Cognitive Behavioral Therapy: Definition & Techniques
Cognitive behavioral therapy works on changing our thoughts and behaviors to change our feelings. This article provides the definition and describes the techniques of this evidence-based therapy.
*This page may include affiliate links; that means we earn from qualifying purchases of products. |
Since the days when modern therapy began, therapists and researchers alike have wanted to know what is really happening in the therapy room. While we will never know exactly how psychotherapy works, or why it works, scholars have spent countless hours trying to determine what is and is not helpful. In this day and age, one therapy has been studied more than any other, and research studies again and again show that it is helpful for a wide range of psychiatric diagnoses (McMain et al., 2015). |
This often-studied therapy is cognitive-behavioral therapy, often shortened to CBT. Most people who have gotten close to the world of therapy, whether as a client or as the loved one of somebody in therapy, have probably heard that acronym mentioned. Still, for many people, a lot of mystery remains around this treatment. Just what is CBT, exactly, and how does it work? This article aims to demystify the story around CBT, so you can understand what CBT looks like in practice and imagine whether it might be helpful for you.
Are You a Therapist, Coach, or Wellness Entrepreneur?
Grab Our Free eBook to Learn How to
Grow Your Wellness Business Exponentially!
✓ Save hundreds of hours of time ✓ Earn more $ faster
✓ Boost your credibility ✓ Deliver high-impact content
What Is Cognitive Behavioral Therapy? (A Definition)
Cognitive-behavioral therapy has both thoughts and behaviors in its name, though, and that is for a reason. Therapists recognized that our thoughts, feelings, and behaviors are all interrelated – more on that in a moment – but we are not equally effective in changing all three aspects of ourselves. In particular, attempting to simply change our emotions generally does not work.
Think about it: have you ever had anybody say to you, “just don’t feel that way”? Any time that’s happened to me, I’ve felt frustrated, not supported, because I can’t “just stop” feeling something. On the other hand, I do have some control over what I think and what I do. Cognitive-behavioral therapy teaches us that if we work on changing our thoughts or our behaviors instead, our feelings will typically change in response.
Therapists and scholars sometimes refer to CBT as an umbrella term, as there are many approaches to psychotherapy with different names that all draw on the central principles of CBT (Hofmann & Asmundson, 2017). Many of these interventions have words like “cognitive” or “behavioral” in their names, such as Dialectical Behavior Therapy, while others, such as Acceptance and Commitment Therapy, do not. These interventions have been used to treat diagnoses as varied as depression, anxiety, PTSD, insomnia, and eating disorders, and have even been used for treatment with couples.
History of Cognitive Behavioral Therapy
While working as a psychoanalyst, Beck decided that his clients were more aware of their own thinking patterns than psychoanalysis might give them credit for, so he decided to try focusing on people’s thoughts as the target of treatment. In doing so, he supported his approach by referring to a long history in philosophy of grappling with thoughts to determine if they are true (Beck et al., 1979).
Meanwhile, behavior therapy had already been developed by other therapists and researchers, but they realized that behavior therapy was not as effective for certain diagnoses as it was for others (Ellis, 1980). In particular, treating depression with behavior therapy was not successful. Therefore, in the 1970s, therapists began to combine the beliefs of behavior therapy and the beliefs of what Beck originally called cognitive therapy, and thus cognitive-behavioral therapy was born.
Therapies developed based on CBT
Since that time, as I noted above, many therapies have been developed based on the core tenets of cognitive-behavioral therapy. For example, some focus more on changing behaviors than changing thoughts. However, while they may bring slightly different philosophical stances to treatment, they seem to be about as effective as each other, have broadly similar goals, and function in similar ways (Feldman, 2007) – namely, by changing thoughts and behaviors to change feelings – so they are all considered part of the CBT umbrella (Hofmann et al., 2010).
Cognitive-behavioral therapy is also different from other psychotherapies in that it has been, since it was first developed, driven by empiricism, or the idea that we can know the truth by experiencing and observing things. This is why CBT is often called the most evidence-based psychotherapy there is, and why therapists can say with some confidence that when they are using CBT techniques, they are using techniques that are known to have helped many people with many different diagnoses (McMain et al., 2015).
