- Cognitive Behavior Therapy Techniques
- Cognitive Behavioral Therapy (CBT)
- How Cognitive Behavioral Therapy Works
- Find a Therapist
- CBT Techniques
- Mental Health Conditions Treated with CBT
- History of Cognitive Behavioral Therapy
- Who Provides Cognitive Behavioral Therapy?
- Concerns and Limitations of Cognitive Behavioral Therapy
- What to Expect
- Cognitive Behavioral Therapy Techniques That Work
- Behavioral Experiments
- Thought Records
- Pleasant Activity Scheduling
- Situation Exposure Hierarchies
- Imagery Based Exposure
- These At-home Cognitive Behavioral Therapy Tips Can Help Ease Your Anxieties
- Change your perspective
- Balance your thoughts
- 5 Get-Positive Techniques From Cognitive Behavioral Therapy
- Alcohol & Other Drugs
- Cognitive-Behavioral Therapy for Depression
- How it works – Cognitive behavioural therapy (CBT)
- CBT sessions
- Cognitive Behavioral Therapy Exercises
Cognitive Behavior Therapy Techniques
Graded Exposure Assignments: Exposure is a cognitive behavior therapy technique that helps people systematically approach what they fear. Generally, fear causes people to avoid situations. Unfortunately, avoidance of feared situations is what maintains feelings of fear and anxiety. Through systematic exposure, people master feared situations one-by-one, and then tackle increasing difficult exposure assignments. Exposure is one of the most effective psychological treatments that exists, having a 90% effectiveness rate with some anxiety disorders.
Activity Scheduling: Activity scheduling is a cognitive behavior therapy technique designed to help people increase behaviors they should be doing more. By identifying and scheduling helpful behaviors, such as meditating, going for a walk, or working on a project, it increases the likelihood of their getting done. This technique is especially helpful for people who do not engage in many rewarding activities due to depression, or people who have difficulty completing tasks due to procrastination.
Successive Approximation: This cognitive behavior therapy technique works for people who have difficulty completing a task, either due to lack of familiarity with the task, or because the task feels overwhelming for some reason. The technique works by helping people master an easier task that is similar to the more difficult task. It’s akin to practicing addition and subtraction before learning long division. Once you are practiced at addition and subtraction, long division isn’t as daunting. Likewise, by having rehearsed one behavior, one that is slightly more difficult feels more manageable.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is a short-term form of behavioral treatment. It helps people problem-solve. CBT also reveals the relationship between beliefs, thoughts, and feelings, and the behaviors that follow. Through CBT, people learn that their perceptions directly influence how they respond to specific situations. In other words, a person’s thought process informs their behaviors and actions.
Cognitive behavioral therapy is not a distinct treatment technique. Instead, it is a general term which refers to a group of therapies. These therapies have certain similarities in therapeutic methodology. The group includes rational emotive behavior therapy, cognitive therapy, and dialectical behavior therapy.
- How Cognitive Behavioral Therapy Works
- CBT Techniques
- Mental Health Conditions Treated with CBT
- History of Cognitive Behavioral Therapy
- Concerns and Limitations of Cognitive Behavioral Therapy
How Cognitive Behavioral Therapy Works
Cognitive behavioral therapy is grounded in the belief that how a person perceives events determines how they will act. It is not the events themselves that determine the person’s actions or feelings. For example, a person with anxiety may believe that “everything will turn out badly today.” These negative thoughts may influence their focus. They may then only perceive negative things that happen. Meanwhile, they may block out or avoid thoughts or actions that could disprove the negative belief system. Afterward, when nothing appears to go right in the day, the person may feel even more anxious than before. The negative belief system may get stronger. The person is at risk of being trapped in a vicious, continuous cycle of anxiety.
Find a Therapist
Cognitive behavioral therapists believe we can adjust our thoughts. This is thought to directly influence our emotions and behavior. The adjustment process is called cognitive restructuring. Aaron T. Beck is the psychiatrist widely considered to be the father of cognitive therapy. He believed a person’s thinking pattern may become established in childhood. He found that certain cognitive errors could lead to depressogenic or dysfunctional assumptions.
Common cognitive errors and their associated dysfunctional assumptions include:
- Self-references: “People always focuses attention on me, especially when I fail.”
- Selective abstraction: “Only my failures matter. I am measured by my failures.”
- Overgeneralizing: “If something is true in one setting, it is true in every setting.”
- Excessive responsibility: “I am responsible for every failure and every bad thing that happens.”
- Dichotomous thinking: Viewing the world in extremes, black or white, with nothing in between.
The cognitive behavioral process is based on an educational model. People in therapy are helped to unlearn negative reactions and learn new ones. These are positive reactions to challenging situations. CBT helps break down overwhelming problems into small, manageable parts. Therapists help people set and reach short-term goals. Then the therapist gradually adjusts how the person in treatment thinks, feels, and reacts in tough situations. Changing attitudes and behaviors can help people learn to address specific issues in productive ways.
Cognitive behavioral therapy involves more than sitting and talking about what comes to mind. This structured approach keeps the therapist and the person in treatment focused on the goals of each session. This ensures the time spent in therapy is productive. The person in therapy benefits from a collaborative relationship. They can reveal personal issues without fear of judgment. The therapist helps them understand the issues at hand. However, they do not tell the person in therapy which choices to make.
CBT techniques incorporate many different therapeutic tools. These tools help people in therapy evaluate their emotional patterns and states. CBT therapists may employ common techniques such as:
- Challenging beliefs
- Social, physical, and thinking exercises. These may help someone become aware of their emotional and behavioral patterns.
Homework is completed by the person in treatment. It might include practical exercises, reading, or writing assignments. This helps reinforce the therapy. The homework is done outside of the scheduled time for therapy. Homework is a crucial aspect of many CBT treatment plans. It challenges the person to continue working on their own, even after therapy comes to an end.
Most people who receive cognitive behavioral therapy do so for an average of 16 sessions. Each of these lasts about an hour. People in treatment learn new coping skills to handle their issues. They develop more positive beliefs and behaviors. Some even resolve long-standing life problems.
Mental Health Conditions Treated with CBT
Some factors make people more likely to benefit from CBT. People with clearly defined behavioral and emotional concerns may find CBT helpful. Those with specific problems that affect their quality of life can also benefit from cognitive behavioral therapy. Under these conditions, the therapist and the person in treatment know which issue to target. This makes CBT’s problem-solving and goal-oriented approach a good fit. CBT is used to effectively treat many conditions, including:
- Mood issues
- Posttraumatic stress
- Obsessions and compulsions
- Chronic fatigue syndrome (CFS)
- Irritable bowel syndrome (IBS)
- Substance dependency
- Disordered eating
- Persistent pain
- Erratic sleep patterns
- Sexual issues
- Anger management issues
CBT is used to treat many mental health issues. But as with any type of therapy, benefits are greatest when people commit fully to the process.
