What influences the way we think and behave is very complex. From our environment, the way we grew up, social media, what we watch, who we spend time with - these things can all shape us in one way or another. However, our feelings, reactions and behaviours are ultimately up to us and they can be changed. The article below outlines Cognitive Behavioural Therapy - what it is, how it can help us to explore/ modify our thoughts & behaviours, and techniques we can implement.
Even if you’re relatively unfamiliar with psychology, chances are you’ve heard of cognitive-behavioural therapy, commonly known as CBT. It’s an extremely common type of talk therapy practiced around the world.
If you’ve ever interacted with a mental health therapist, a counsellor, or a psychiatry clinician in a professional setting, it’s likely you’ve participated in CBT. If you’ve ever heard friends or loved ones talk about how a mental health professional helped them identify unhelpful thoughts and patterns and behaviour and alter them to more effectively work towards their goals, you’ve heard about the impacts of CBT.
CBT is one of the most frequently used tools in the psychologist’s toolbox. Though it’s based on simple principles, it can have wildly positive outcomes when put into practice.
What is CBT?
“This simple idea is that our unique patterns of thinking, feeling, and behaving are significant factors in our experiences, both good and bad. Since these patterns have such a significant impact on our experiences, it follows that altering these patterns can change our experiences” (Martin, 2016).
Cognitive-behavioural therapy aims to change our thought patterns, our conscious and unconscious beliefs, our attitudes, and, ultimately, our behaviour, in order to help us face difficulties and achieve our goals.
Psychiatrist Aaron Beck was the first to practice cognitive behavioural therapy. Like most mental health professionals at the time, Beck was a psychoanalysis practitioner.
While practicing psychoanalysis, Beck noticed the prevalence of internal dialogue in his clients and realised how strong the link between thoughts and feelings can be. He altered the therapy he practiced in order to help his clients identify, understand, and deal with the automatic, emotion-filled thoughts that regularly arose in his clients.
Beck found that a combination of cognitive therapy and behavioural techniques produced the best results for his clients. In describing and honing this new therapy, Beck laid the foundations of the most popular and influential form of therapy of the last 50 years.
This form of therapy is not designed for lifelong participation and aims to help clients meet their goals in the near future. Most CBT treatment regimens last from five to ten months, with clients participating in one 50- to 60-minute session per week.
CBT is a hands-on approach that requires both the therapist and the client to be invested in the process and willing to actively participate. The therapist and client work together as a team to identify the problems the client is facing, come up with strategies for addressing them, and creating positive solutions (Martin, 2016).
Cognitive Distortions
Many of the most popular and effective cognitive-behavioural therapy techniques are applied to what psychologists call “cognitive distortions,” inaccurate thoughts that reinforce negative thought patterns or emotions (Grohol, 2016).
There are 15 main cognitive distortions that can plague even the most balanced thinkers.
1. Filtering
Filtering refers to the way a person can ignore all of the positive and good things in life to focus solely on the negative. It’s the trap of dwelling on a single negative aspect of a situation, even when surrounded by an abundance of good things.
2. Polarised thinking / Black-and-white thinking
This cognitive distortion is all-or-nothing thinking, with no room for complexity or nuance—everything’s either black or white, never shades of grey.
If you don’t perform perfectly in some area, then you may see yourself as a total failure instead of simply recognising that you may be unskilled in one area.
3. Overgeneralisation
Overgeneralisation is taking a single incident or point in time and using it as the sole piece of evidence for a broad conclusion.
For example, someone who overgeneralizes could bomb an important job interview and instead of brushing it off as one bad experience and trying again, they conclude that they are terrible at interviewing and will never get a job offer.
4. Jumping to conclusions
Similar to overgeneralisation, this distortion involves faulty reasoning in how one makes conclusions. Unlike overgeneralising one incident, jumping to conclusions refers to the tendency to be sure of something without any evidence at all.
For example, we might be convinced that someone dislikes us without having any real evidence, or we might believe that our fears will come true before we have a chance to really find out.
