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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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Problem

Therapy tool

Language

CBT Thought Record

The CBT Thought Record is an essential tool in cognitive behavioral therapy. Thought challenging records help people to evaluate their negative automa ... https://www.psychologytools.com/resource/cbt-thought-record/

Worksheet

Thought Challenging Record 7 Column

The thought record is an essential tool in cognitive behavioral therapy (CBT). Thought challenging records help people to evaluate their negative auto ... https://www.psychologytools.com/resource/thought-challenging-record-7-column/

Worksheet

Simple Thought Challenging Record

Disputing thoughts is a critical skill in cognitive therapy. The Simple Thought Challenging Record encourages clients to identify alternative perspect ... https://www.psychologytools.com/resource/simple-thought-challenging-record/

Worksheet

Simple Thought Monitoring Record

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). This Simple Thought Monitoring Record ... https://www.psychologytools.com/resource/simple-thought-monitoring-record/

Worksheet

Simple Thought Record

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). This Simple Thought Record is an exce ... https://www.psychologytools.com/resource/simple-thought-record/

Worksheet

CBT Thought Record Portrait

The CBT Thought Record is an essential tool in cognitive behavioral therapy. Thought challenging records help people to evaluate their negative automa ... https://www.psychologytools.com/resource/cbt-thought-record-portrait/

Worksheet

Catching Your Thoughts (CYP)

Before thoughts can be examined or challenged they must be ‘caught’ – they must be noticed and distinguished from events and feelings. The Catch ... https://www.psychologytools.com/resource/catching-your-thoughts-cyp/

Worksheet

Court Trial Thought Challenging Record

Thought challenging records are commonly used in CBT to help people to evaluate their negative automatic thoughts for accuracy and bias. This Court Tr ... https://www.psychologytools.com/resource/court-trial-thought-challenging-record/

Worksheet

Belief-O-Meter (CYP)

The Belief-O-Meter is an engaging way of helping children and adolescents to relate to their thoughts differently. It is a form of cognitive restructu ... https://www.psychologytools.com/resource/belief-o-meter-cyp/

Worksheet

Self Critical Thought Monitoring Record

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioural therapy (CBT). This Self-Critical Thought Monitorin ... https://www.psychologytools.com/resource/self-critical-thought-monitoring-record/

Worksheet

Health Anxiety Thought Monitoring Record

Individuals with health anxiety experience clinically significant distress associated with health concerns. This thought-monitoring record enables cli ... https://www.psychologytools.com/resource/health-anxiety-thought-monitoring-record/

Worksheet

Self Criticism Self Monitoring Record

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioural therapy (CBT). This Self-Criticism Self-Monitoring ... https://www.psychologytools.com/resource/self-criticism-self-monitoring-record/

Worksheet

Simple Self Monitoring Record

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioural therapy (CBT). This worksheet helps clients begin t ... https://www.psychologytools.com/resource/simple-self-monitoring-record/

Worksheet

Self Critical Thought Challenging Record

Disputing thoughts is a critical skill in cognitive therapy. The Self-Critical Thought Challenging Record helps clients to identify and challenge thei ... https://www.psychologytools.com/resource/self-critical-thought-challenging-record/

Worksheet

Anger Thought Challenging Record

Disputing thoughts is a critical skill in cognitive therapy. The Anger Thought Monitoring Record helps clients to identify and challenge their angry t ... https://www.psychologytools.com/resource/anger-thought-challenging-record/

Worksheet

Thoughts Or Feelings

Differentiating between thoughts and feelings (emotions and body sensations) is an essential skill in cognitive behavioral therapy (CBT). Thoughts Or ... https://www.psychologytools.com/resource/thoughts-or-feelings/

Exercise

Daily Record of Dysfunctional Thoughts

Thought challenging records are commonly used in CBT to help people to evaluate their negative automatic thoughts for accuracy and bias. The Daily Rec ... https://www.psychologytools.com/resource/daily-record-of-dysfunctional-thoughts/

Worksheet

Challenging Your Negative Thinking

A cornerstone of cognitive behavioral therapy is that an individual’s interpretation of an event determines how they feel and behave. We all experie ... https://www.psychologytools.com/resource/challenging-your-negative-thinking/

Guide

Anger Thought Monitoring Record

Understanding the relationship between thoughts, emotions, body sensations and behavior is a first step towards making changes. The Anger Thought Moni ... https://www.psychologytools.com/resource/anger-thought-monitoring-record/