History of Cognitive Behavioral Therapy
Albert Ellis, PhD first presented his rational approach to therapy at the 1957 American Psychological Association convention. He had first learned and practiced various forms of psychoanalytic treatment. But Ellis grew dissatisfied with the lack of efficiency and effectiveness of classical analysis. Ellis agreed with Freud that irrational forces may have significant effects on thoughts and behavior. But he came to believe these forces were not due to unconscious conflicts in early childhood. Ellis had seen too many people in therapy who understood their childhood experiences and unconscious processes. But they remained in a troubled state. With this in mind, Ellis chose to challenge the belief system of people with seemingly irrational thoughts. He encouraged people in therapy to actively work against those beliefs.
Around the same time, Aaron Beck was developing his own approach to therapy. Like Ellis, Beck was a student of the psychoanalytic approach. But evidence from his work on dreams and ideational material led Beck away from psychoanalysis. He formulated a cognitive theory. Beck discovered he could train people in therapy to analyze and test their maladaptive cognitions. He learned that doing so could improve their attitudes and emotions. Cognitive therapy garnered worldwide attention. It sparked extensive research efforts. The approach incorporates various behavioral elements. Due to this, it is widely known as cognitive behavioral therapy.
In addition to Ellis and Beck, others contributed to the development and global recognition of CBT. Some of these contributors include Maxie Maultsby, Michael Mahoney, Donald Meichenbaum, David Burns, Marsha Linehan, and Arthur Freeman.
Who Provides Cognitive Behavioral Therapy?
A growing number of mental health professionals use cognitive behavioral therapy. This is often what makes up most of their regular sessions. Other therapists incorporate CBT techniques into their practices. They may use it alongside other approaches.
A variety of training and certification programs exist for therapists who wish to further their training in CBT. The National Association of Cognitive-Behavioral Therapists (NACBT) is one of the most well-known CBT organizations. It provides four certifications for qualified cognitive behavioral therapists to earn including:
- Diplomate in Cognitive-Behavioral Therapy
- Certified Cognitive-Behavioral Therapist
- Certified Cognitive-Behavioral Group Therapist
- Certified Cognitive-Behavioral Group Facilitator
The highest certification awarded by the NACBT is the Diplomate in Cognitive-Behavioral Therapy. The Academy of Cognitive Therapy (ACT) is another well-known organization that offers training and certification in cognitive therapy. ACT and NACBT certifications may demonstrate a higher level of dedication to and specialized training in CBT. But no certification is required for a therapist to practice CBT.
Concerns and Limitations of Cognitive Behavioral Therapy
CBT is not a quick fix for behavioral and mental health issues. Therapists need to demonstrate considerable expertise in the approach. People in therapy will benefit most when they cooperate fully with the treatment program. People with certain complex mental health needs may not be able to benefit right away from cognitive behavioral therapy. This could include people with issues that stem from severe trauma. In some cases, emotional issues must be addressed before cognitive work can begin.
Some people have vague feelings of unhappiness, without clearly defined symptoms. They may also have limited success with cognitive behavioral therapy. People with long-term health issues such as irritable bowel syndrome or chronic fatigue syndrome can use CBT to better cope with their condition. But the physical symptoms of these conditions cannot be cured with CBT.
Finally, CBT can help people develop more positive thought patterns and behaviors. But without a more traditional approach to therapy, they may not gain deeper insights into the psychological and emotional causes of their behavior.
What to Expect
You can get CBT from a psychologist, licensed counselor, licensed clinical social worker, or other professionals with mental health training. Sessions can be one-on-one, in a group, or with self-help materials under your therapist’s guidance.
Your therapist will work with you to set treatment goals, like to feel less depressed or to cut back on alcohol. Usually, you won’t spend much time focusing on your past or your personality traits. Instead, your therapist will help you focus on what you feel and think now, and how to change it.
Treatment usually lasts 10-20 sessions. Some people go just a few times, while others may get therapy for more than a year. Your therapist may give you tasks to do on your own.
Before your treatment ends, your therapist will show you skills to keep your depression from coming back. If it does, it’s a good idea to pick up therapy again. You can also do it any time you feel bad or need to work through a tough problem.
Work only with trained psychotherapists. Their job titles can differ, depending on their role and their education. Most have a master’s or a doctoral degree with specific training in psychological counseling. Psychiatrists, for example, are medical doctors who can prescribe medication and offer psychotherapy.
Before you pick a therapist, check their:
- Certification and license in your state
- Area of expertise, and if it includes depression. Some therapists specialize in eating disorders, PTSD, and other conditions.
It’s important that you trust your therapist and feel they’re on your side. If you’re uncomfortable or don’t see any improvements, you may want to switch therapists.
Cognitive Behavioral Therapy Techniques That Work
Cognitive behavioral therapy techniques come in many shapes and sizes, offering a wide variety to choose from to suit your preferences.
You and your therapist can mix and match techniques depending on what you’re most interested in trying and what works for you. You can also try the following cognitive behavioral therapy techniques as self-help.
In cognitive behavioral therapy, behavioral experiments are designed to test thoughts. For example, you might do a behavioral experiment to test the thought, “If I criticize myself after overeating, I’ll overeat less,” vs. “If I talk to myself kindly after overeating, I’ll overeat less.”
To do this, you would try each approach on different occasions and monitor your subsequent eating habits. This would give you objective feedback about whether self-criticism or self-kindness was more effective in reducing future overeating.
This type of behavioral experiment might also help counteract a (related) thought like, “If I’m kind to myself, it’s like giving myself a free pass to overeat and I’ll lose all self-control.”
Like behavioral experiments, thought records are also designed to test the validity of thoughts. For example, a clinical psychology student who gets negative feedback from a supervisor might jump to the conclusion, “My supervisor thinks I’m useless.” The student could do a thought record evaluating the evidence for and against that thought.
Evidence against the thought might be things like, “My supervisor gave me positive feedback yesterday” or “My supervisor is allowing me to run assessments and give feedback to clients. If she thought I was useless, she probably wouldn’t be allowing me to do that.”
Once you’ve looked at the objective evidence for and against a thought side by side, you’ll be able to come up with more balanced thoughts to take its place. An example of a balanced thought might be, “I made a mistake; making mistakes is normal. I can learn from this. My supervisor will be impressed to see me learning from my mistakes and incorporating her feedback.”
Thought records tend to help change beliefs on a logical level, whereas behavioral experiments may be more helpful in changing beliefs on a gut or felt level—i.e., what you emotionally feel is true, regardless of the objective evidence.
Pleasant Activity Scheduling
Pleasant activity scheduling is a surprisingly effective cognitive behavioral therapy technique. It’s particularly helpful for depression.
Try this: Write the next seven days down on a piece of paper, starting with today (e.g., Thursday, Friday, Saturday). For each day, schedule one pleasant activity (anything you enjoy that’s not unhealthy) that you wouldn’t normally do. It could be as simple as reading a chapter of a novel or eating your lunch away from your desk without rushing.
An alternative version of this technique is to schedule one activity per day that gives you a sense of mastery, competence, or accomplishment. Again, choose something small that you wouldn’t usually do. Aim for something that will take you less than ten minutes. An advanced version of this technique would be to schedule three pleasant activities per day—one for the morning, one for the afternoon, and one for the evening.
