As you can tell from the list of CBT’s key ingredients, CBT is much more than a collection of techniques. Nonetheless, you can learn about some of the most common CBT techniques and strategies below. This list isn’t exhaustive, but you can expect to see at least some of these techniques in your treatment plan. Of course, the specific combination of techniques incorporated in your treatment will be selected in collaboration with you based on your individualized case conceptualization.
Acceptance refers to acknowledging reality, including the painful parts of reality, without judgment. Acceptance is different than saying you like or approve of reality or that you want it to be this way forever; acceptance simply involves dropping the fight against reality. Acceptance takes a lot of practice, but with help from your therapist, you’ll learn strategies to stop wasting your energy wishing it weren’t so, which will free you up to focus your energy on solving the problem or simply living with the reality you have.
Skills-training in assertive communication will help you learn how to describe and express your thoughts, feelings, and desires in a clear and direct manner to increase your likelihood of getting what you want. As you learn the assertive middle ground between passively ignoring your needs and aggressively demanding your own way, your therapist can provide feedback to you to fine-tune your skills or otherwise help you address any of the barriers that arise as you experiment with a new way of communicating.
Behavioural Activation/ Activity Scheduling
Behavioural activation is typically an intervention for depression, where you schedule activities into your routine that give you the opportunity to experience some combination of pleasure, accomplishment, and social connection. Instead of waiting to feel motivated to do the activities you’ve been putting off, behavioural activation gets you acting based on a plan instead of based on your mood. Your therapist will help you start small and problem-solve potential barriers, and once you get moving on your plans for meaningful activity, you’ll find that your motivation and mood will catch up to your behaviour.
Behavioural experiments are experiences you will set up with your therapist to test the accuracy of your beliefs. Rather than testing your beliefs by looking backwards at existing evidence, behavioural experiments allow you to gather new information to find out whether your predictions are accurate. Like true scientists, you and your therapist will design the experiments without knowing in advance what will happen. Because anything can happen, behavioural experiments can help to change your thinking not only at an intellectual level, but also at the emotional level when you have the "aha" experience that your predictions aren’t always accurate. Examples might include testing your beliefs about what will happen if you don’t proofread an email three times before sending it or if you say "hello" to a stranger at a grocery store.
Chain analysis is a way for you and your therapist to examine the chain of events leading up to and following a behaviour you want to change. By looking at the chain reaction of thoughts, behaviours, physical sensations, urges, emotions, and external events before and after the behaviour you want to change, you and your therapist will gain a greater understanding of what’s causing and maintaining your behaviour. This information can be very instrumental for developing strategies to break the links in the chain and interrupt the problem behaviour, whether it’s by changing the environment or building new skills.
Cognitive restructuring is one of the core strategies in CBT. During cognitive restructuring, your therapist will help you identify the thoughts running through your mind, examine the evidence you have to support or go against your thoughts, and replace any inaccurate or unhelpful thoughts with thoughts that are more balanced or thoughts that are more effective for getting you to move towards your goals. Cognitive restructuring isn’t just replacing negative thoughts with positive thoughts, but it’s about helping you think more flexibly based on the facts of the current situation. There are lots of ways to accomplish this flexible thinking, whether it’s by learning how to complete a formal worksheet called a ‘thought record’ or by simply learning how to approach your thoughts like a curious detective who’s interested in finding out whether there’s other information or perspectives worth considering.
Coping Ahead/ Relapse Prevention
Coping ahead refers to the planning you will do with your therapist to anticipate problems you may encounter and prepare solutions in advance. Coping ahead is particularly useful when you are trying to change harmful habits you’ve developed, whether it’s substance use, gambling, or intentionally self-injurious behaviour. You and your therapist might identify and change the seemingly irrelevant decisions you make that increase your risk of relapse (e.g., keeping alcohol in the house) and the things you might say to yourself to give you permission to engage in the harmful behaviour (e.g., “I deserve a break after the week I had”). By coping ahead, you’ll have an established plan for what you might do or say to yourself to decrease the likelihood of engaging in the behaviour you’re trying to stop.
Coping ahead can also take the form of relapse prevention at the end of treatment, where you’ll work with your therapist to anticipate the early warning signs that you might be slipping back into old patterns, such as avoiding anxiety, withdrawing from meaningful activities, cleaning excessively, or using substances recreationally. The idea is that if you know what you’re on the lookout for, you’ll be able to implement your relapse prevention plan sooner in the process, which will make for easier work.
A cost-benefit analysis is a strategy to build motivation for change. This analysis involves looking at the costs and benefits of your current way of thinking or behaving, as well as the costs and benefits of a new way of thinking or behaving. By acknowledging both sides of the status quo and change, you and your therapist can be sure that whatever changes you work towards are realistic and in your best interests. A cost-benefit analysis can also be introduced as a formal step to help with decision-making or problem-solving.