Worksheet

Anxiety Self-Monitoring Record

Self-monitoring is a fundamental tool in cognitive behavioral therapy (CBT). This Anxiety Self-Monitoring Record is designed to help clients to bette ... https://www.psychologytools.com/resource/anxiety-self-monitoring-record/

Worksheet

Anger Self-Monitoring Record

Self-monitoring is a fundamental tool in cognitive behavioral therapy (CBT). This Anger Self-Monitoring Record is designed to help clients to better ... https://www.psychologytools.com/resource/anger-self-monitoring-record/

Worksheet

Thought Distortion Monitoring Record

Thinking is often biased in particular ways and individuals often have their own characteristic patterns of bias. The Thought Distortion Monitoring Re ... https://www.psychologytools.com/resource/thought-distortion-monitoring-record/

Worksheet

Cognitive Behavioral Model Of Low Self-Esteem (1997)

Low self-esteem is characterized as a negative sense of the self and co-occurs with many other mental health problems. Although not formally represent ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-low-self-esteem-1997/

Information Handout

Cross Sectional Formulation

Case conceptualizations (formulations) help therapists and clients come to a shared understanding of a problem. This Cross Sectional Formulation explo ... https://www.psychologytools.com/resource/cross-sectional-formulation/

Worksheet

Health Anxiety Thought Record

Individuals with health anxiety experience clinically significant distress associated with health concerns. This thought-challenging record enables cl ... https://www.psychologytools.com/resource/health-anxiety-thought-record/

Worksheet

Prompts For Challenging Negative Thinking

The CBT model proposes that how we think affects the way we feel. Challenging our unhelpful thoughts (cognitive restructuring) is an essential skill w ... https://www.psychologytools.com/resource/prompts-for-challenging-negative-thinking/

Information Handout

Intrusion Record

What differentiates intrusive congitions in OCD is the meaning that clients with OCD attach to them. The Intrusion Record is a CBT worksheet for captu ... https://www.psychologytools.com/resource/intrusion-record/

Worksheet

Cognitive Behavioral Model Of Obsessive Compulsive Disorder (1998)

The essential insight of the cognitive behavioral model of obsessive compulsive disorder (OCD) is that it is the client’s interpretation of the intr ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-obsessive-compulsive-disorder-1998/

Worksheet

Rumination Self-Monitoring Record

Rumination-Focused CBT (RF-CBT) takes a functional-analytic approach to rumination and aims to help depressed clients to identify the contexts in whic ... https://www.psychologytools.com/resource/rumination-self-monitoring-record/

Worksheet

Positive Belief Record

Some cognitive change can happen quickly – for example challenging negative automatic thoughts. Other cognitive structures such as schemas are m ... https://www.psychologytools.com/resource/positive-belief-record/

Worksheet

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

Worksheet

Interpersonal Beliefs And Styles

Interpersonal issues and relationship problems form an important part of what clients bring to therapy: they might present as clients’ current conce ... https://www.psychologytools.com/resource/interpersonal-beliefs-and-styles/

Worksheet

Perspective-Taking

Cognitive restructuring techniques in CBT teach clients ways of analyzing situations in ways that might initially be unfamiliar. A simple way of intro ... https://www.psychologytools.com/resource/perspective-taking/

Exercise

Assertive Responses

Being able to communicate assertively is an essential skill for developing and maintaining healthy relationships and positive self-esteem. Individuals ... https://www.psychologytools.com/resource/assertive-responses/

Exercise

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/

Exercise

Schema Formulation

Beck’s cognitive model proposes that cognition and perception in the here-and-now is influenced by our ‘schemas’ which shape our per ... https://www.psychologytools.com/resource/schema-formulation/

Worksheet

Anger Diary

Self monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). The Anger Diary is ... https://www.psychologytools.com/resource/anger-diary/

Worksheet

Rumination Diary

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). The Rumination Diary helps clients to ... https://www.psychologytools.com/resource/rumination-diary/

Worksheet

Panic Diary

The Panic Diary is a cognitive behavioral therapy (CBT) diary for panic symptoms. Clients can record panic attack frequency along with information abo ... https://www.psychologytools.com/resource/panic-diary/

Worksheet

Identifying The Meaning Of Body Sensations

Some anxiety disorders (including panic and health anxiety), are concerned with body sensations and symptoms. The Identifying The Meaning Of Body Sens ... https://www.psychologytools.com/resource/identifying-the-meaning-of-body-sensations/

Worksheet

Panic Attack Record Form

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). The Panic Attack R ... https://www.psychologytools.com/resource/panic-attack-record-form/

Worksheet

Autonomic Nervous System

The autonomic nervous system (ANS) automatically regulates the function of body systems outside of voluntary control. The Autonomic Nervous System han ... https://www.psychologytools.com/resource/autonomic-nervous-system/

