What techniques are used with

CBT? 
The key principle behind CBT is that your thought patterns affect your
emotions, which, in turn, can affect your behaviors.

For instance, CBT highlights how negative thoughts can lead to negative

feelings and actions. But, if you reframe your thoughts in a more positive way,
it can lead to more positive feelings and helpful behaviors.

Your therapist will teach you how to make changes you can implement right
now. These are skills you can continue to use for the rest of your life.

Depending on the issue you’re dealing with and your goals, there are several
ways to approach CBT. Whatever approach your therapist takes, it will
include:

 identifying specific problems or issues in your daily life

 becoming aware of unproductive thought patterns and how they can
impact your life
 identifying negative thinking and reshaping it in a way that changes how
you feel
 learning new behaviors and putting them into practice

After speaking with you and learning more about the issue you want help with,
your therapist will decide on the best CBT strategies to use.

Some of the techniques that are most often used with CBT include the
following 9 strategies:
1. Cognitive restructuring or reframing

This involves taking a hard look at negative thought patterns.

Perhaps you tend to over-generalize, assume the worst will happen, or place

far too much importance on minor details. Thinking this way can affect what
you do and it can even become a self-fulfilling prophecy.

Your therapist will ask about your thought process in certain situations so you
can identify negative patterns. Once you’re aware of them, you can learn how
to reframe those thoughts so they’re more positive and productive.

For example: “I blew the report because I’m totally useless” can become “That
report wasn’t my best work, but I’m a valuable employee and I contribute in
many ways.”

2. Guided discovery

In guided discovery, the therapist will acquaint themselves with your

viewpoint. Then they’ll ask questions designed to challenge your beliefs and
broaden your thinking.

You might be asked to give evidence that supports your assumptions, as well
as evidence that does not.

In the process, you’ll learn to see things from other perspectives, especially
ones that you may not have considered before. This can help you choose a
more helpful path.

3. Exposure therapy
Exposure therapy can be used to confront fears and phobias. The therapist
will slowly expose you to the things that provoke fear or anxiety, while
providing guidance on how to cope with them in the moment.

This can be done in small increments. Eventually, exposure can make you
feel less vulnerable and more confident in your coping abilities.

4. Journaling and thought records

Writing is a time-honored way of getting in touch with your own thoughts.

Your therapist may ask you to list negative thoughts that occurred to you
between sessions, as well as positive thoughts you can choose instead.

Another writing exercise is to keep track of the new thoughts and new
behaviors you put into practice since the last session. Putting it in writing can
help you see how far you’ve come.

5. Activity scheduling and behavior activation

If there’s an activity you tend to put off or avoid due to fear or anxiety, getting
it on your calendar can help. Once the burden of decision is gone, you may be
more likely to follow through.

Activity scheduling can help establish good habits and provide ample
opportunity to put what you’ve learned into practice.

6. Behavioral experiments

Behavioral experiments are typically used for anxiety disorders that

involve catastrophic thinking.
Before embarking on a task that normally makes you anxious, you’ll be asked
to predict what will happen. Later, you’ll talk about whether the prediction
came true.

Over time, you may start to see that the predicted catastrophe is actually not
very likely to happen. You’ll likely start with lower-anxiety tasks and build up
from there.

7. Relaxation and stress reduction techniques

In CBT, you may be taught some progressive relaxation techniques, such as:

 deep breathing exercises

 muscle relaxation
 imagery

You’ll learn practical skills to help lower stress and increase your sense of

control. This can be helpful in dealing with phobias, social anxieties, and other
stressors.

8. Role playing

Role playing can help you work through different behaviors in potentially
difficult situations. Playing out possible scenarios can lessen fear and can be
used for:

 improving problem solving skills

 gaining familiarity and confidence in certain situations
 practicing social skills
 assertiveness training
  improving communication skills

9. Successive approximation

This involves taking tasks that seem overwhelming and breaking them into
smaller, more achievable steps. Each successive step builds upon the
previous steps so you gain confidence as you go, bit by bit.

