This article contains a lot of information about CBT including a complete list of CBT techniques.
What is cognitive behavioral therapy (CBT) in psychology? CBT techniques actually stands for cognitive behavioral therapy techniques. Cognitive behavioral therapy (CBT) is a very popular form of therapy because a large number of scientific studies have proven that it works for a high percentage of people suffering from anxiety, depression, and other mental illnesses.
Cognitive Behavioral Therapy (CBT) Techniques Article Contents:
- What is cognitive behavioral therapy?
- Who can CBT help?
- How is cognitive behavioural therapy administered?
- What are the main cognitive distortions in cognitive behavioral therapy?
- List of CBT Techniques
- CBT Case Conceptualizations
Here is a summary of the complete list of cognitive behavioral therapy techniques:
List of Cognitive Behavioral Therapy (CBT) techniques (Summary):
- Journaling (creating a detailed thought record)
- Unraveling cognitive distortions.
- Cognitive restructuring
- Behavioral experiments
- Exposure and response prevention.
- Interoceptive exposure.
- Imagery based exposure
- Nightmare exposure and rescripting
- Play the script until the end
- Progressive muscle relaxation (PMR)
- Relaxed breathing
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List of Cognitive Distortions (Summary):
- Splitting (all or nothing thinking)
- Discounting the positives
- Control fallacies
- Jumping to conclusions
- Fairness fallacy
- Karma fallacy (also known as “Heaven’s reward”)
- Labeling / Mislabeling
- Emotional reasoning
- Fallacy of change
- Always being right
These are explained in much more detail below.
This article is meant to help provide a brief introduction to cognitive behavioral therapy (CBT) as well as some resources on where you can get cognitive behavioral therapy (CBT). I also link to a brief cognitive behavioral therapy (CBT) manual and some free CBT worksheets for therapists (which other people might be interested in as well). Also, many people are able to work through their problems using cognitive behavioral therapy (CBT) in a workbook such as the exceptionally popular CBT Toolbox, which is a workbook for clients and clinicians. As well, I recommend Mind Over Mood to better understand cognitive behavioral therapy (CBT). I provide a list of CBT techniques close to the end of this article as well as CBT case conceptualizations.
What is cognitive behavioral therapy (CBT)?
Definition: Cognitive behavioral therapy (CBT) is a psychotherapy method that can helps people learn to manage life’s problems by altering their patterns of thinking and behaving. The theory behind this is that by changing the way you think and behave, your mood will also change.
CBT has been scientifically proven to be extremely effective for anxiety, depression, and many other mental and physical conditions.
CBT, a combination of cognitive and behavioral therapies, is used to treat mood and anxiety disorders. Fundamentally, cognitive behavioral therapy (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 further down in this article. This list of cognitive behavioral therapy techniques is not exhaustive, but includes a list of the most important cognitive behavioral therapy techniques.
Some people have (correctly) pointed out over the years that, often, emotions come to us prior to thoughts, and so there are those who wonder if we truly can alter emotions by altering thoughts. However, usually, the relationship between thoughts and feelings is cyclical. For example, an event might happen such as, for example, we might perform poorly on an exam or a performance evaluation. After this event, we might think negative thoughts about ourselves, but before we even realize we are thinking negative thoughts, we feel sad.
How does cognitive behavioral therapy (CBT) work?
How can cognitive behavioral therapy (CBT) help if we already feel sad before we even know we are thinking these negative thoughts (also known as “automatic thoughts”)? Well, it helps in two ways:
- Normally, after we feel sad as a result of an “automatic thought,” we take this as confirmation that the thought was true. We reason (incorrectly) that since we feel bad, we must actually be bad. And then these thoughts make us feel bad and those bad feelings lead to more negative thoughts about ourselves, which lead to… you guessed it, more bad feelings. It is a vicious cycle. Cognitive behavioral therapy (CBT) allows us to break into that cycle and challenge the thoughts we are having so that we are able to begin to break these cycles of negative thought. These negative thought cycles are sometimes called “rumination” and if they get to be a chronic pattern can lead to depression. So, breaking these cycles can be extremely beneficial and therapeutic.