Doing activities that produce higher levels of positive emotions in your daily life will help make your thinking less negative, narrow, rigid, and self-focused.
Situation Exposure Hierarchies
Situation exposure hierarchies involve putting things you would normally avoid on a list, ordered from bad to slightly better. For example, a client with an eating disorder might make a list of “forbidden foods,” with ice cream at the top of the list and full-fat yogurt near the bottom. A client with social anxiety might put asking someone on a date at the top of her list and asking someone for directions near the bottom. The theme of the list should reflect your most pressing problem, essentially.
For each item on your list, rate how distressed you think you’d be if you did it. Use a scale from 0 to 10. For example, ice-cream = 10; full-fat yogurt = 2. Order your list from highest to lowest.
Try to have several items at each distress number so there are no big jumps. The idea is to work your way through the list, from lowest to highest. You would likely experiment with each item several times over a period of a few days until the distress you feel about being in that situation is about half of what it was the first time you tried it (e.g., you can eat full-fat yogurt with a level of distress that’s 3 out of 10 instead of 6 out of 10). Then move to the next item up the list.
Imagery Based Exposure
One version of imagery exposure involves bringing to mind a recent memory that provoked strong negative emotions. Let’s take, for instance, the earlier example of a clinical psychology student being given critical feedback by a supervisor.
In imagery exposure, the person would bring the situation of being given the feedback to mind and remember it in lots of sensory detail (e.g., the supervisor’s tone of voice, what the room looked like). They would also attempt to accurately label the emotions and thoughts they experienced during the interaction, and what their behavioral urges were (e.g., to run out of the room and cry, to get angry, etc.). In prolonged imagery exposure, the person would keep visualizing the image in detail until their level of distress reduced to about half its initial level (say from 8 out of 10 to 4 out of 10).
Imagery based exposure can help counteract rumination because it helps make intrusive painful memories less likely to trigger rumination. Because of this, it also tends to help reduce avoidance coping. When a person is less distressed by intrusive memories, they’re able to choose healthier coping actions.
This list of cognitive behavioral therapy techniques is far from exhaustive—but it will give you a good idea of the variety of techniques that are used in cognitive behavioral therapy. If you’re working with a therapist and you’ve been doing your own reading about CBT, you can let your therapist know what techniques you’re excited to try.
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These At-home Cognitive Behavioral Therapy Tips Can Help Ease Your Anxieties
Move over, Freud: There’s a new, popular kind of therapy in town, and it doesn’t involve lying on a couch or talking about your mom.
It’s called cognitive behavioral therapy (CBT), and it’s actually not that new, having been around in one form or another since at least the 1960s. CBT is a form of talk therapy where you interact with a trained therapist, but it isn’t about dredging up your past. Instead, it focuses on the present and teaches you to recognize how you respond to stressors in your life and how you might change your responses in order to ease your distress.
“The therapist and client work together, with the understanding that each person has expertise. The therapist has expertise about how to change behavior and the client has expertise on their life experiences and what matters most to them,” says Kristen Lindgren, Ph.D., a psychologist and CBT expert who practices at University of Washington Medical Center-Roosevelt.
CBT is based on the idea that our thoughts, emotions and behaviors are interconnected and that changing one can change the others. This may sound trendy, but it’s also effective and has been rigorously studied. There are variations of CBT for all kinds of mental health problems, from anxiety to depression to schizophrenia to substance use disorders.
The goal is to learn skills you can use outside the therapist’s office to address real-life problems, Lindgren says. The more you practice, the more of a habit CBT skills will become.
“If you’re someone who has good intentions but need someone to be accountable to, I would make an appointment with a therapist,” Lindgren says. “But if you know you’re a person who is good at being self-taught, it’s reasonable to think about doing it on your own.”
Here are her tips for practicing the techniques at home (or wherever you happen to be).
Change your perspective
Using a technique called cognitive restructuring can help you modify problematic thoughts, which in turn can help you change your behavior. The next time you notice yourself feeling anxious or depressed, ask yourself: What am I thinking about or what emotions am I struggling with that might be causing me to feel this way? Notice if any particular thoughts or memories give rise to distressing physical symptoms; you can even make a list. Doing this will help you begin to understand how your emotions and thoughts are connected and what triggers you.
Balance your thoughts
Many mental health struggles involve distressing, but inherently flawed, thoughts or predictions that influence behavior. For example, if you get anxious when you’re in crowds and thus actively avoid them, you might tell yourself that if you tried to go to a crowded place—like a sports game or concert—you’d panic, do something to embarrass yourself, and wouldn’t enjoy it. That belief then reinforces your avoidance.
SELF HELP FOR DEPRESSION
Depression can happen to anyone – and does happen to one in four of us over our lifetimes. Different factors that make it more likely to happen, include biological make-up, upbringing, or reaction to life events. What keeps it going though, is how we deal with those things. The way we think and what we do affects the way we feel. Depression is often accompanied by other feelings such as guilt, shame, anger and anxiety.
People who are depressed tend to think very negatively about themselves, the future and the world around them. It can be like seeing life through “gloomy specs”.
Everything is hopeless – nothing can change
I’m useless, worthless
It’s all my fault
The world is a terrible place – everything goes wrong
We can dwell on these thoughts repeatedly, mulling over things, asking ourselves why, thinking regretful things about the past, what we should or shouldn’t have done.
“When the past calls, let it go to voicemail – it has nothing new to say.”
Tiredness, fatigue, lethargy
Difficulty concentrating or remembering
Sleep changes (sleep more or less)
Eating changes (eat more or less)
Lose interest in hobbies, activities, sex
Because of the tiredness, difficulty sleeping and eating, and negative style of thinking, we tend to do less and less. We stop doing the things we used to do and enjoy. It could get so bad that we can`t even go to work, or do things at home. We want to stay in bed, or stay at home doing very little. We might isolate ourselves from friends and family.
Vicious Cycle of Depression
Vicious Cogs of Depression
By looking at the “cogs” that keep the central problem going, we can target and make positive changes in each of the cogs, which will at least, slow down, and at best, stop, the central problem, for example:
Print a blank Cogs PDF and fill in the factors that keep your depression going.
Depression Self Help VIDEO
BREAKING THE CYCLE
Activity & Physical Exercise
When we’re depressed, we can feel particularly tired and lack any motivation to do anything. Just increasing our activity and exercise levels can make an enormous impact on our mood as it stimulates the body to produce natural anti-depressants. Just increasing our activity and exercise levels can make an enormous impact on our mood by:
Making us feel better about ourselves
Making us feel less tired
Motivating us to do more
Improving our ability to think more clearly
Helping us think about something other than focussing on our unhelpful thoughts
Using up the adrenaline resources created by anxiety and anger
Giving us a sense of achievement
Being with other people
Stimulating the body to produce natural anti-depressants
Making us generally more healthy
Stimulating our appetite
Schedule ACE activities each day which give you a sense of:
Closeness to others
ACE Activity – video
It’s important to get a healthy balance of activities which give you a sense of achievement, enjoyment and being close to others. Choose activities which are important to you, have positive meanings, or are purposeful, and you might want to plan rest periods too.
