CBT has become increasingly popular with clinicians and the general public alike over recent years. Surveys of therapists indicate the CBT is fast becoming the majority orientation of practicing psychologists. Partly because of its commonsense and clear principles, self-help books based on CBT approaches also have come to dominate the market. Even media articles frequently extol the virtues of this form of psychotherapy. A recent Washington Post article proclaimed: “For better or worse, cognitive therapy is fast becoming what people mean when they say they are “getting therapy”.

-Brandon A. Gaudiano, Ph.D

1. Cognitive restructuring or reframing

This involves taking a hard look at negative thought patterns.

Perhaps you tend to over-generalize, assume the worst will happen or place far too much importance on minor details. Thinking this way can affect what you do and it can even become a self-fulfilling prophecy.

Your therapist will ask about your thought process in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts so they’re more positive and productive.

For example: “I blew the report because I’m totally useless” can become “That report wasn’t my best work, but I’m a valuable employee and I contribute in many ways.”

2. Guided discovery

In guided discovery, the therapist will acquaint themselves with your viewpoint. Then they’ll ask questions designed to challenge your beliefs and broaden your thinking.

You might be asked to give evidence that supports your assumptions, as well as evidence that does not.

In the process, you’ll learn to see things from other perspectives, especially ones that you may not have considered before. This can help you choose a more helpful path.

3. Exposure therapy

Exposure therapy can be used to confront fears and phobias. The therapist will slowly expose you to the things that provoke fear or anxiety while providing guidance on how to cope with them at the moment.

This can be done in small increments. Eventually, exposure can make you feel less vulnerable and more confident in your coping abilities.

4. Journaling and thought records

Writing is a time-honored way of getting in touch with your own thoughts.

Your therapist may ask you to list negative thoughts that occurred to you between sessions, as well as positive thoughts you can choose instead.

Another writing exercise is to keep track of the new thoughts and new behaviors you put into practice since the last session. Putting it in writing can help you see how far you’ve come.

5. Activity scheduling and behavior activation

If there’s an activity you tend to put off or avoid due to fear or anxiety, getting it on your calendar can help. Once the burden of decision is gone, you may be more likely to follow through.

Activity schedules can help establish good habits and provide ample opportunity to put what you’ve learned into practice.

6. Behavioral experiments

Behavioral experiments are typically used for anxiety disorders that involve catastrophic thinking.

Before embarking on a task that normally makes you anxious, you’ll be asked to predict what will happen. Later, you’ll talk about whether the prediction came true.

Over time, you may start to see that the predicted catastrophe is actually not very likely to happen. You’ll likely start with lower-anxiety tasks and build up from there.

7. Relaxation and stress reduction techniques

In CBT, you may be taught some progressive relaxation techniques, such as:

• deep breathing exercises
• muscle relaxation
• imagery

You’ll learn practical skills to help lower stress and increase your sense of control. This can be helpful in dealing with phobias, social anxieties, and other stressors.

8. Roleplaying

Role-playing can help you work through different behaviors in potentially difficult situations. Playing out possible scenarios can lessen fear and can be used for:

• improving problem-solving skills
• gaining familiarity and confidence in certain situations
• practicing social skills
• assertiveness training
• improving communication skills

9. Successive approximation

This involves taking tasks that seem overwhelming and breaking them into smaller, more achievable steps. Each successive step builds upon the previous steps so you gain confidence as you go, bit by bit.