What happens during a CBT

session? 
In your first session, you’ll help the therapist understand the problem you’re
dealing with and what you hope to achieve with CBT. The therapist will then
formulate a plan to achieve a specific goal.

Goals should be:

 Specific
 Measurable
 Achievable
 Realistic
 Time-limited

Depending on your situation and your SMART goals, the therapist might
recommend individual, family, or group therapy.

Sessions generally last about an hour and take place once a week, though
this can vary according to individual needs and availability.
Homework is also part of the process, so you’ll be asked to fill out worksheets,
a journal, or perform certain tasks between sessions.

Open communication and feeling comfortable with your therapist are key. If
you don’t feel completely comfortable with your therapist, try to find a therapist
you can connect with and open up to more easily.

Look for a therapist who’s trained in CBT and who has experience treating
your specific problem. Check to make sure they’re properly certified and
licensed.

You may want to talk to your doctor or other healthcare providers for
recommendations. Practitioners may include:

 psychiatrists
 psychologists
 psychiatric nurse practitioners
 social workers
 marriage and family therapists
 other professionals with mental health training

Most of the time, CBT takes a few weeks to a few months to start seeing
results.

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What can CBT help with? 
CBT can help with a variety of everyday problems, such as learning to cope
with stressful situations or dealing with anxiety over a certain issue.

You don’t need a medical diagnosis to benefit from CBT.

It can also help with:

 learning to manage powerful emotions like anger, fear, or sadness

 dealing with grief
 managing symptoms or preventing mental illness relapses
 coping with physical health problems
 conflict resolution
 improving communication skills
 assertiveness training

CBT can be effective for a variety of conditions, either alone or in combination

with other therapies or medications. This includes:

 addictions
 anxiety disorders
 bipolar disorders
 chronic pain
 depression
 eating disorders
 obsessive-compulsive disorder (OCD)
 phobias
  post-traumatic stress disorder (PTSD)
 schizophrenia
 sexual disorders
 sleep disorders
 tinnitus

Are there any risks? 

CBT is not generally considered a risky therapy, though there are some things
to keep in mind:

 It’s a very individual thing, but in the beginning, some people might find
it stressful or uncomfortable to confront their problems.
 Some types of CBT, like exposure therapy, can increase stress and
anxiety while you’re working your way through it.
 It doesn’t work overnight. It takes commitment and willingness to work
on new techniques between sessions and after therapy has ended. It’s
helpful to think of CBT as a lifestyle change that you intend to follow and
improve upon throughout your life.

The bottom line

Cognitive behavioral therapy (CBT) is a well-established, effective type of
short-term therapy. It’s based on the connections between your thoughts,
emotions, and behaviors, and how they can influence each other.
There are quite a few techniques that are used with CBT. Depending on the
type of issue you want help with, your therapist will help figure out which CBT
strategy is best suited to your particular needs.

The cognitive techniques found in my book and others include:

Identifying your thought patterns.

Discovering how your thoughts affect your feelings and behaviors.

Determining if your thoughts are accurate.

Replacing biased thoughts with more realistic ones.

Common behavioral techniques include:

Scheduling activities that bring you enjoyment and a sense of accomplishment.

Recognizing how your actions influence your thoughts and emotions.

Making the best use of your time.

Breaking down daunting tasks into more manageable ones.

Facing your fears gradually so they diminish.

How to Use Cognitive Restructuring

Follow the steps below to use the cognitive restructuring technique.

This framework is based on the 7-Column Thought Record by Christine A.

Padesky, from the book "Mind Over Mood," which is well worth reading for a
deeper understanding of this technique.

Step 1: Calm Yourself

If you're still upset or stressed by the thoughts you want to explore, you may
find it hard to concentrate on using the tool. Use meditation  or deep
breathing  to calm yourself down if you feel particularly stressed or upset.
Step 2: Identify the Situation
Start by describing the situation that triggered your negative mood.