Keep your goals realistic and set achievable limits. Eg aim to walk for 15 minutes rather than a half-marathon, or wash the dishes rather than spring clean the whole house. Don`t set yourself up to fail! You can build up your activity over time.
If you struggle with motivation….use the 5 minute rule. Commit to do the activity for just 5 minutes. After 5 minutes, you can choose to stop or continue (and you might find that you want to continue)
Nature as Therapy
See NHS Exercise Videos here
When you’re doing well, or remembering to pace yourself, doing more of what helps, or doing less of what doesn’t – give yourself a treat, a pat on the back.
DOING THINGS DIFFERENTLY
If lack of activity and tiredness is helping to maintain our negative thinking, and therefore keeping us depressed, then doing more (in spite of feeling tired and depressed) will help us feel better.
Do something different (to what you normally do)
Mindfulness – learn Mindful Breathing
Focus your attention fully on another activity – Mindful activity
Relaxation techniques – try lots and find one that works for you
Put on some music – sing and dance along, or just listen attentively (use music that is likely to help you feel your desired emotion – avoid sad songs if you`re depressed)
Meditation or Prayer
Be with others – contact a friend, visit family
Talk to someone
Grounding techniques – look around you, what do you see, hear, smell, sense? Hold a comforting object.
Physical exercise – walk, swim, go to the gym, cycle
- Nature as Therapy
Engage in a hobby or other interest – if you don`t have one, find one! What have you enjoyed in the past? What have you sometimes thought about doing but not got around to?
Recharge your battery and plan more energising activities – do more of those things that help you feel better (see video below)
Write down your thoughts and feelings – get them out of your head. Just write, or use a thought record sheet.
Just take one step at a time – don`t plan too far ahead
Pamper yourself – do something you really enjoy, or do something relaxing
Positive self-talk – encourage yourself, tell yourself: I can do this, I am strong and capable – find an affirmation that works for you (even if you don`t believe it at first!). Write it down and memorise it for when you need it.
Do something creative – make a box of items that remind you to use the techniques that help, or put photos on paper, or write and decorate a list
Consider using a Light Box- particularly with Seasonal Affective Disorder (Depression due to lack of natural light, e.g. every winter, although some people experience SAD at other times)
Use Safe Place Imagery
Tell yourself: “This will pass, it`s only temporary”. “I`ve got through this before, I can do it now”. When we`re going through a tunnel and become fearful of being trapped, there`s no point in stopping – we just have to carry on in order to reach the end of the tunnel. That light is there, and waiting!
Notice the positives – write down or record 3 positive things every day.
Visualise yourself enjoying doing the things you used to enjoy doing, or would like to enjoy doing, and successfully doing the things you need to do.
The Battery: LIFT vs DROP activities
STOPP! Pause, take a breath
What am I reacting to? What have I been thinking about here?
Am I getting things out of proportion?
Is this fact or opinion?
How important is this really? How important will it be in 6 months time?
Am I expecting something from this person or situation that is unrealistic?
What is the worst (and best) that could happen? What is most likely to happen?
Am I using that negative filter? Those gloomy specs? Is there another way of looking at it?
What advice would I give to someone else in this situation?
Am I spending time ruminating about the past or worrying about the future? What could I do right now that would help me feel better?
When I think back to that time I made such a bad decision, could I be looking at it with a hindsight bias?
Am I putting more pressure on myself, setting up expectations of myself that are almost impossible? What would be more realistic?
Am I jumping to conclusions about what this person meant? Am I (mis)reading between the lines? Is it possible that they meant something else?
What do I want or need from this person or situation? What do they want or need from me? Is there a compromise?
Am I just focusing on the worst possible thing that could happen? What would be more realistic?
Is there another way of looking at this? The helicopter view
Am I exaggerating the good aspects of others, and putting myself down? Or am I exaggerating the negative and minimising the positives? How would someone else see it? What`s the bigger picture?
Notice the positives
Things aren`t either totally white or totally black, there are always shades of grey. Where is this on the spectrum?
This is just a reminder of the past. That was then, and this is now. Even though this memory makes me feel upset, it`s not actually happening again right now.
What would be the consequences of doing what I normally do?
Is there another way of dealing with this? What would be the most helpful and effective action to take? (for me, for the situation, for the other person)
Challenge your automatic thoughts
Visualisation: Breathe in orange (for positive energy) and breathe out blue/black. Colour breathing
Coping with Suicidal Thoughts
Depression Thought Record Sheet
vs Draining Activities
SHARP Specs: Notice the Positives
Behavioural Activation Worksheet
Healthy Eating for Depression
Challenge your automatic thoughts
More Self Help resources
Self Help mp3s to reinforce or as stand-alone therapy
POSITIVE IMAGERY FOR DEPRESSION
Female voice, with music.
29 mins 15s
BEHAVIOURAL ACTIVATION FOR DEPRESSION mp3
Female voice, with music.
POSITIVE IMAGERY FOR DEPRESSION
Male voice, with music.
More Self Help mp3s
Self Help Books
5 Get-Positive Techniques From Cognitive Behavioral Therapy
Negative thinking can slow depression recovery, and the reason is obvious: If you think negative thoughts, you’re more likely to stay depressed. But what’s less obvious is the way people with depression deal with positive emotions. Researchers have made a surprising observation: People with depression don’t lack positive emotions, they just don’t allow themselves to feel them.
This cognitive style is called “dampening,” says Chloe Carmichael, PhD, a clinical psychologist in New York. It involves suppressing positive emotions with thoughts such as, “I don’t deserve to be this happy” or “This good feeling won’t last.” For example, a new mother with postpartum depression might tell herself she doesn’t deserve to recover because she’s a bad mother for being depressed in the first place, Dr. Carmichael says.
Why do people with depression think this way? Carmichael refers to that negative voice as defensive pessimism — protection against getting high hopes dashed. “You don’t want to be the fool, so you resort to dampening positive thoughts to protect yourself from potential disappointment,” she says.
How CBT Can Help With the Negative Thoughts of Depression
Cognitive behavioral therapy (CBT) has been found to help significantly with depression treatment. In CBT, you and your therapist work together to agree on patterns of behavior that need to be changed. The goal is to recalibrate the part of your brain that’s keeping such a tight hold on happy thoughts.
“An unexpected reaction to a major life event might be at the root of the dampening effect,” Carmichael says. “Through CBT, you and your therapist address it and work toward putting it into perspective.”
Regular CBT sessions and work you do on your own outside of therapy can help reinforce the new patterns, “To be able to recognize those negative thoughts and leave them behind can be very liberating,” Carmichael says.