- Learning the tools of cognitive behavioral therapy (CBT) allows us to see the types of automatic thoughts that we are having, and, by examining and challenging them, over time, we can reduce and eliminate those types of thoughts. We begin to have automatic thoughts that lead to more positive emotions.
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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 techniques.
According to that chart, the following are well-suited to cognitive behavioral therapy techniques:
- 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 techniques:
- Specific phobias
- Crisis intervention
Finally, the chart suggests that the following are NOT suitable for cognitive behavioral therapy techniques, 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 CBT can do: what can and cannot be helped by using cognitive behavioral therapy techniques.
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 practice these cognitive behavioral therapy techniques with 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 cognitive behavioral therapy techniques 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.
As well, there are smartphone and tablet apps for cognitive behavioral therapy (CBT) self help. Also, there are some well-reviewed on-line diy CBT programs. I have heard good things about two in particular:
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
Cognitive behavioral therapy (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 (more on those below). By identifying and finding a way to move past the cognitive distortion, we are able to hopefully overcome the negative mood that it creates.
What is a cognitive distortion?
A cognitive distortion is when you use a seemingly valid rationalization to support an unhealthy thinking pattern. It is tricky because, on the surface, it seems like a valid thought, but when a cognitive distortion is examined more deeply, we can see that the thought is not supported by actual evidence, but rather by faulty logic and assumptions.
Cognitive distortions are errors in our thinking process. 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.
A List of CBT techniques is 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, 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. 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.
What are the 15 most common cognitive distortions in cognitive behavioral therapy?
As I mentioned, CBT techniques are applied to cognitive distortions. These cognitive distortions are inaccurate or distorted thoughts that serve to bolster negative thought patterns and/or emotions. Because cognitive distortions represent some fallacy in our thinking, they lead us to incorrect assumptions about our lives and about what will happen in our futures.
These are the main cognitive distortions that are corrected by cognitive behavioral therapy techniques:
- Overgeneralization: In the cognitive distortion of overgeneralization a single incident is generalized to make a general conclusion. For example, if you have one bad exam, you might conclude (falsely) that you are going to fail the course. In a more radical example of overgeneralization, you might take that one bad exam mark and conclude that you won’t graduate.
- Filtering: Filtering is focusing on the negative and ignoring the positives. In the cognitive distortion of filtering, the positives are literally filtered out.
- Splitting: Also known as dichotomous thinking, polarized thinking, or “black and white” thinking, splitting is when you see things in all or nothing terms. If you find yourself using expressions like “always,” “never,” “every time,” etc., you are likely splitting. For example, you might see yourself as a total success or a total failure.
- Discounting the positives: This cognitive distortion involves not noticing or minimizing the positive events or accomplishments in your life.
- Control Fallacies: Always assigning an internal or external locus of control to events. In other words in this distortion the person either always assumes things are out of their control or always assumes they can control everything. The reality is that we have control over some things and not others.
- Jumping to Conclusions: In this cognitive distortion you jump to a conclusion with little or no evidence to back it up. Two specific types of jumping to conclusions are mind-reading and fortune telling. In mind-reading the person imagines that they know what other people’s (negative) thoughts about them are. In fortune-telling, they predict the (negative) outcome of events.
- Personalization: In personalization a person assumes the blame for something that is not their fault.
- Fairness Fallacy: It is considered a cognitive distortion to expect life to be fair. Because life is not fair. Unfortunately.
- Karma Fallacy: Related to the fairness fallacy, the karma fallacy is the belief that people will get what they deserve. While that may or may not be true in the long run, believing karma will level the playing field in short order is a cognitive distortion.
- Labeling / Mislabeling: This could be considered a more extreme case of the cognitive distortion of overgeneralization. In labeling, a person assigns a label to themselves or others based on flimsy evidence. For example, if a person was trying to lose weight and ate some ice cream, if they called themselves a “cow,” that would be labeling. Mislabeling is really the same thing because these labels are clearly incorrect. However, the term “mislabeling” is usually used to describe other people’s behaviour rather than our own. For example, if someone cuts you off in traffic and you say they must have gotten their driver’s license as the prize in a Cracker Jack box, that is labeling.
