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Cognitive Behavioral Therapy (CBT)

Cognitive behavior therapy (CBT) is a popular form of psychological therapy that works with our thoughts, feelings, and behaviors. CBT is an integration of principles from behavior therapy with theory and methods from the cognitive therapies developed by Aaron Beck and Albert Ellis. The CBT that is practiced today has evolved with new developments in basic and applied research; it is grounded in empirical research and clinical practice. CBT is a broad church: the family of ‘cognitive and behavioral therapies’ encompasses many approaches including cognitive therapy, acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and compassion-focused therapy (CFT). Beck’s cognitive model identifies different levels of human cognitions: automatic thoughts are the most superficial level of cognition and describe the thoughts, words, ideas, and images that seem to pop into our minds; rigid and over-generalized core beliefs about ourselves, the world, and other people; and intermediate attitudes, rules, and assumptions that are influenced by our core beliefs. The cognitive model proposes that how we feel emotionally, and how we act, are determined by how we interpret and think about a situation. It argues that psychological problems and disorders are the result of dysfunctional thinking, and are maintained by self-defeating behavior influenced by inaccurate beliefs. Cognitive behavior therapists understand that by changing the way we think and act in the here-and-now we can change the way we feel, and CBT often begins with a focus on what is maintaining a problem in the present. For lasting change, CBT therapists often work with the deeper levels of their client’s beliefs and assumptions. Read more
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61 of 261 resources

Trauma And Dissociation

Trauma and Dissociation is a guide written for clients who have experienced trauma and who are troubled by dissociation. It provides clear informatio ... https://www.psychologytools.com/resource/trauma-and-dissociation

Guides

Trauma, Dissociation, And Grounding (Archived)

NOTE: An improved version of this resource is available here: Trauma And Dissociation. Older versions of a resource may be archived in the event that ... https://www.psychologytools.com/resource/trauma-dissociation-and-grounding

Archived

Treating Your OCD With Exposure And Response (Ritual) Prevention: Workbook

Exposure and Response (Ritual) Prevention for Obessssive-Compulsive Disorder comes in two volumes. This page is for the Client Workbook. Click on the ... https://www.psychologytools.com/resource/treating-your-ocd-with-exposure-and-response-ritual-prevention-workbook

Treatments That Work®

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record

Worksheets

Understanding Anorexia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-anorexia

Guides

Understanding Body Dysmorphic Disorder

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-body-dysmorphic-disorder

Guides

Understanding Bulimia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-bulimia

Guides

Understanding Burnout

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-burnout

Guides

Understanding Depersonalization And Derealization

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-depersonalization-and-derealization

Guides

Understanding Depression

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-depression

Guides

Understanding Fears And Phobias

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-fears-and-phobias

Guides

Understanding Generalized Anxiety And Worry

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-generalized-anxiety-and-worry

Guides

Understanding Health Anxiety

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-health-anxiety

Guides

Understanding Low Self-Esteem

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-low-self-esteem

Guides

Understanding My Panic

The Cognitive Behavioral Model Of Panic identifies catastrophic misinterpretation of body sensations as a criticial maintenance factor which serves to ... https://www.psychologytools.com/resource/understanding-my-panic

Information handouts

Understanding Obsessive Compulsive Disorder (OCD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are ... https://www.psychologytools.com/resource/understanding-obsessive-compulsive-disorder-ocd

Guides

Understanding Panic

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-panic

Guides

Understanding Perfectionism

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-perfectionism

Guides

Understanding Post-Traumatic Stress Disorder (PTSD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-post-traumatic-stress-disorder-ptsd

Guides

Understanding Psychosis

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-psychosis

Guides

Understanding PTSD

Ehlers & Clark's cognitive model of PTSD outline key maintaining factors. Understanding PTSD is a simple pictorial explanation of the maintenance ... https://www.psychologytools.com/resource/understanding-ptsd