5 CBT Techniques to Counteract the Negative Thinking of Depression
Carmichael has found that people with depression rarely respond well to self-study. For this reason, she recommends committing to CBT for at least six weeks. Your therapist will teach you CBT strategies that can help counteract the negative thinking associated with depression. She or he can also help you stay on track with practicing the techniques. Here are five CBT strategies you might end up working on with your therapist:
1. Locate the problem and brainstorm solutions. Journaling and talking with your therapist can help you discover the root of your depression. Once you have an idea, write down in a simple sentence exactly what’s bothering you and think of ways to improve the problem. A hallmark of depression, Carmichael says, is hopelessness — a disbelief that things can ever get better. Writing down a list of things you can do to improve a situation can help ease depressive feelings. For example, if you’re battling loneliness, action steps to try might include joining a local club based on your interests or signing up for online dating.
2. Write self-statements to counteract negative thoughts. After locating the root problems of your depression, think of the negative thoughts you use to dampen positive ones. Write a self-statement to counteract each negative thought. Remember your self-statements and repeat them back to yourself when you notice the little voice in your head creeping in to snuff out a positive thought. In time, you’ll create new associations, replacing the negative thoughts with positive ones.
Carmichael says that the self-statement shouldn’t be too far from the negative thought, or the mind might not accept it. For example, if the negative thought is, “I’m so depressed right now,” rather than saying, “I’m feeling really happy now,” a better statement might be, “Every life has ups and downs, and mine does, too.” The message tells you that it’s okay to bump up the degree of happiness you experience. At the same time, your mind applauds itself for keeping joy in check to protect from disappointment. “It’s okay to recognize that part of you that’s trying to do something healthy,” she says.
Sometimes self-statements become too routine and need to be refreshed, Carmichael says. She recommends to translate your self-statements into other languages that you might speak, or rephrase them, possibly even bumping up their joyful feelings a bit. “For example, the self-statement “It’s okay to explore my ups” might become “It’s okay to have a super ‘up’ day.”
3. Find new opportunities to think positive thoughts. People who enter a room and immediately think, “I hate that wall color,” might instead train themselves to locate five things in the room that they feel positively about as quickly as possible. Set your phone to remind you three times a day to reframe your thoughts into something positive. Carmichael recommends “buddying up” with someone else working on the same technique. That way, you and your buddy can get excited over having positive thoughts and experiences to share with each other throughout the day.
4. Finish each day by visualizing its best parts. At the end of each day, write down or type into an online journal the things in your life you’re most thankful for. Recording positive thoughts, and even sharing those thoughts online, can help you form new associations in your mind or create new pathways, Carmichael says. Someone who’s created a new pathway of thinking might go from waking up in the morning thinking, “Ugh, another workday” to “What a beautiful day it is.”
5. Learn to accept disappointment as a normal part of life. Disappointing situations are a part of life, and your response can affect how quickly you can move forward. Someone going through a breakup might blame him or herself or even gain weight, thinking, “What’s the point in looking good? I’ll never meet anyone else.” A better approach might be to allow yourself to feel disappointed and remember that some things are out of your control. Work on what is within your control: Write down what happened, what you learned from the experience, and what you can do differently next time, watching out for overly negative thoughts. This can help you move on and feel better about your future.
Alcohol & Other Drugs
Part science, part art
Michelle Patterson, PhD, RPsych
Reprinted from “CBT” issue of Visions Journal, 2009, 6 (1), p. 6
Cognitive-behavioural therapy (CBT) combines basic theories about how people learn (behaviourism) with theories about the way people think about and interpret events in their lives (cognition). CBT is now firmly established as the leading psychological treatment for many mental health conditions. Many research studies have demonstrated its effectiveness.1 Research shows that the skills people learn through CBT last long after the treatment ends.2
In CBT, the therapist and the client work together to identify unhelpful patterns of thinking and behaviour. For example, someone might only notice the negative things that happen to them and not notice the positive things. Or, someone might set unrealistic standards for themselves, such as “making mistakes at work is unacceptable.” It’s also important to identify unhelpful behaviours that maintain symptoms, such as avoiding certain situations and withdrawing from others.
The client and therapist also look at how thoughts and behaviours impact feelings. For example, if someone believes that nothing will work out for them in life, they may withdraw from others and avoid new opportunities. This, in turn, can lead to feelings of increased sadness, emptiness and anxiety. This is sometimes called a “vicious circle” of thoughts, feelings and behaviours.
Carefully constructed exercises are used to help clients evaluate and change their thoughts and behaviours. Some aspects of treatment focus more on thoughts and some aspects focus more on behaviours. If a client has difficulty identifying and challenging negative thoughts, the therapist might focus on addressing behaviours such as avoidance, withdrawal or poor social skills. On the other hand, if such behaviours are not as noticeable, the therapist may focus on challenging unrealistic thinking.
Common CBT interventions include:
setting realistic goals and learning how to solve problems (e.g., engaging in more social activities; learning how to be assertive)
learning how to manage stress and anxiety (e.g., learning relaxation techniques such as deep breathing, coping self-talk such as “I’ve done this before, just take deep breaths,” and distraction)
identifying situations that are often avoided and gradually approaching feared situations
identifying and engaging in enjoyable activities such as hobbies, social activities and exercise
identifying and challenging negative thoughts (e.g., “Things never work out for me”)
keeping track of feelings, thoughts and behaviours to become aware of symptoms and to make it easier to change thoughts and behaviours
CBT is most widely applied to mood disorders (such as depression) and anxiety disorders. It is also used to help people with substance use problems, personality disorders, eating disorders, sexual problems and psychosis. It is successfully delivered in individual, group and couples formats.
Applying CBT for depression and problem substance use
CBT for depression usually starts with education about depression and helping the client understand their symptoms as part of an illness that they can do something about.
Treatment strategies include helping clients to establish structure around daily activities, to become more aware of their mood and challenge negative thoughts, and to engage in pleasurable activities.
The therapist and client work together to challenge negative attitudes the client holds about the self, the world and the future, which may contribute to feelings of hopelessness.
John believed he was “no good” and a “failure” at work, in his romantic relationship and in his friendships. Over the years, he came to expect that bad things would happen and that things would always be difficult for him. This led him to give up on things quickly and believe that there was “no point in trying.” John’s therapist helped him identify these beliefs and look at the evidence for and against them. He was able to learn that he viewed the world in black and white, and started challenging himself to see the middle ground. John also learned to be more assertive and to do more activities that made him feel good about himself.
Substance use disorders
In the area of substance use, CBT was first used as a method to prevent relapse when treating problem drinking. It was later adapted to treat individuals who are addicted to nicotine, cocaine, marijuana and other drugs.
Cognitive-behavioural strategies for substance use disorders are based on the theory that learning processes, such as reinforcement and conditioning, play an important role in the development of addictive behaviours. People learn to identify and change problem behaviours by applying a range of different skills that can be used to reduce or stop drug use. Specific skills include:
exploring the positive and negative consequences of continued substance use
self-monitoring to recognize alcohol or drug cravings early on
identifying high-risk situations for substance use
developing strategies for coping with and avoiding high-risk situations and the desire to use
The therapist and client work together to anticipate problems and develop effective coping strategies.
Lynn has been struggling with problem drinking for several years. She knew there would be alcohol served at the upcoming company party. She also knew her co-workers sometimes drink too much and pressure her to drink. Lynn and her therapist developed a plan before the party. Lynn decided to avoid punch and only drink what she could measure, have soft drinks until she got a feel for the party, have no more than one alcoholic drink, stay no more than three hours and ask her boyfriend to pick her up.