5. Catastrophising / Magnifying or Minimising
This distortion involves expecting that the worst will happen or has happened, based on an incident that is nowhere near as catastrophic as it is made out to be. For example, you may make a small mistake at work and be convinced that it will ruin the project you are working on, that your boss will be furious, and that you’ll lose your job.
Alternatively, one might minimise the importance of positive things, such as an accomplishment at work or a desirable personal characteristic.
6. Personalisation
This is a distortion where an individual believes that everything they do has an impact on external events or other people, no matter how irrational that may be. A person with this distortion will feel that he or she has an exaggerated role in the bad things that happen around them.
For instance, a person may believe that arriving a few minutes late to a meeting led to it being derailed and that everything would have been fine if they were on time.
7. Control fallacies
This distortion involves feeling like everything that happens to you is either a result of purely external forces or entirely due to your own actions. Sometimes what happens to us is due to forces we can’t control, and sometimes what it’s due to our own actions, but the distortion is assuming that it is always one or the other.
We might assume that difficult co-workers are to blame for our own less-than-stellar work, or alternatively assume that every mistake another person makes is because of something we did.
8. Fallacy of fairness
We are often concerned about fairness, but this concern can be taken to extremes. As we all know, life is not always fair. The person who goes through life looking for fairness in all their experiences will end up resentful and unhappy.
Sometimes things will go our way, and sometimes they will not, regardless of how fair it may seem.
9. Blaming
When things don’t go our way, there are many ways we can explain or assign responsibility for the outcome. One method of assigning responsibility is blaming others for what goes wrong.
Sometimes we may blame others for making us feel or act a certain way, but this is a cognitive distortion. Only you are responsible for the way you feel or act.
10. “Shoulds”
“Shoulds” refer to the implicit or explicit rules we have about how we and others should behave. When others break our rules, we are upset. When we break our own rules, we feel guilty. For example, we may have an unofficial rule that customer service representatives should always be accommodating to the customer.
When we interact with a customer service representative that is not immediately accommodating, we might get angry. If we have an implicit rule that we are irresponsible if we spend money on unnecessary things, we may feel exceedingly guilty when we spend even a small amount of money on something we don’t need.
11. Emotional reasoning
This distortion involves thinking that if we feel a certain way, it must be true. For example, if we feel unattractive or uninteresting in the current moment, we think we are unattractive or uninteresting. This cognitive distortion boils down to:
“I feel it, therefore it must be true.”
Clearly, our emotions are not always indicative of the objective truth, but it can be difficult to look past how we feel.
12. Fallacy of change
The fallacy of change lies in expecting other people to change as it suits us. This ties into the feeling that our happiness depends on other people, and their unwillingness or inability to change, even if we demand it, keeps us from being happy.
This is a damaging way to think because no one is responsible for our own happiness except ourselves.
13. Global labelling / mislabelling
This cognitive distortion is an extreme form of generalising, in which we generalise one or two instances or qualities into a global judgment. For example, if we fail at a specific task, we may conclude that we are a total failure in not only that area but all areas.
Alternatively, when a stranger says something a bit rude, we may conclude that he or she is an unfriendly person in general. Mislabelling is specific to using exaggerated and emotionally loaded language, such as saying a woman has abandoned her children when she leaves her children with a babysitter to enjoy a night out.
14. Always being right
While we all enjoy being right, this distortion makes us think we must be right, that being wrong is unacceptable.
We may believe that being right is more important than the feelings of others, being able to admit when we’ve made a mistake or being fair and objective.
15. Heaven’s Reward Fallacy
This distortion involves expecting that any sacrifice or self-denial will pay off. We may consider this karma, and expect that karma will always immediately reward us for our good deeds. This results in feelings of bitterness when we do not receive our reward (Grohol, 2016).
Many tools and techniques found in cognitive behavioural therapy are intended to address or reverse these cognitive distortions.