- Blaming: This is the opposite of personalization. In blaming, the person abdicates responsibility for a problem and puts all the blame on the other person (or people) involved. The person does not look at what role they had to play in the matter.
- Shoulds: When a person tells themselves they “should” have done something differently, this is considered a cognitive distortion. The main reason it is a cognitive distortion is that it does not tend to lead to improved behavior, but rather to rumination, guilt, and unhappiness. “Should” and “must” are similar in this regard.
- Emotional Reasoning: In emotional reasoning people assume that if they feel a certain way, it must be true. For example, “I feel stupid, therefore I am stupid.”
- Fallacy of Change: This cognitive distortion rests on two ideas: first is the idea that, through manipulation, we can change others to behave as we would like them to, and second, that by changing others, we can make ourselves happy.
- Always Being Right: In this cognitive distortion it is more important to be right than anything else including other people’s feelings.
Those are the main cognitive distortions that can be corrected or improved by the cognitive behavioral therapy techniques listed below.
List of CBT techniques (Cognitive behavioral therapy techniques):
- 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. This journaling process is sometimes referred to as a thought record and belongs at the top of any list of CBT techniques.
- 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.
- Behavioral Experiments. In cognitive behavioral therapy behavioral experiments are used to test the validity of the thoughts you are having and their underlying beliefs. For example, if you are afraid to say “no” because you think your friends will not like you if you do, you might do a behavioral experiment wherein you say “no” to someone in your life. You then observe what happens and gather information. Does it result in the person truly liking you less? How can you tell? Are you making assumptions? A good handout for this cognitive behavioral exercise can be found here.
- Exposure and response prevention. This is an excellent cognitive behavioral 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.
- Imagery based exposure is another exposure-based form of cognitive behavioral therapy. Instead of being directly exposed to whatever is causing negative emotions, in imagery based exposure, you are asked to remember an incident or scene that caused such emotions. What is key here is to evoke the memory in as much sensory detail as possible using the five senses. What did you see, hear, feel, smell, or taste (if relevant)? And what was going on in your mind at the time? You are encouraged to both accurately label the thoughts and emotions experienced as well as labeling what your behavioral impulses were (for example, did you feel like crying, running away, getting angry?) You might be asked to continue this visualization until the level of discomfort associated with the memory is reduced by half or more from its initial level. This can help reduce rumination (which is commonly associated with depression) in that it reduces the emotional power of painful, intrusive memories which might trigger rumination and avoidance.
- 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 hat you can learn. Here is a worksheet that might help.
CBT Case Conceptualization
Although cognitive behavioral therapy is one form of therapy, there are several different types of CBT case conceptualizations. What is a case conceptualization? Case conceptualization, also known as case formulation is a core component of CBT. It helps therapists and clients to find and understand the beginning, current state, and factors that maintain a problem. Case conceptualizations can range from cross-sectional formulations, which focus on the present — the “here and now” — to longitudinal case formulations, which focus on the origin of a problem. Additionally, there are case conceptualization models for specific disorders as well as models that are unique to a particular client’s situation.
A CBT case conceptualization can be considered as any method used to help you to understand your problem, its origin, and what keeps it going. Often CBT case conceptualizations have five key components:
- Presenting problem(s)
- Predisposing factors which made you vulnerable to this(these) problem(s)
- Triggers that brought on the problem(s).
- Factors that maintain your problem or are unintentional consequences of your efforts to cope with the problem(s).
- Protective factors – What assets do you have that you may or may not appreciate which provide resilience?