Information handouts

Understanding Social Anxiety

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-social-anxiety

Guides

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. In the 1960s, Aaron Beck identified several of these biases which were common in his d ... https://www.psychologytools.com/resource/unhelpful-thinking-styles

Information handouts

Using Behavioral Activation To Overcome Depression

Using Behavioral Activation To Overcome Depression is a guide written for clients who are currently depressed. It provides clear information about dep ... https://www.psychologytools.com/resource/using-behavioral-activation-to-overcome-depression

Guides

Vertical Arrow Down Arrow Vertical Descent

Vertical Arrow / Downward Arrow / Vertical Descent is a form of Socratic questioning in which the therapist asks a succession of questions to uncover ... https://www.psychologytools.com/resource/vertical-arrow-down-arrow-vertical-descent

Exercises

What Are Safety Behaviors?

Safety-seeking behaviors (‘safety behaviors’) are actions that people take in response to a real – or perceived – threat. When a threat is rea ... https://www.psychologytools.com/resource/what-are-safety-behaviors

Information handouts

What Do People Think About Themselves (CYP)?

People are not born with low self-esteem. Instead, we develop ideas about ourselves and our place in the world as a result of our life experiences. Pe ... https://www.psychologytools.com/resource/what-do-people-think-about-themselves-cyp

Exercises

What Is A Panic Attack?

Panic attacks are single episodes of intense fear or discomfort that begin suddenly and reach a peak within minutes. The cognitive behavioral model of ... https://www.psychologytools.com/resource/what-is-a-panic-attack

Information handouts

What Is Anorexia?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-anorexia

Information handouts

What Is Body Dysmorphic Disorder (BDD)?

Many people have concerns about how they look, but significant and persistent worry about one's appearance may be a sign of body dysmorphic disorder ( ... https://www.psychologytools.com/resource/what-is-body-dysmorphic-disorder-bdd

Information handouts

What Is Bulimia?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-bulimia

Information handouts

What Is Burnout?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-burnout

Information handouts

What Is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is fundamentally concerned with the meanings which people make of their experiences. The insight of the CBT model i ... https://www.psychologytools.com/resource/what-is-cbt-worksheet-handout

Information handouts

What Is Exposure Therapy?

Exposure is an effective evidence-based treatment for fear. This information handout describes the key principles of Exposure Therapy. Clients who are ... https://www.psychologytools.com/resource/what-is-exposure-therapy

Information handouts

What Is Generalized Anxiety Disorder (GAD)?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-generalized-anxiety-disorder-gad

Information handouts

What Is Imagery Rescripting?

Unwanted images are a feature common to a variety of problems including PTSD and depression. Imagery rescripting is an evidence-based treatment techni ... https://www.psychologytools.com/resource/what-is-imagery-rescripting

Information handouts

What Is Panic Disorder?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-panic-disorder

Information handouts

What Is Post-Traumatic Stress Disorder (PTSD)?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-post-traumatic-stress-disorder-ptsd

Information handouts

What Is Social Anxiety Disorder?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-social-anxiety-disorder

Information handouts

What Is TF-CBT?

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for post-traumatic stress disorder (PTSD). This information handou ... https://www.psychologytools.com/resource/what-is-tf-cbt

Information handouts

What Keeps Anorexia Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-anorexia-going

Information handouts

What Keeps Body Dysmorphic Disorder (BDD) Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-body-dysmorphic-disorder-bdd-going

Information handouts

What Keeps Bulimia Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-bulimia-going

Information handouts

What Keeps Burnout Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-burnout-going

Information handouts

What Keeps Depression Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-depression-going

Information handouts

What Keeps Fears And Phobias Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-fears-and-phobias-going

Information handouts

What Keeps Generalized Anxiety And Worry Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-generalized-anxiety-and-worry-going

Information handouts

What Keeps Health Anxiety Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-health-anxiety-going

Information handouts

What Keeps Low Self-Esteem Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-low-self-esteem-going