9 Essential CBT Techniques and Tools
There are many tools and techniques used in cognitive behavioural therapy, many of which can be used in both a therapy context and in everyday life. The nine techniques and tools listed below are some of the most common and effective CBT practices.
1. Journaling
This technique is a way to gather about one’s moods and thoughts. A CBT journal can include the time of the mood or thought, the source of it, the extent or intensity, and how we reacted, among other factors.
This technique can help us to identify our thought patterns and emotional tendencies, describe them, and change, adapt, or cope with them (Utley & Garza, 2011).
2. Unravelling cognitive distortions
This is a primary goal of CBT and can be practiced with or without the help of a therapist. In order to unravel cognitive distortions, you must first become aware of the distortions from which you commonly suffer (Hamamci, 2002).
Part of this involves identifying and challenging harmful automatic thoughts, which frequently fall into one of the 15 categories listed earlier.
3. Cognitive restructuring
Once you identify the distortions you hold, you can begin to explore how those distortions took root and why you came to believe them. When you discover a belief that is destructive or harmful, you can begin to challenge it (Larsson, Hooper, Osborne, Bennett, & McHugh, 2015).
For example, if you believe that you must have a high-paying job to be a respectable person, but you’re then laid off from your high-paying job, you will begin to feel bad about yourself.
Instead of accepting this faulty belief that leads you to think negative thoughts about yourself, you could take an opportunity to think about what really makes a person “respectable,” a belief you may not have explicitly considered before.
4. Exposure and response prevention
This technique is specifically effective for those who suffer from obsessive-compulsive disorder (OCD; Abramowitz, 1996). You can practice this technique by exposing yourself to whatever it is that normally elicits a compulsive behaviour, but doing your best to refrain from the behaviour.
You can combine journaling with this technique, or use journaling to understand how this technique makes you feel.
5. Interoceptive exposure
This technique is intended to treat panic and anxiety. It involves exposure to feared bodily sensations in order to elicit the response (Arntz, 2002). Doing so activates any unhelpful beliefs associated with the sensations, maintains the sensations without distraction or avoidance, and allows new learning about the sensations to take place.
It is intended to help the sufferer see that symptoms of panic are not dangerous, although they may be uncomfortable.
6. Nightmare exposure and rescripting
Nightmare exposure and rescripting are intended specifically for those suffering from nightmares. This technique is similar to interoceptive exposure, in that the nightmare is elicited, which brings up the relevant emotion (Pruiksma, Cranston, Rhudy, Micol, & Davis, 2018).
Once the emotion has arisen, the client and therapist work together to identify the desired emotion and develop a new image to accompany the desired emotion.
7. Play the script until the end
This technique is especially useful for those suffering from fear and anxiety. In this technique, the individual who is vulnerable to crippling fear or anxiety conducts a sort of thought experiment in which they imagine the outcome of the worst-case scenario.
Letting this scenario play out can help the individual to recognise that even if everything he or she fears comes to pass, the outcome will still be manageable (Chankapa, 2018).
8. Progressive muscle relaxation
This is a familiar technique to those who practice mindfulness. Similar to the body scan, this technique instructs you to relax one muscle group at a time until your whole body is in a state of relaxation (McCallie, Blum, & Hood, 2006).
You can use audio guidance, a YouTube video, or simply your own mind to practice this technique, and it can be especially helpful for calming nerves and soothing a busy and unfocused mind.
9. Relaxed breathing
This is another technique that will be familiar to practitioners of mindfulness. There are many ways to relax and bring regularity to your breath, including guided and unguided imagery, audio recordings, YouTube videos, and scripts. Bringing regularity and calm to your breath will allow you to approach your problems from a place of balance, facilitating more effective and rational decisions (Megan, 2016).
Some More CBT Interventions and Exercises
Haven’t had enough CBT tools and techniques yet? Read on for additional useful and effective exercises.
1. Behavioural experiments
These are related to thought experiments, in that you engage in a “what if” consideration. Behavioural experiments differ from thought experiments in that you actually test out these “what ifs” outside of your thoughts (Boyes, 2012).