Does CBT have limitations?
CBT has been criticized as being overly rigid and mechanistic, that is, focused mainly on an educational approach and setting goals. This may prevent an exploration of the big picture, which includes relationships, family of origin issues and emotions.
Also, relatively little is known about the process of matching treatments (including CBT) to individual people. Skilled practitioners, though, are generally able to adapt CBT to a wide variety of people and circumstances.
CBT is not the best approach for all clients, however. Individuals who have a more chronic or recurring illness may need repeated interventions. Or they may need a shift to approaches other than CBT to address early life experiences as well as personality, interpersonal and identity issues. And given that
CBT is quite structured and tends to focus on thinking rather than emotions, it may not be the best therapy for people who have strong and immediate emotional reactions. More generally, when a client feels very emotional, a focus on cognition and behaviour is less effective for change.
Although CBT has been used with children as young as seven to nine years old, it’s most effective with children over 14. At this age, children have more fully developed cognitive skills. Younger children, or teens and adults with cognitive disabilities, usually respond best to behavioural strategies and structuring of the environment rather than a focus on thinking.
The development of cultural adaptations to CBT is still in the beginning stages. CBT is largely based on the values supported by the dominant culture. In North America, these values include assertiveness, personal independence, verbal ability, logic and behaviour change. But specific manuals have been developed for adapting CBT to Chinese Americans and Haitian American adolescents.3-4 *
CBT should not be applied as a ‘cookie-cutter’ approach. The therapist must carefully assess the client’s motivations and how to best approach him or her. Otherwise, the client may resist the treatment if they don’t accept the model or don’t feel the therapist is listening to them.
Clearly, a skilled practitioner must apply CBT within a good working relationship with the client. This is the art, as opposed to the science, of therapy.
Michelle is an Adjunct Professor and clinical psychologist working at the Centre for Applied Research in Mental Health and Addiction (CARMHA) at Simon Fraser University.
Cognitive-Behavioral Therapy for Depression
CBT is a more short-term approach than psychoanalysis and psychodynamic therapies. Other types of therapies may require several years for discovery and treatment. CBT often requires only 10 to 20 sessions.
The sessions provide opportunities to identify current life situations that may be causing or contributing to your depression. You and your therapist identify current patterns of thinking or distorted perceptions that lead to depression.
This is different from psychoanalysis. That type of therapy involves working backward through your life history to discover an unconscious source of the problems you’re facing.
You may be asked to keep a journal as part of CBT. The journal provides a place for you to record life events and your reactions. The therapist can help you break down reactions and thought patterns into several categories of self-defeating thought. These include:
- all-or-nothing thinking: viewing the world in absolute, black-and-white terms
- disqualifying the positive: rejecting positive experiences by insisting they “don’t count” for some reason
- automatic negative reactions: having habitual, scolding thoughts
- magnifying or minimizing the importance of an event: making a bigger deal about a specific event or moment
- overgeneralization: drawing overly broad conclusions from a single event
- personalization: taking things too personally or feeling actions are specifically directed at you
- mental filter: picking out a single negative detail and dwelling on it exclusively so that the vision of reality becomes darkened
You and your therapist can use the journal to help replace negative thought patterns or perceptions with more constructive ones. This can be done through a series of well-practiced techniques, such as:
- learning to control and modify distorted thoughts and reactions
- learning to accurately and comprehensively assess external situations and reactions or emotional behavior
- practicing self-talk that is accurate and balanced
- using self-evaluation to reflect and respond appropriately
You can practice these coping methods on your own or with your therapist. Alternately you can practice them in controlled settings in which you’re confronted with challenges. You can use these settings to build on your ability to respond successfully. Another option is online CBT. This allows you to practice these methods in the comfort of your home or office.
How it works
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT)
CBT can be carried out with a therapist in 1-to-1 sessions or in groups with other people in a similar situation to you.
If you have CBT on an individual basis, you’ll usually meet with a CBT therapist for between 5 and 20 weekly or fortnightly sessions, with each session lasting 30 to 60 minutes.
Exposure therapy sessions usually last longer to ensure your anxiety reduces during the session. The therapy may take place:
- in a clinic
- outside – if you have specific fears there
- in your own home – particularly if you have agoraphobia or OCD involving a specific fear of items at home
Your CBT therapist can be any healthcare professional who has been specially trained in CBT, such as a psychiatrist, psychologist, mental health nurse or GP.
The first few sessions will be spent making sure CBT is the right therapy for you, and that you’re comfortable with the process. The therapist will ask questions about your life and background.
If you’re anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They’ll also ask about events that may be related to your problems, treatments you’ve had, and what you would like to achieve through therapy.
If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it’s not appropriate, or you do not feel comfortable with it, they can recommend alternative treatments.
After the initial assessment period, you’ll start working with your therapist to break down problems into their separate parts. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.
You and your therapist will analyse your thoughts, feelings and behaviours to work out if they’re unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:
- questioning upsetting thoughts and replacing them with more helpful ones
- recognising when you’re going to do something that will make you feel worse and instead doing something more helpful
You may be asked to do some “homework” between sessions to help with this process.
At each session, you’ll discuss with your therapist how you’ve got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.
Confronting fears and anxieties can be very difficult. Your therapist will not ask you to do things you do not want to do and will only work at a pace you’re comfortable with. During your sessions, your therapist will check you’re comfortable with the progress you’re making.
One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return.
Learning about Anxiety: Psychoeducation
An important first step in overcoming a psychological problem is to learn more about it, otherwise known as “psychoeducation.”
Learning about your problem can give you the comfort of knowing that you’re not alone and that others have found helpful strategies to overcome it. You may even find it helpful for family members and friends to learn more about your problem as well. Some people find that just having a better understanding of their problems is a huge step towards recovery.
For example, an individual suffering from frequent panic attacks would begin by learning what a panic attack is (see Panic Disorder). In learning about panic, one would discover that although a panic attack is an uncomfortable experience, it’s temporary and not dangerous.
A CBT therapist is able to provide helpful information on your particular problem, but you can also find information on your own through reputable sources at bookstores and on the Internet.
Psychoeducation is a vital first step, but it’s important to remember that this is only one part of a complete treatment plan.
Learning how to relax your body can be a helpful part of therapy. Muscle tension and shallow breathing are both linked to stress and anxiety (and sometimes depression). So, it’s important to become aware of these bodily sensations and to regularly practice exercises to help you learn to relax.
Two strategies often used in CBT are Calm Breathing, which involves consciously slowing down the breath, and Progressive Muscle Relaxation, which involves systematically tensing and relaxing different muscle groups. As with any other skill, the more these relaxation strategies are practiced, the more effectively and quickly they will work. Other helpful relaxation strategies include listening to calm music, meditation, yoga and massage.
It’s important to realize, however, that the goal of relaxation is not to avoid or eliminate anxiety (because anxiety is not dangerous), but to make it a little easier to ride out these feelings.
