Cognitive Behavioral Therapy

Cognitive Behavioral Therapy Techniques That Work

Mix and match cognitive behavioral therapy techniques to fit your preferences.

Posted Dec 06, 2012

Cognitive behavioral therapy techniques come in many shapes and sizes, offering a wide variety to choose from to suit your preferences.

You and your therapist can mix and match techniques depending on what you're most interested in trying and what works for you. You can also try the following cognitive behavioral therapy techniques as self-help.

Behavioral Experiments

In cognitive behavioral therapy, behavioral experiments are designed to test thoughts. For example, you might do a behavioral experiment to test the thought, "If I criticize myself after overeating, I'll overeat less," vs. "If I talk to myself kindly after overeating, I'll overeat less."

To do this, you would try each approach on different occasions and monitor your subsequent eating habits. This would give you objective feedback about whether self-criticism or self-kindness was more effective in reducing future overeating.

This type of behavioral experiment might also help counteract a (related) thought like, "If I'm kind to myself, it's like giving myself a free pass to overeat and I'll lose all self-control." 

Thought Records

Like behavioral experiments, thought records are also designed to test the validity of thoughts. For example, a clinical psychology student who gets negative feedback from a supervisor might jump to the conclusion, "My supervisor thinks I'm useless." The student could do a thought record evaluating the evidence for and against that thought.

Evidence against the thought might be things like, "My supervisor gave me positive feedback yesterday" or "My supervisor is allowing me to run assessments and give feedback to clients. If she thought I was useless, she probably wouldn't be allowing me to do that."

Once you've looked at the objective evidence for and against a thought side by side, you'll be able to come up with more balanced thoughts to take its place. An example of a balanced thought might be, "I made a mistake; making mistakes is normal. I can learn from this. My supervisor will be impressed to see me learning from my mistakes and incorporating her feedback."

Thought records tend to help change beliefs on a logical level, whereas behavioral experiments may be more helpful in changing beliefs on a gut or felt level—i.e., what you emotionally feel is true, regardless of the objective evidence.

Pleasant Activity Scheduling

Pleasant activity scheduling is a surprisingly effective cognitive behavioral therapy technique. It's particularly helpful for depression.

Try this: Write the next seven days down on a piece of paper, starting with today (e.g., Thursday, Friday, Saturday). For each day, schedule one pleasant activity (anything you enjoy that's not unhealthy) that you wouldn't normally do. It could be as simple as reading a chapter of a novel or eating your lunch away from your desk without rushing.

An alternative version of this technique is to schedule one activity per day that gives you a sense of mastery, competence, or accomplishment. Again, choose something small that you wouldn't usually do. Aim for something that will take you less than ten minutes. An advanced version of this technique would be to schedule three pleasant activities per day—one for the morning, one for the afternoon, and one for the evening.

Doing activities that produce higher levels of positive emotions in your daily life will help make your thinking less negative, narrow, rigid, and self-focused.

Situation Exposure Hierarchies

Situation exposure hierarchies involve putting things you would normally avoid on a list, ordered from bad to slightly better. For example, a client with an eating disorder might make a list of "forbidden foods," with ice cream at the top of the list and full-fat yogurt near the bottom. A client with social anxiety might put asking someone on a date at the top of her list and asking someone for directions near the bottom. The theme of the list should reflect your most pressing problem, essentially.

For each item on your list, rate how distressed you think you'd be if you did it. Use a scale from 0 to 10. For example, ice-cream = 10; full-fat yogurt = 2. Order your list from highest to lowest.

Try to have several items at each distress number so there are no big jumps. The idea is to work your way through the list, from lowest to highest. You would likely experiment with each item several times over a period of a few days until the distress you feel about being in that situation is about half of what it was the first time you tried it (e.g., you can eat full-fat yogurt with a level of distress that's 3 out of 10 instead of 6 out of 10). Then move to the next item up the list.

Imagery Based Exposure

One version of imagery exposure involves bringing to mind a recent memory that provoked strong negative emotions. Let's take, for instance, the earlier example of a clinical psychology student being given critical feedback by a supervisor.

In imagery exposure, the person would bring the situation of being given the feedback to mind and remember it in lots of sensory detail (e.g., the supervisor's tone of voice, what the room looked like). They would also attempt to accurately label the emotions and thoughts they experienced during the interaction, and what their behavioral urges were (e.g., to run out of the room and cry, to get angry, etc.). In prolonged imagery exposure, the person would keep visualizing the image in detail until their level of distress reduced to about half its initial level (say from 8 out of 10 to 4 out of 10).

Imagery based exposure can help counteract rumination because it helps make intrusive painful memories less likely to trigger rumination. Because of this, it also tends to help reduce avoidance coping. When a person is less distressed by intrusive memories, they're able to choose healthier coping actions.

Summary

This list of cognitive behavioral therapy techniques is far from exhaustive—but it will give you a good idea of the variety of techniques that are used in cognitive behavioral therapy. If you're working with a therapist and you've been doing your own reading about CBT, you can let your therapist know what techniques you're excited to try.

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