In order to test a thought, you can experiment with the outcomes that different thoughts produce. For example, you can test the thoughts:
“If I criticise myself, I will be motivated to work harder” versus “If I am kind to myself, I will be motivated to work harder.”
First, you would try criticising yourself when you need the motivation to work harder and record the results. Then you would try being kind to yourself and recording the results. Next, you would compare the results to see which thought was closer to the truth.
These behavioural Experiments to Test Beliefs can help you learn how to achieve your therapeutic goals and how to be your best self.
2. Thought records
Thought records are useful in testing the validity of your thoughts (Boyes, 2012). They involve gathering and evaluating evidence for and against a particular thought, allowing for an evidence-based conclusion on whether the thought is valid or not.
For example, you may have the belief “My friend thinks I’m a bad friend.” You would think of all the evidence for this belief, such as “She didn’t answer the phone the last time I called,” or “She cancelled our plans at the last minute,” and evidence against this belief, like “She called me back after not answering the phone,” and “She invited me to her barbecue next week. If she thought I was a bad friend, she probably wouldn’t have invited me.”
Once you have evidence for and against, the goal is to come up with more balanced thoughts, such as, “My friend is busy and has other friends, so she can’t always answer the phone when I call. If I am understanding of this, I will truly be a good friend.”
Thought records apply the use of logic to ward off unreasonable negative thoughts and replace them with more balanced, rational thoughts (Boyes, 2012).
Here’s a helpful Thought Record Worksheet to download.
3. Pleasant activity scheduling
This technique can be especially helpful for dealing with depression (Boyes, 2012). It involves scheduling activities in the near future that you can look forward to.
For example, you may write down one activity per day that you will engage in over the next week. This can be as simple as watching a movie you are excited to see or calling a friend to chat. It can be anything that is pleasant for you, as long as it is not unhealthy (i.e., eating a whole cake in one sitting or smoking).
You can also try scheduling an activity for each day that provides you with a sense of mastery or accomplishment (Boyes, 2012). It’s great to do something pleasant, but doing something small that can make you feel accomplished may have more long-lasting and far-reaching effects.
This simple technique can introduce more positivity into your life, and our Pleasant Activity Scheduling Worksheet is designed to help.
4. Imagery-based exposure
This exercise involves thinking about a recent memory that produced strong negative emotions and analysing the situation.
For example, if you recently had a fight with your significant other and they said something hurtful, you can bring that situation to mind and try to remember it in detail. Next, you would try to label the emotions and thoughts you experienced during the situation and identify the urges you felt (e.g., to run away, to yell at your significant other, or to cry).
Visualising this negative situation, especially for a prolonged period of time, can help you to take away its ability to trigger you and reduce avoidance coping (Boyes, 2012). When you expose yourself to all of the feelings and urges you felt in the situation and survive experiencing the memory, it takes some of its power away.
5. Graded exposure worksheet
This technique may sound complicated, but it’s relatively simple.
Making a situation exposure hierarchy involves means listing situations that you would normally avoid (Boyes, 2012). For example, someone with severe social anxiety may typically avoid making a phone call or asking someone on a date.
Next, you rate each item on how distressed you think you would be, on a scale from 0 to 10, if you engaged in it. For the person suffering from severe social anxiety, asking someone on a date may be rated a 10 on the scale, while making a phone call might be rated closer to a 3 or 4.
Once you have rated the situations, you rank them according to their distress rating. This will help you recognise the biggest difficulties you face, which can help you decide which items to address and in what order. It’s often advised to start with the least distressing items and work your way up to the most distressing items.
Here are some of the most popular workbooks and manuals for clients to use alone or with a therapist:
The CBT Toolbox: A Workbook for Clients and Clinicians by Jeff Riggenbach;
Client’s Guidebook: “Activities and Your Mood” by Community Partners in Care;
The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by William J. Knaus and Jon Carlson;
The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program by William J. Knaus and Albert Ellis;
Cognitive-Behavioral Therapy Skills Workbook by Barry Gregory;
A Course in CBT Techniques: A Free Online CBT Workbook by Albert Bonfil and Suraji Wagage.