Information handouts

What Keeps Obsessive Compulsive Disorder (OCD) Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-obsessive-compulsive-disorder-ocd-going

Information handouts

What Keeps Panic Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-panic-going

Information handouts

What Keeps Perfectionism Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-perfectionism-going

Information handouts

What Keeps Post-Traumatic Stress Disorder (PTSD) Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-post-traumatic-stress-disorder-ptsd-going

Information handouts

What Keeps Psychosis Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-psychosis-going

Information handouts

What Keeps Social Anxiety Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-social-anxiety-going

Information handouts

Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

Information handouts

Worry – Self-Monitoring Record

The Worry – Self-Monitoring Record worksheet is designed to help clients capture information about situations where they engaged in worry. Consisten ... https://www.psychologytools.com/resource/worry-self-monitoring-record

Worksheets

Worry Decision Tree

Worry is a cognitive process that involves thinking about problems that might happen in a way that can leave you feeling anxious or apprehensive. Not ... https://www.psychologytools.com/resource/worry-decision-tree

Exercises

Worry Diary (Archived)

NOTE: An improved version of this resource is available here: Worry – Self-Monitoring Record. Older versions of a resource may be archived in t ... https://www.psychologytools.com/resource/worry-diary-archived

Archived

Worry Postponement

Worry postponement ("worry time") is often prescribed as an exploratory or standalone intervention relatively early in the treatment of GAD, but  ... https://www.psychologytools.com/resource/worry-postponement

Exercises

Worry Thought Record

Anxiety stems from negative predictions about the future (and also from assumptions that one will not be able to cope with the magnitude of the threat ... https://www.psychologytools.com/resource/worry-thought-record

Worksheets

Assessment

Cognitive therapy competence / adherence measures

Case Conceptualization / Case Formulation

Presentations

  • Making CBT Work (Working with your CBT therapist / Making your CBT therapist work with you) | Paul Salkovskis download  archived copy
  • The unified protocol for the transdiagnostic treatment of emotional disorders | Ellen Frank, Fiona Ritchey | 2015 download  archived copy
  • Transdiagnostic treatments for anxiety disorders | Martin Anthony | 2013 download  archived copy
  • A case formulation approach to cognitive-behavior therapy | Jacqueline Persons | 2015  download  archived copy
  • The role of a case conceptualization model and core tasks of intervention | Donald Miechenbaum | 2014  download  archived copy

Recommended Reading

  • Arch, J. J., & Craske, M. G. (2009). First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatric Clinics of North America, 32(3), 525-547 download  archived copy
  • Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research, 36(5), 427-440 download
  • Padesky, C. A., Mooney, K. A. (1990). Clinical tip: presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14 download archived copy
  • A therapists’ guide to brief cognitive behavioral therapy by Cully & Teten download

This series of articles are good introduction to the basics of CBT. The authors have gone on to sell a branded form of CBT using some of these metaphors / explanation but the messages apply equally to generic CBT.

  • Williams, C., & Garland, A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8(3), 172-179. download
  • Garland, A., Fox, R., & Williams, C. (2002). Overcoming reduced activity and avoidance: a Five Areas approach. Advances in Psychiatric Treatment, 8(6), 453-462. download
  • Williams, C., & Garland, A. (2002). Identifying and challenging unhelpful thinking. Advances in Psychiatric Treatment, 8(5), 377-386. download
  • Wright, B., Williams, C., & Garland, A. (2002). Using the Five Areas cognitive–behavioural therapy model with psychiatric patients. Advances in Psychiatric Treatment, 8(4), 307-315. download

What Is Cognitive Behavioral Therapy?

