down my breath and probably more years before I realized the impact that had on my body. Maybe you already know because you learn faster than me :). It can be frustrating learning to focus on your breath. This is a known fact amongst Buddhist monks and meditation practitioners worldwide. Allow yourself room to “do it wrong” so that you can learn. Here is a worksheet that might help.
So, that is a list of CBT techniques and an overview of what CBT in psychology is. However, remember that CBT is more than a simple list of techniques. It is a way of doing therapy. It is using thoughts and behaviours to target emotion. There is a mountain of evidence to suggest that CBT works and works very well for many people in many situations.
What is MBCT – Mindfulness based cognitive therapy – and why do I like it?
Personally, I prefer a variation of CBT called MBCT, which is mindfulness based cognitive therapy. In mindfulness based cognitive therapy, a large part of the focus is on developing self-awareness and on meditation. What I like about this is that I think sometimes people are not 100% conscious of what their thoughts and emotions are.
The mindfulness aspect helps ground people so that they know what underlying thoughts and emotions are causing trouble. It can be very hard to be still and face yourself. It takes a lot of courage, but I think it is a journey worth taking. (If you are interested in MBCT, my favorite book for this is The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness (affiliate link). The book comes with a CD that guides you through progressive muscle relaxation and some other exercises in mindfulness.)
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