Information Handout

Assertive Communication

Communicating and acting assertively is an interpersonal skill that helps people to maintain healthy relationships, resolve interpersonal conflict, an ... https://www.psychologytools.com/resource/assertive-communication/

Information Handout

Schema Metaphors

Core beliefs (schemas) are self-sustaining. They act to ‘attract’ confirmatory evidence and ‘repel’ or ‘distort’ d ... https://www.psychologytools.com/resource/schema-metaphors/

Information Handout

Schema Bias

Core beliefs (schemas) are self-sustaining. They act to ‘attract’ confirmatory evidence and ‘repel’ or ‘distort’ d ... https://www.psychologytools.com/resource/schema-bias/

Information Handout

Modifying Rules And Assumptions

Assumptions are often considered dysfunctional if they are inflexible, rigid, or lead to counterproductive behaviors. Modifying Rules And Assumptions ... https://www.psychologytools.com/resource/modifying-rules-and-assumptions/

Worksheet

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

Information Handout

Symptom Tracker

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). This generic symptom tracker helps cl ... https://www.psychologytools.com/resource/symptom-tracker/

Worksheet

Therapy Blueprint For OCD

A therapy blueprint represents the past (the problems, what maintained them), the present (the therapy itself, new knowledge learned and skills develo ... https://www.psychologytools.com/resource/therapy-blueprint-for-ocd/

Worksheet

Belief Driven Formulation

Cognitive behavioral theory proposes that our thoughts, feelings, and behavior in the here-and-now are influenced by our schemas / core beliefs / assu ... https://www.psychologytools.com/resource/belief-driven-formulation/

Worksheet

Intrusion Diary

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). The Intrusion Diar ... https://www.psychologytools.com/resource/intrusion-diary/

Worksheet

Reciprocal CBT Formulation

CBT therapists often describe finding it difficult to apply CBT skills when clients bring relational problems to therapy. Familiar methods of visua ... https://www.psychologytools.com/resource/reciprocal-cbt-formulation/

Worksheet

OCD Diary

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). Clients will find ... https://www.psychologytools.com/resource/ocd-diary/

Worksheet

Panic Symptom Tracker

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). This symptom tracker helps clients to ... https://www.psychologytools.com/resource/panic-symptom-tracker/

Worksheet

PTSD And Memory

Alterations in the way the brain processes ‘normal’ vs. ‘traumatic’ material are thought to be responsible for the intrusive n ... https://www.psychologytools.com/resource/ptsd-and-memory/

Information Handout

Safety Behaviors

Safety behaviors are actions carried out with the intention of preventing a feared catastrophe. In the short-term they often give a sense of relief, b ... https://www.psychologytools.com/resource/safety-behaviors/

Information Handout

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

Worksheet

Cognitive Behavioral Model Of Intolerance Of Uncertainty (2019)

Intolerance of uncertainty (IU) has been defined as “an underlying fear of the unknown”. Intolerance of uncertainty is a risk factor for the deve ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-intolerance-of-uncertainty-2019/

Worksheet

ABC Belief Monitoring

Functional analysis explores relationships between stimuli and responses. This behavioral analysis tool is arranged in an ABC (Antedents, Behaviors, C ... https://www.psychologytools.com/resource/abc-belief-monitoring/

Worksheet

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 Handout

Process Focused Case Formulation

The Process-Focused Case Formulation encourages clinicians to make hypotheses regarding mechanisms or processes which they believe may be maintainin ... https://www.psychologytools.com/resource/process-focused-case-formulation/

Worksheet

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 Handout

Longitudinal Formulation 2

Case conceptualizations (formulations) help therapists and clients come to a shared understanding of a problem. This longitudinal case formulation wor ... https://www.psychologytools.com/resource/longitudinal-formulation-2/

Worksheet

Longitudinal Formulation 1

Case conceptualizations (formulations) help therapists and clients come to a shared understanding of a problem. This case formulation worksheet is a t ... https://www.psychologytools.com/resource/longitudinal-formulation-1/

Worksheet

Dissociation Record

Dissociation is a set of physical and behavioral adaptations (‘skills’) that human beings have developed because they can help us to survive extre ... https://www.psychologytools.com/resource/dissociation-record/

Worksheet

Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD) (1998)

Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Numer ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-generalized-anxiety-disorder-gad-1998/

Information Handout

Assessment

Cognitive therapy competence / adherence measures

Case Conceptualization / Case Formulation

Presentations

Recommended Reading

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.

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.