There are several different ways to generate a CBT case conceptualization. It helps both the client and the professional to create a diagram of some sort that can frame the problem and break it down into a CBT case conceptualization because this creates a sort of map that can be used to determine what direction will be most helpful in therapy. Although fundamentally the same, there are several different ways to generate a case conceptualization for CBT. Here are the main ones, which have formulation worksheets on psychologytools.com:
- Belief driven case conceptualization – The Belief-Driven case formulation is a core-belief-driven cross-sectional (here and now) cognitive behavioral therapy case conceptualization. The focus here is that your underlying beliefs are the key to how you interpret a particular situation. Because of what you believe, the way you view a situation might be biased or prejudiced in ways that are not immediately obvious to you. Working on this type of case conceptualization can lead to discussing schema bias and prejudice to encourage schema therapy change work. You can find the belief driven case conceptualization worksheet and instructions here.
- Compassion focused case conceptualization – Compassion focused therapy (CFT) is a most helpful when dealing with shame and self-blame. Adapted from a formulation by Gilbert & Procter (2006), a Compassion Formulation worksheet is available from psychologytools.com. The worksheet is a case conceptualization diagram which follows a problem -> coping strategy -> unintended consequences format with emphasis on compassion.
- “Friendly” formulation – This CBT case conceptualization diagram is considered “friendly” in that it incorporates the five key aspects of CBT case formulations in one accessible diagram, which is framed by the simple question, “How did the problem develop?”
- Jacqueline Persons style CBT formulation – The Jacqueline Persons style case conceptualization is a CBT case formulation diagram adapted from Jacqueline Persons’ approach. Persons’ book, “The Case Formulation Approach to Cognitive Behavior Therapy”, is an excellent introduction to CBT case conceptualization. In Person’s case conceptualization, the focus is on the ways in which we maintain (or continue) our problems. Although this worksheet is a great way to guide clinician’s thinking, it may not be the ideal way to convey information to the client. In particular, the last section, “obstacles to treatment” might need to be communicated in a tactful manner, depending on whether those obstacles are obvious only to the clinician or whether they are already known to the client.
- Judith Beck style CBT case conceptualization – The Judith Beck Style case formulation is a cognitive behavioral case formulation diagram adapted from Judith Beck’s approach. Judith Beck has written several books about CBT including “Cognitive Therapy for Challenging Problems: What to Do When the Basics Don’t Work”. The Judith Beck case conceptualization combines a longitudinal and cross-sectional approach. Information is gathered about adverse childhood events. This is then analyzed to determine how it informs core beliefs, which can also be considered schemas. Conditional assumptions as well as coping behaviors are also gathered. All of this is used to understand how you respond to situations in the present moment.
- Longitudinal CBT case conceptualization – The Longitudinal formulation is a longitudinal CBT case formulation which addresses the five key components of a CBT case conceptualization. Also, the diagram includes a cross-sectional component in the form of the thoughts, feelings, behaviors, and physical sensations associated with a specific present moment situation. Using this type of formulation can assist in identifying the connections between your beliefs (schemas) and your current patterns of behavior and thought. Here is a second longitudinal CBT case conceptualization diagram.
- Schema activation CBT formulation – Cognitive behavioral therapy deals with three levels of cognition: automatic thoughts, conditional assumptions, and core beliefs (schemas). Of these, our schemas can perhaps be considered the foundation because they usually develop at an early age and they shape the way we view all aspects of ourselves and our world. The schema case formulation worksheet is here.
- Vicious flower CBT case conceptualization – On the surface the Vicious Flower formulation appears to be a simple CBT case conceptualization diagram. However, this simplicity is deceptive. The tool focuses on the “vicious” maintenance cycles which unintentionally prolong a problem. In other words it targets the mechanisms behind this prolonging of the problem. It represents these maintenance cycles graphically as each one forms the petals of a flower.
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 cognitive behavioral therapy 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. It is useful to have a CBT case conceptualization as a framework to guide you through your CBT work and help you to understand the origin, triggers, and factors that maintain your problem.
What is MBCT – Mindfulness based cognitive therapy?
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.)
You might also be interested in:
- Recommended Books on CBT
- Books about overcoming depression
- Mental Health Resources
- Free CBT Worksheets for Clients and Therapists
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