Effectively managing negative emotions involves identifying negative thinking and replacing it with realistic and balanced thinking. Because our thoughts have a big impact on the way we feel, changing our unhelpful thoughts to realistic or helpful ones is a key to feeling better. “Realistic thinking” means looking at yourself, others, and the world in a balanced and fair way, without being overly negative or positive. For example:
|Unhelpful and unrealistic thought||More realistic and balanced thought|
|I always screw things up, I’m such a loser. What’s wrong with me?||Everyone makes mistakes, including me – I’m only human. All I can do now is try my best to fix the situation and learn from this experience.|
|I can’t do it. I feel way too anxious. Why can’t I control my anxiety?||It’s OK and normal to feel anxious. It’s not dangerous, and it doesn’t have to stop me. I can feel anxious and STILL go to the party.|
Steps to Realistic Thinking
Know what you’re thinking or telling yourself. Most of us are not used to paying attention to the way we think, even though we are constantly affected by our thoughts. Paying attention to your thoughts (or self-talk) can help you keep track of the kind of thoughts you typically have.
Once you’re more aware of your thoughts, try to identify the thoughts that make you feel bad, and determine if they’re problematic thoughts that need to be challenged. For example, if you feel sad thinking about your grandmother who’s been battling cancer, this thought doesn’t need to be challenged because it’s absolutely normal to feel sad when thinking about a loved one suffering. But, if you feel sad after a friend cancels your lunch plans and you begin to think there’s obviously something seriously wrong with you and no one likes you, this is problematic because this thought is extreme and not based on reality.
Pay attention to the shift in your emotion, no matter how small. When you notice yourself getting more upset or distressed, ask yourself, “What am I telling myself right now?” or “What is making me feel upset?”
When you’re accustomed to identifying thoughts that lead to negative emotions, start to examine these thoughts to see if they’re unrealistic and unhelpful. One of the first things to do is to see if you’ve fallen into Thinking Traps (e.g., catastrophizing or overestimating danger), which are overly negative ways of seeing things. You can also ask yourself a range of questions to challenge your negative thoughts (see Challenge Negative Thinking), such as “What is the evidence that this thought is true?” and “Am I confusing a possibility with a probability? It may be possible, but is it likely?”
Finally, after challenging a negative thought and evaluating it more objectively, try to come up with an alternative thought that is more balanced and realistic. Doing this can help lower your distress. In addition to coming up with realistic statements, try to come up with some quick and easy-to-remember coping statements (e.g., “This has happened before and I know how to handle it”) and positive self-statements (e.g., “It takes courage to face the things that scare me”).
It can also be particularly helpful to write down your realistic thoughts or helpful coping statements on an index card or piece of paper. Then, keep this coping card with you to help remind you of these statements when you are feeling too distressed to think clearly.
Facing Fears: Exposure
It’s normal to want to avoid the things you fear because this reduces your anxiety in the short term. For example, if you’re afraid of small, enclosed places like elevators, taking the stairs instead will make you less anxious. However, avoidance prevents you from learning that the things you fear aren’t as dangerous as you think. So, in this case, taking the stairs prevents you from learning that nothing bad happens when you do take the elevator.
In CBT, the process of facing fears is called exposure – and it’s the most important step in learning to effectively manage your anxiety. Exposure involves gradually and repeatedly entering feared situations until you feel less anxious. You start with situations that only cause you a little bit of anxiety, and you work your way up to facing things that cause you a greater deal of anxiety (See Facing Fears: Exposure).
The first step involves making a list of the situations, places or objects that you fear. For example, if you’re afraid of spiders and want to overcome this fear so you can enjoy camping with friends, the list may include: looking at pictures of spiders, watching videos of spiders, observing a spider in an aquarium, and standing across the room from someone holding a spider. Once you have a list, order it from the least scary to the scariest.
Starting with the situation that causes you the least anxiety, repeatedly take part in that activity or face that situation (e.g., looking at pictures of spiders) until you start to feel less anxious doing it. Once you can face that specific situation many different times without experiencing much anxiety, you’re ready to move on to the next step on your list.
CBT stresses the importance of facing fears on a regular basis. The more you practice, the faster your fears will fade! Having successes and feeling good about your progress is a powerful motivator to keep going.
How to Prevent a Relapse
Managing your problem effectively is a lot like exercise – you need to “keep in shape” and make practicing the helpful skills a daily habit. However, sometimes people slip back into old habits, lose the improvements they’ve made and have a relapse. A relapse is a complete return to all of your old ways of thinking and behaving before you learned new strategies for managing your problem. While it’s normal for people to experience lapses (a brief return to old habits) during times of stress, low mood or fatigue, a relapse certainly does not have to take place. Here are some tips on how to prevent lapses and relapses:
Keep practicing your CBT skills! This is the best way to prevent a relapse. If you’re practicing regularly, you’ll be in good shape to handle whatever situations you’re faced with.
Tip: Make a schedule for yourself of what skills you’re going to work on every week.
Know when you are more vulnerable to having a lapse (e.g., during times of stress or change), and you’ll be less likely to have one. It also helps to make a list of warning signs (e.g., more anxious thoughts, frequent arguments with loved ones) that tell you your anxiety might be increasing. Once you know what your warning signs or “red flags” are, you can then make an action plan to cope with them. This might involve, for example, practicing some CBT skills like calm breathing or challenging your negative thinking.
Remember that, like everyone else on earth, you are a work in progress! A good way to prevent future lapses is to continue working on new challenges. You’re less likely to slide back into old habits if you’re continually working on new and different ways of overcoming your anxiety.
If you have had a lapse, try to figure out what situation led you to it. This can help you make a plan to cope with difficult situations in the future. Keep in mind that it’s normal to occasionally have lapses and that you can learn a lot from them.
How you think about your lapse has a huge impact on your later behaviour. If you think that you’re a failure and have undone all your hard work, you’re more likely to stop trying and end up relapsing. Instead, it’s important to keep in mind that it’s impossible to unlearn all the skills and go back to square one (i.e., having anxiety and not knowing how to handle it) because you do know how to handle your anxiety. If you have a lapse, you can get back on track. It’s like riding a bike: once you know how to ride one, you don’t forget it! You might become a bit rusty, but it won’t be long until you’re as good as before.
Remember that lapses are normal and can be overcome. Don’t beat yourself up or call yourself names like “idiot” or “loser,” because this doesn’t help. Be kind to yourself, and realize that we all make mistakes sometimes!
Finally, make sure to reward yourself for all the hard work you’re doing. A reward might be going out for a nice meal or buying yourself a little treat. Managing anxiety is not always easy or fun, and you deserve a reward for your hard work!
Essentially, the client brings in the problems they’d like to overcome or the situations they find stressful, and the therapist and client work together to create an action plan. An action plan means they identify the problematic thoughts or behaviors, find a way to change them, and develop a strategy to implement this change in the coming week. This is where “homework” comes in.