The Theory of Cognitive Behavioral Therapy
Let’s make this more concrete with an example. One of my ongoing fears is that if I lose my hair, people will find me unattractive. Having this thought again and again has led me to think that in general, I will be treated differently if I go bald (a negative view about the world), and makes me worry that I will have difficulty finding a potential life partner when I’m dating (a negative view about the future). Finally, it makes me engage in behaviors, like checking my hairline often, that can be distracting, and it makes me feel sadness and fear.
My thought about losing my hair is where the trouble starts. I have made an assumption that I am only attractive if I have a full head of hair. A therapist using CBT with me would engage me in a fact-finding mission about this statement: How do I know that I must have a full head of hair to be attractive? Are there any men around me who are bald who seem to be well-liked and who have partners? We would eventually come to the conclusion that my thought about balding isn’t true and that my life might be easier if I had a more realistic thought to say instead when that false belief comes up.
Cognitive Behavioral Therapy Triangle
Although the example I just shared focused on changing a thought, CBT treats our thoughts, feelings, and behaviors as reciprocally affecting each other. For example, I might think my hairline doesn’t look good, which makes me feel bad about myself, which leads me to decline an invitation to a gathering of my friends. Now, I might think even more negative thoughts about myself.
To capture this reciprocal relationship, CBT therapists use the CBT triangle, which puts thoughts, feelings, and behaviors at each point of a triangle. This is a visual representation of how we can move back and forth between thoughts, feelings, and behaviors, with each one influencing the next. We can also think of the sides of the triangle as places where we might successfully intervene, using our CBT skills, to stop the back and forth that causes us pain and suffering (Kendall et al., 2014). For example, when I start to think about how I am losing my hair, I remind myself of the steps I am taking to protect my remaining hair, and then I am less likely to feel sad.
Benefits of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy Techniques
- Psychoeducation. Therapists spend time with each client orienting them to CBT theory. They use examples from their own and the client’s lives to look at how thoughts, feelings, and behaviors are reciprocally related to each other, using the CBT triangle. They may also correct any unhelpful beliefs people may have, such as the idea that we can simply control our feelings.
- Behavioral activation. Mainly used with people with depression – who have often stopped engaging in some of their primary healthy habits and behaviors – behavioral activation is a stage of therapy in which the therapist focuses on getting the client to engage in behaviors that boost their mood and connect them with other people. For example, an adult with depression might be encouraged to return to, or initiate, weekly partner dance lessons.
- Cognitive reappraisal. CBT therapists help clients critically examine their own thoughts to see whether they are (a) true and (b) helpful. Using a form of Socratic dialogue, the therapist will help the client identify ways that they are engaged in common thinking errors, such as treating a situation as black and white when it has many shades of grey.
- Chain analysis. To identify places for intervention, and to practice applying the theory of CBT, therapists have clients walk them through problematic situations in their lives, drawing the links among behaviors, actions, and feelings.
- Emotion regulation. CBT therapists help clients develop effective emotion regulation strategies. For example, using breathing techniques to calm oneself down when stressed out can make it easier to use other CBT skills. (This is a good example of changing a behavior to change an emotion.)
- Homework. CBT therapists have clients track their thoughts, feelings, and behaviors in order to apply CBT theory and techniques in their daily lives. For example, a client might be asked to write down each time they worry about possibly getting fired and the CBT skills they use to try to cope with that thought. Or if a client finds their daily commute highly stressful, the therapist might ask the client to use a muscle relaxation technique each day before they leave the house.
To see some of these techniques and others in action, I recommend watching this video:
Video: What a Cognitive Behavioral Therapy (CBT) Session Looks Like
Cognitive Behavioral Therapy for Insomnia
Cognitive behavioral therapy has been established as an effective treatment for insomnia, using behavioral changes, psychoeducation about sleep hygiene, and correction of unhelpful thoughts to improve sleep quality and duration (Edinger & Means, 2005).