Step 3: Analyze Your Mood

Next, write down the mood, or moods, that you felt during the situation.

Here, moods are the fundamental feelings that we have, but they are not
thoughts about the situation. Drs Greenberger and Padesky suggest an easy
way to distinguish moods from thoughts: you can usually describe moods in
one word, while thoughts are more complex.

For example, "He trashed my suggestion in front of my co-workers" would be

a thought, while the associated moods might be humiliation, frustration, anger,
or insecurity.

Step 4: Identify Automatic Thoughts

Now, write down the natural reactions, or "automatic thoughts," you
experienced when you felt the mood. In the example above, your thoughts
might be:

 "Maybe my analysis skills aren't good enough."

 "Have I failed to consider these things?"
 "He hasn't liked me since…"
 "He's so rude and arrogant!"
 "No one likes me."
 "But my argument is sound."
 "This undermines my future with this company."
In this example, the most distressing thoughts (the "hot thoughts") are likely to
be "Maybe my analysis skills aren't good enough," and, "No one likes me."

Step 5: Find Objective Supportive Evidence

Identify the evidence that objectively supports your automatic thoughts. In our
example, you might write the following:

 "The meeting moved on and decisions were made, but my suggestion

was ignored."
 "He identified a flaw in one of my arguments."
Your goal is to look objectively at what happened, and then to write down
specific events or comments that led to your automatic thoughts.

Step 6: Find Objective Contradictory Evidence

Next, identify and write down evidence that contradicts the automatic thought.
In our example, this might be:

 "The flaw was minor and did not alter the conclusions."
 "The analysis was objectively sound, and my suggestion was realistic
and well-founded."
 "I was top of my class when I trained in the analysis method."
 "My clients respect my analysis, and my opinion."
As you can see, these statements are fairer and more rational than the
reactive thoughts.

Step 7: Identify Fair and Balanced Thoughts

By this stage, you've looked at both sides of the situation. You should now
have the information you need to take a fair, balanced view of what happened.

If you still feel uncertain, discuss the situation with other people, or test the
question in some other way.

When you come to a balanced view, write these thoughts down. The balanced
thoughts in this example might now include:

 "I am good at this sort of analysis. Other people respect my abilities."

 "My analysis was reasonable, but not perfect."
 "There was an error, but it didn't affect the validity of the conclusions."
 "The way he handled the situation was not appropriate."
 "People were surprised and a little shocked by the way he handled my
suggestion." (This comment would have followed an informal conversation
with other people at the meeting.)

Step 8: Monitor Your Present Mood

You should now have a clearer view of the situation, and you're likely to find
that your mood has improved. Write down how you feel.

Next, reflect on what you could do about the situation. (By taking a balanced
view, the situation may cease to be important, and you might decide that you
don't need to take action.)

Finally, create some positive affirmations  that you can use to counter any

similar automatic thoughts in the future.
Warning:
Negative thinking can cause severe health problems and, in extreme cases,
death. While cognitive restructuring has been shown to have a positive effect
on reducing occasional negative thinking, they are for guidance only, and
readers should take the advice of suitably qualified health professionals if
they have any concerns over related illnesses or if negative thoughts
are causing significant or persistent unhappiness. Health professionals should
also be consulted before any major change in diet or levels of exercise.
Key Points
Cognitive restructuring is useful for understanding what lies behind negative
moods. These may undermine our performance, or damage our relationships
with other people.

To use cognitive restructuring, work through the following process:

 Calm yourself.
 Write down the situation that triggered the negative thoughts.
 Identify the moods that you felt in the situation.
 Write down the automatic thoughts you experienced when you felt the
mood. The most significant of these are your "hot thoughts."
 Identify the evidence that supports these hot thoughts.
 Identify the evidence that contradicts the hot thoughts.
 Now, identify fair, balanced thoughts about the situation.
 Finally, observe your mood now, and decide on your next steps.
Go through this process when you experience a negative mood, or when you
feel fear, apprehension, or anxiety about a person or event.
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