There are many other manuals and workbooks available that can help get you started with CBT, but the tools above are a good start.
5 Final Cognitive behavioural Activities
Before we go, there are a few more CBT activities and exercises that may be helpful for you or your clients that we’d like to cover.
1. Mindfulness meditation
Mindfulness can have a wide range of positive impacts, including helping with depression, anxiety, addiction, and many other mental illnesses or difficulties.
The practice can help those suffering from harmful automatic thoughts to disengage from rumination and obsession by helping them stay firmly grounded in the present (Jain et al., 2007).
Mindfulness meditations, in particular, can function as helpful tools for your clients in between therapy sessions, such as to help ground them in the present moment during times of stress.
2. Successive approximation
This is a fancy name for a simple idea that you have likely already heard of: breaking up large tasks into small steps.
It can be overwhelming to be faced with a huge goal, like opening a business or remodelling a house. This is true in mental health treatment as well, since the goal to overcome depression or anxiety and achieve mental wellness can seem like a monumental task.
By breaking the large goal into small, easy-to-accomplish steps, we can map out the path to success and make the journey seem a little less overwhelming (e.g., Emmelkamp & Ultee, 1974).
3. Writing self-statements to counteract negative thoughts
This technique can be difficult for someone who’s new to CBT treatment or suffering from severe symptoms, but it can also be extremely effective (Anderson, 2014).
When you (or your client) are being plagued by negative thoughts, it can be hard to confront them, especially if your belief in these thoughts is strong. To counteract these negative thoughts, it can be helpful to write down a positive, opposite thought.
For example, if the thought “I am worthless” keeps popping into your head, try writing down a statement like “I am a person with worth,” or “I am a person with potential.” In the beginning, it can be difficult to accept these replacement thoughts, but the more you bring out these positive thoughts to counteract the negative ones, the stronger the association will be.
4. Visualise the best parts of your day
When you are feeling depressed or negative, it is difficult to recognise that there are positive aspects of life. This simple technique of bringing to mind the good parts of your day can be a small step in the direction of recognising the positive (Anderson, 2014).
All you need to do is write down the things in your life that you are thankful for or the most positive events that happen in a given day. The simple act of writing down these good things can forge new associations in your brain that make it easier to see the positive, even when you are experiencing negative emotions.
5. Reframe your negative thoughts
It can be easy to succumb to negative thoughts as a default setting. If you find yourself immediately thinking a negative thought when you see something new, such as entering an unfamiliar room and thinking “I hate the colour of that wall,” give reframing a try (Anderson, 2014).
Reframing involves countering the negative thought(s) by noticing things you feel positive about as quickly as possible. For instance, in the example where you immediately think of how much you hate the colour of that wall, you would push yourself to notice five things in the room that you feel positively about (e.g., the carpet looks comfortable, the lampshade is pretty, the windows let in a lot of sunshine).
You can set your phone to remind you throughout the day to stop what you are doing and think of the positive things around you. This can help you to push your thoughts back into the realm of the positive instead of the negative.
A Take-Home Message
In this post, we offered many techniques, tools, and resources that can be effective in the battle against depression, anxiety, OCD, and a host of other problems or difficulties.
However, as is the case with many treatments, they depend on you (or your client) putting in a lot of effort. We encourage you to give these techniques a real try and allow yourself the luxury of thinking that they could actually work.
When we approach a potential solution with the assumption that it will not work, that assumption often becomes a self-fulfilling prophecy. When we approach a potential solution with an open mind and the belief that it just might work, it has a much better chance of succeeding.
So if you are struggling with negative automatic thoughts, please consider these tips and techniques and give them a shot. Likewise, if your client is struggling, encourage them to make the effort, because the payoff can be better than they can imagine.’
Article author: Courtney Ackerman
Article source: https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/