Cognitive Behavioral Therapy for Anxiety
Cognitive behavioral therapies are the most evidence-based psychotherapy for several kinds of anxiety, including generalized anxiety disorder to obsessive-compulsive disorder (Otte, 2011).
Cognitive Behavioral Therapy for Depression
CBT is known to work as well or better than psychiatric medication for treating depression, including among people with severe depression (Feldman, 2007). (It’s important to note that some people are best treated with both CBT and antidepressant medication.)
Cognitive Behavioral Therapy for PTSD
CBT is also widely used to treat posttraumatic stress disorder (PTSD). It successfully helps people change unhelpful beliefs about the world and themselves that they may have developed in response to experiencing traumas (Foa, 1993). While different treatments are available for adults versus children, both are effective in treating PTSD (Lenz & Hollenbaugh, 2015; Resick et al., 2016).
Video: Does Cognitive Behavioral Therapy Work For Everyone?
Articles Related to Cognitive Behavioral Therapy
Books Related to Cognitive Behavioral Therapy
Final Thoughts on Cognitive Behavioral Therapy
I was trained in several models of CBT and I use many of these techniques with clients and on myself. Therapists who draw on CBT techniques in their work are using skills that we know come from successful treatments. For people seeking therapy, I recommend seeking out providers who are at least aware of and have experience with these techniques. While not everybody benefits from traditionally-delivered CBT – that’s why there are so many kinds of therapy – I think these techniques and perspectives are broadly useful and worth knowing.
Don’t Forget to Grab Our Free eBook to Learn How to
Grow Your Wellness Business Exponentially!
References
- Beck, A. T. (1970). Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy, 1, 184–200.
- Beck, A. T., Rush, A. J., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
- David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9, 4.
- Edinger, J. D., & Means, M. K. (2005). Cognitive–behavioral therapy for primary insomnia. Clinical Psychology Review, 25(5), 539-558.
- Ellis, A. (1980). Rational-emotive therapy and cognitive behavior therapy: Similarities and differences. Cognitive Therapy and Research, 4, 325-340.
- Feldman, G. (2007). Cognitive and behavioral therapies for depression: Overview, new directions, and practical recommendations for dissemination. Psychiatric Clinics of North America, 30(1), 39-50.
- Foa, E. B. (1993). Posttraumatic stress disorder in rape victims. Review of Psychiatry, 12, 273-303.
- Hofmann, S. G., & Asmundson, G. J. (Eds.). (2017). The science of cognitive behavioral therapy. Academic Press.
- Hofmann, S. G., Sawyer, A. T., & Fang, A. (2010). The empirical status of the “new wave” of cognitive behavioral therapy. Psychiatric Clinics, 33(3), 701-710.
- Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42, 349-357.
- Kendall, P. C., Rodriguez, K. A. O., Villabø, M. A., Martinsen, K. D., Stark, K. D., & Banneyer, K. (2014). Cognitive-behavioral therapy with children and adolescents. In J. Ehrenreich-May & B. C. Chu (Eds.), Transdiagnostic treatments for children and adolescents: Principles and practice (pp. 161–182). Guilford Press.
- Leahy, R. L. (2008). The therapeutic relationship in cognitive-behavioral therapy. Behavioural and Cognitive Psychotherapy, 36(6), 769-777.
- Lenz, A. S., & Hollenbaugh, K. M. (2015). Meta-analysis of trauma-focused cognitive behavioral therapy for treating PTSD and co-occurring depression among children and adolescents. Counseling Outcome Research and Evaluation, 6(1), 18-32.
- McMain, S., Newman, M. G., Segal, Z. V., & DeRubeis, R. J. (2015). Cognitive behavioral therapy: Current status and future research directions. Psychotherapy Research, 25(3), 321-329.
- Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13, 413–421.
- Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.
Are You a Therapist, Coach, or Wellness Entrepreneur?
Grab Our Free eBook to Learn How to Grow Your Wellness Business Fast!