Assumptions of CBT

  • people actively process information;
  • our appraisals (the way that we think and interpret events) determine how we feel;
  • dysfunctional thinking and biases in information processing (cognition/​thinking) are responsible for the problems that people experience;
  • different problems are associated with different cognitive themes (cognitive specificity theory): depression is associated with loss and defeat; anxiety is associated with danger and threat; obsessive-compulsive disorder is associated with inflated responsibility; substance abuse is associated with permissive beliefs; eating disorders are associated with self-criticism; social anxiety is associated with fear of evaluation; and PTSD is associated with appraisals of immediate threat;
  • the thoughts that we have can be ‘distorted’ or biased. Common biases include over-generalization, arbitrary inference, selective abstraction, and catastrophizing;
  • changing how we think and act will impact how we feel: cognition, emotion, and behavior interact in a reciprocal manner;
  • psychopathology is a result of an interaction between stress and vulnerability;
  • cognition happens at multiple levels (Alford & Beck, 1997) and all can influence the way that we feel and behave: preconscious, unintentional, automatic (e.g., negative automatic thoughts); the conscious level (e.g., if a patient is asked to explain the meaning of an automatic thought); and the metacognitive level (beliefs about beliefs);
  • experiences, memories, thoughts, attitudes, and beliefs are encapsulated as ‘schemas’ and which may become activated and influence our perceptions and behaviors.

Principles of CBT

Judith Beck (1995) identified 11 principles of the practice of cognitive behavioral therapy, and these were expanded by Wills (2009):

  • cognitive behavioral therapists use formulation to focus their therapeutic work
  • cognitive behavioral therapists use formulation to tackle interpersonal and alliance issues
  • cognitive behavioral therapy requires a sound therapeutic relationship
  • cognitive behavioral therapists stress the importance of collaboration in the therapeutic relationship
  • cognitive behavioral therapy is brief and time-limited
  • cognitive behavioral therapy is structured and directional
  • cognitive behavioral therapy is problem- and goal-oriented
  • cognitive behavioral therapy initially emphasizes a focus on the present
  • cognitive behavioral therapy uses an educational model
  • homework and self-practice is a central feature of cognitive behavioral therapy (incorporating the use of CBT worksheets)
  • cognitive behavioral therapists teach clients to evaluate and modify their thoughts
  • cognitive behavioral therapy uses various methods to change cognitive content including thought records, behavioral experiments, surveys
  • cognitive behavior therapy uses a variety of methods to promote behavioral change including exposure, behavioral experiments, role-play.

Procedures and Techniques of CBT

  • Data gathering and symptom monitoring are used to understand problems and to measure change. CBT is an evidence-based approach that relies upon accurate data gathering regarding symptoms and experiences.
  • Behavioral activation is a set of techniques for encouraging engagement in meaningful activity and is an effective treatment for depression.
  • Case formulation is a method for understanding the origin and maintenance of a problem in cognitive and behavioral terms. CBT therapists may use a mixture of cross-sectional formulation to understand difficulties in the here-and-now, longitudinal formulation to understand the origins and precipitants of a problem, and cognitive behavioral models to understand the mechanisms underlying a problem.
  • Cognitive restructuring describes techniques for changing what we think. It often involves the use of thought records, behavioral experiments, data gathering, or psychoeducation.
  • Exposure is a technique from behavior therapy that is extensively used by CBT therapists, particularly for the treatment of anxiety. ‘Facing your fears’ is an essential behavioral component of CBT.
  • Problem solving describes a series of techniques that are often taught as part of a CBT intervention. Effective problem solving helps people to make adaptive choices.
  • Socratic methods are used by CBT therapists to help their clients explore what they know, and to form their own opinions on a topic. Aaron Beck encouraged the use of Socratic-like technique in his original treatment manual “use questioning rather than disputation and indoctrination … it is important to try to elicit from the patient what he is thinking rather than telling the patient what the therapist believes he is thinking” (Beck et al, 1979).

References

  • Alford, B. A., & Beck, A. T. (1997). The relation of psychotherapy integration to the established systems of psychotherapy. Journal of psychotherapy integration7(4), 275-289.
  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.
  • Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
  • Wills, F. (2009). Beck’s cognitive therapy. CBT Distinctive Features Series. New York: Routledge.