5. What is CBT homework like?
CBT is focused on providing a quick (8 to 12 sessions, which is quick by therapy standards) and effective reduction of symptoms, which is best done by applying the techniques throughout the week, not just during the therapy session. Typical homework might include relaxation exercises, keeping a journal of thoughts and emotions throughout the week, using worksheets that target a specific area of growth, reading a book that applies to your issues, or seeking out situations to apply your new approach. For example, Jane may want to keep an eye out for meet-up events that challenge her to overcome her fears while she applies her new relaxation techniques.
Another example: Let’s say a major factor in John Doe’s depression is his negative internal self-talk—he constantly belittles and berates himself on a loop. John and his CBT therapist may discuss a technique called “thought stopping” where he abruptly disrupts the flow of negative thoughts by yelling (in his mind) “Stop!” as he redirects his thoughts to something more positive like an affirmation or a meditation app. Homework may involve practicing this technique at least once every day until the next session. John and his therapist will debrief in the next session, evaluate what worked and what didn’t, and tweak the process for the following week.
6. How long does CBT treatment usually last?
One of the highlights of CBT is that it is focused on eliminating symptoms as quickly as possible, typically in a few weeks to a few months. Of course, people rarely have only a single issue to work on in therapy, so this length depends on the number and severity of the issues, but brevity is key to this approach.
This brings up one of the major differences between CBT and many other forms of therapy. According to Donald Meichenbaum, one of the founders of CBT, “ what and how questions. Why questions are not very productive.” While other treatment approaches spend a great deal of time digging deep and asking why you feel depressed, anxious, or have low self-esteem, CBT sticks to the current thoughts and behaviors. Rather than examining why you are afraid of snakes, CBT focuses on helping you reduce your fear. While some people are content with reducing their symptoms, others want to know why they exist in the first place. For them, deeper approaches like psychodynamic therapy may be more satisfying.
7. Are there CBT techniques that people can use outside of actual therapy sessions?
Have you ever kept a gratitude journal? What about monitoring your donut intake? Have you tracked your daily steps or monitored your sleep? Then you’re already applying some of the principles of CBT in your everyday life. You can find many of CBT’s techniques in books like David Burns’s Feeling Good or Edmund Bourne’s Anxiety and Phobia Workbook, online, or in popular apps like Headspace and Happify. But for a course of CBT tailored to you and your issues, a period of time in structured therapy is still the best approach.
8. How much does CBT cost, and will insurance cover it?
CBT is psychotherapy, so if your insurance covers psychotherapy or behavioral medicine, it should cover most, if not all, of your CBT therapy. If you’re paying out of pocket, CBT costs range from free or on a sliding scaled at some community clinics, to $200+ per session in a private practice. Again, the length of time someone spends in treatment is generally less than other treatment approaches, so it may be cheaper in the long run. You can search for a therapist who practices CBT and fits your budget on a therapist finder website like Psychology Today or GoodTherapy.
9. Are there down sides to choosing CBT versus another type of therapy?
Some clients may feel that they want therapy to be a place where they come and process their experiences with some gentle facilitation by their therapist. Their main goal may not be dealing with a specific symptom or problematic habit, but more about general growth and a long-term relationship with a therapist. Maybe they want to explore their memories, dreams, and early relationships with guidance from their therapist. Given that CBT can be a more direct and practical style of therapy, it may not feel helpful for someone seeking that kind of deep, relational work. Having said that, many skilled therapists who practice CBT are very flexible with their approach, and can adjust to meet the needs of a variety of clients.
CBT is not without its critiques, as even Dr. Hsia admits. “Fair criticisms of CBT highlight its ‘one-size-fits-all’ assumptions about what helps people get better,” he says. Again, CBT focuses on symptoms instead of those symptoms’ deeper roots, and some psychologists who feel the deeper roots are essential would consider CBT short-sighted. In the end, you need to find out what works best for you, and that might take some trial and error.
You may find it most helpful to talk to your therapist (or potential therapist) about what you’re seeking help for and ask them how they would approach the treatment. Whether you receive CBT treatment or another method, the most important thing is that you feel a safe, trusting connection with your therapist and that the treatment makes sense to you.
Ryan Howes, Ph.D., ABPP, is a licensed clinical therapist who practices in Pasadena, California.
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Cognitive Behavioral Therapy Exercises
What is CBT?
CBT provides a simple way of understanding challenging situations and problematic reactions to them. Cognitive behavioral therapy emphasizes three main components implicated in psychological problems: thoughts, emotions, and behaviors. By breaking down difficult feelings into these component parts, it becomes very clear where and how to intervene when an issue arises. If a particular negative thought seems to be causing a chain reaction of negative emotion and behavior, the best solution may be to reexamine that thought. If a behavioral pattern seems responsible, it’s likely a new behavioral response to the situation would be helpful.
Often, all three components are interwoven throughout difficult problems and feelings. Cognitive behavioral therapy exercises are designed to intervene on all three components simultaneously. For instance, when uncontrollable worry is the problem, CBT exercises can help people to identify more effective and grounded thoughts, which lessens anxiety. In turn, reduced anxiety makes it easier to engage in skillful behavior to actively address the triggering problematic situation.
Below is a list of cognitive behavioral therapy exercises common to a number of different CBT treatments:
Cognitive Restructuring: Cognitive restructuring is a cognitive behavioral therapy exercise designed to help people examine unhelpful thinking patterns and devise new ways of reacting to problematic situations. Cognitive restructuring often involves keeping a thought record, which is a way of tracking dysfunctional automatic thoughts, and devising adaptive alternative responses.
Cognitive Behavioral Therapy Exercises: Cognitive Restructuring
During Cognitive Behavioral Therapy the client and therapist collaborate through an open dialogue to develop a problem definition and goal. Goals can be behavioral, cognitive, or physical in nature and can be defined by problem or process. Cognitive Behavioral Therapy uses a range of therapeutic techniques to achieve these goals. Ultimately, however, despite the vast toolbox of techniques, client change is related to his/her investment in the process of CBT.
5 Common Cognitive Behavioral Techniques:
- Socratic Questioning: Questioning allows the therapist to stimulate the client’s self-awareness, focus in on the problem definition, expose the client’s belief system, and challenge irrational beliefs while revealing the clients cognitive processes.
- Homework: To assist with cognitive restructuring, clients are often assigned homework. Typical CBT homework assignments may include activities in behavioral activation, monitoring automatic thoughts, reviewing the previous therapy session, and preparing for the next therapy session.
- Self-Monitoring: Also called diary work, self-monitoring is used to record the amount and degree of thoughts and behaviors. This provides the client and therapist information regarding the degree of a client’s negative affirmations.
- Behavioral Experiments: The experiment process includes experiencing, observing, reflecting, and planning. These steps are conducted through thought testing, discovery, activity, and/or observation.
- Systematic Desensitization: Systematic Desensitization pairs relaxation with exposure to something stressful. Clients are taught to relax in anxiety producing situations.
If you live in the Lehigh Valley, including Allentown, Bethlehem, Easton, and surrounding areas and would like to discuss your goals with a cognitive behavioral therapist, simply complete the form on the right or call (610) 434-1540 to schedule an appointment.