Sometimes problems arise that we can’t solve right away, whether it’s because the problem is out of our hands or because our emotions are too intense that they’re getting in the way of our ability to use our other skills. In these situations, your therapist might recommend a range of distress tolerance skills that are designed to help you survive painful emotions or situations without doing something to make the problem worse. Distress tolerance skills include a range of strategies to help you relax, self-soothe, or temporarily distract yourself from whatever problem you can’t immediately solve.
During exposure exercises, you will work with your therapist to plan opportunities for you to face the situations, objects, or thoughts that you typically avoid due to fear of what might happen. As you face your fears in a gradual and systematic way, you’ll learn that your worst predictions don’t come true. When you stop avoiding your emotions, you’ll also learn that emotions can go down on their own without you having to push them away. The benefit of facing anxiety-provoking situations is that you’ll gain the confidence and the freedom to live the life that’s meaningful to you instead of the life that’s left over for you when you avoid anxiety. Exposure is a first-line intervention for anxiety, trauma-related, and obsessive-compulsive and related disorders.
Skills-training and practice in mindfulness teaches you how to build your awareness of the present moment and improve your ability to attend to the present moment without getting attached to it or judging it. People who practice mindfulness find that they feel more connected to the world and people around them, that they're less reactive to emotional stressors, and that they're better able to concentrate and direct their attention.
Beginners to mindfulness often benefit from being guided through exercises to help them observe, describe, and participate in their lives. These exercises might include something as simple as a guided breathing exercise or learning to pay attention to the sensations they experience while doing an everyday activity, such as brushing their teeth. From there, mindfulness practice can be shaped to fit the goals and lives of the individual. Mindfulness fits into CBT by helping people to separate from their thoughts and emotions, allowing them to recognize that they don’t have to respond in habitual ways just because a thought enters their mind or an emotion arises.
CBT is based on the idea that it’s our thoughts that drive our emotional reactions, but sometimes these thoughts reflect real and current problems that we can do something about. When people lack confidence in their problem-solving skills, they tend to avoid problems or act impulsively to eliminate the problem with the first solution that comes to mind. Both of these strategies can result in problems getting bigger.
As an alternative to avoiding problems or acting impulsively to solve them, your therapist can help you develop concrete skills to define the problem that’s interfering with your quality of life, brainstorm possible solutions, evaluate the different solutions you come up with, implement the best solution, assess how the solution worked out, and restart the problem-solving process if necessary. By addressing your problems in a head-on and stepwise fashion, you can anticipate to encounter fewer triggers for negative emotions.
Sometimes we get caught up in the big stuff and forget the basics of taking care of ourselves. If we’re not getting a balanced diet, adequate sleep, and regular exercise and otherwise taking care of our physical health, we’ll be much more vulnerable to negative emotions. Your therapist can help you remove any barriers that are getting in the way of your basic self-care so that the stage is set for you to maximize your benefits from all of the other components of CBT.
If increasing your self-compassion is a treatment goal, your therapist will lead you through exercises to help you learn to treat yourself with kindness, understanding, and acceptance when you notice your shortcomings, failures, or human imperfections. Self-compassion can be the first step towards self-improvement because it fosters your sense of inherent worthiness as a human being, which is more motivating than trying to make improvements while judging and criticizing yourself. Self-compassion is associated with greater emotional resilience, improved self-awareness, and more caring behaviour towards others. Building self-compassion is more effective than building self-esteem because, to enhance your self-esteem, you have to see yourself positively or as better than others, which can result in a sense of narcissism and defensiveness.
Self-monitoring involves keeping track of the experiences you want to change between sessions, whether it’s tracking the frequency, intensity, or specific qualities of an emotion, thought, symptom, or behaviour. You and your therapist will come up with a strategy for self-monitoring that works for you, including how often you’ll record the information throughout the day and whether this logging will be done on a personalized worksheet, in a journal, or on an app or notepad on your phone. Self-monitoring is very useful for building self-awareness of your patterns, identifying targets for treatment, and monitoring progress.
Sleep hygiene refers to a range of habits that you can develop to promote a good night’s sleep. These habits include things like being consistent with the times you go to bed and wake up, making your bedroom a comfortable and relaxing place, avoiding large meals and substances before bed, limiting the use of your bed to only sleep and sex, and turning off electronic devices at least 30 minutes before sleep. Your therapist will help you set goals for yourself to strengthen these healthy habits that can improve your quality and quantity of sleep.
Often times people enter therapy because there’s something in their lives that they’re trying to move away from, whether it’s emotional pain, a situational stressor, or a relationship issue. Values-based goal-setting flips this motivation for therapy on its head by identifying what you want to move towards instead of what you’re moving away from. Essentially, what is it that you’d be doing more of if you didn’t have whatever problem that brought you to therapy? You’ll work with your therapist to identify your values—such as creativity, kindness, integrity, security, or adventure—and then you’ll develop specific, measurable, and realistic goals for yourself that bring those values to life. As you start moving towards those values-based goals, you can expect to experience a greater sense of meaning and life satisfaction, often regardless of whether the symptom or problem that brought you to therapy goes away.
Keep learning about CBT by clicking on the links below.