The brain is an amazing organ. It works 24/7 and determines the condition of nearly every aspect of life.
The average person has 70,000 thoughts in a single day (Robertson, 2010). These thoughts (good or bad) determine our emotions, actions, and behaviors.
Distressful emotions and maladaptive behaviors are generally a result of negative or irrational thoughts. Cognitive therapy techniques provide a mental toolkit that can help individuals see the world in a better light (Beck & Haigh, 2014).
Cognitive therapy was originally developed by Aaron Beck (1995) in the 1960s and makes the connection between thoughts, feelings, and behaviors. The simple act of identifying and changing thinking patterns can alter physical, mental, and emotional wellbeing.
Let’s find out more about how it works, what can be treated with cognitive therapy techniques, and some recommended books and exercises.
Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.
Cognitive therapy (CT) is based on the cognitive model, which states that thoughts, feelings, and behaviors are connected, and individuals can overcome challenges and reach goals by altering inaccurate thinking, problematic behavior, and distressing emotional responses (Beck & Haigh, 2014).
The cognitive model divides the mind into three levels: automatic thoughts, intermediate beliefs, and core beliefs (Beck & Haigh, 2014). According to Beck and Haigh (2014), CT is designed to be structured and directive, with the purpose of identifying, reality testing, and correcting distorted thoughts.
CT may include testing assumptions by looking for new information that leads to different emotional or behavioral reactions. Change begins by targeting maladaptive thoughts and behaviors and aligning them with client goals.
Such maladaptive thoughts are also known as cognitive distortions or automatic thoughts (from the cognitive model mentioned above).
This video discusses a variety of cognitive distortions and provides practical skills to identify and change them.
1. Cognitive Restructuring
Cognitive restructuring is an example of a crucial technique used in CT. It involves a series of steps (Beck, 2017).
The first step is identifying the problematic thoughts (automatic thoughts or cognitive distortions). These are dysfunctional or false views of oneself, the situation, environment, or the future, and are based on an individual’s core beliefs.
The next step involves rationally disputing these thoughts.
Finally, a rational rebuttal of the automatic/dysfunctional thoughts is created, and the client is encouraged to internalize these thoughts.
2. Socratic questioning
Socratic questioning is a method of cognitive restructuring. This line of questioning challenges faulty assumptions by thinking of reasonable alternatives, evaluating consequences, and creating distance between a thought and action (Beck, 2017).
Some examples of Socratic questioning are:
“What is another explanation of this situation? What is another reason it happened?” (reasonable alternative)
“What’s the effect of thinking/believing this? What would happen if you thought differently and let go of this belief?” (evaluating consequences)
“Imagine a friend or family member in the same situation. What would you tell them or have them do?” (distancing)
3. Guided discovery
Guided discovery is a cognitive therapy technique that empowers clients to find their own answers. Through guided discovery, a therapist highlights behavioral problems and distorted thinking patterns by creating new experiences that lead clients to adopt new skills and take on new perspectives.
This method uses both cognition and behavior change, which enables individuals to find solutions on their own (Beck, 2017). Clients discover more adaptive ways of thinking and coping with stressors in the environment by altering automatic thoughts and cognitive distortions.
4. A look at group Cognitive-Behavioral Therapy
Group CBT simply uses aspects of CT in a group setting. Like most forms of group therapy, group CBT includes a set of ground rules, can be open or closed, and is generally composed of five to 10 members. Therapists leading these groups may use CT concepts on a weekly basis for eight to 16 weeks.
Group therapy can help normalize irrational thoughts and encourage members to get out of the negative self-talk cycle. Shared identity with group members can build a sense of acceptance and support which facilitates cognitive therapy techniques.
CT is also very effective in group settings to help individual members learn new behaviors, redirect faulty thinking patterns, and provide positive reinforcement as new thoughts and behaviors are learned. Watching other group members struggle and succeed with similar issues is another form of encouragement and reinforcement.
What Can You Treat With Cognitive Therapy?
CT is an evidence-based method of therapy that has demonstrated effectiveness in treating a variety of conditions, from generalized anxiety and stress to major mood disorders.
Some of the most promising research includes CT treatment for depression, schizophrenia, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder.
Cognitive therapy for depression
Cognitive therapy was originally designed to treat depression, and current research supports its effectiveness (Rupke et al., 2006).
It is a treatment process that enables clients to correct false self-beliefs that lead to negative moods and behaviors. A variety of meta-analysis studies have shown that CT is more effective at decreasing levels of depression than no treatment, a placebo, or medication alone (Rupke et al., 2006).
Clients that struggle with depression can learn to recognize negative automatic thoughts and discover alternate thoughts that more closely reflect reality (Rupke et al., 2006).
Behavioral aspects of CT are often used at the beginning of therapy to reinforce pleasurable activities and create inertia. These include scheduling positive activities into the day, finding social support, getting physical activity, and taking care of physical health.
Schizophrenia cognitive treatment
CT can be used to treat symptoms of schizophrenia by helping the client understand the onset of psychotic symptoms. For this population, CT uses a stress-vulnerability model that emphasizes that everyone can experience psychotic symptoms under sufficient stress (Pilling et al., 2002). This helps normalize the psychotic experience so the client feels less anxious about distressful symptoms, and they can be addressed more openly.
CT helps the person with schizophrenia link thoughts and feelings about current symptoms and reevaluate the thoughts in relation to them (Pilling et al., 2002). A therapist can help the client identify specific thoughts and come up with alternate explanations for their symptoms or psychotic episodes.
For example, if the person with schizophrenia believes voices they hear are from Satan, finding alternate explanations and normalizing the voices can make the symptoms less distressful.
How to treat OCD with cognitive therapy
Patients with OCD often come to therapy distressed about thoughts, obsessions, and compulsive behaviors (Valderhaug & Gotestam, 2007). CT helps them identify the automatic and unrealistic thoughts and change their interpretation of the meaning of the thoughts. This reduces anxiety and compulsive actions.
One effective CT technique in treating OCD is a thought record (Valderhaug & Gotestam, 2007). This requires the client to record the obsession, the interpretation of the obsession, what the client was doing at the time, and what (if any) compulsion followed the obsession.
This thought record can be reviewed with the client, and the therapist can use Socratic questioning to challenge the unrealistic belief verbally.
A look at treating PTSD
CT is an effective method of treating post-traumatic stress disorder (PTSD) and its symptoms (Ehlers & Clark, 2000).
Treating PTSD involves challenging negative memories and evaluations of trauma to interrupt thought patterns and behaviors that interfere with daily life.
The first step is helping the client understand the meaning behind the trauma and how it can exaggerate current feelings of threat. A therapist can help the individual find new meaning to the trauma and reevaluate the experience. A meaningful narrative account of the trauma can be created starting before the event and ending after the client feels secure and safe (Ehlers & Clark, 2000).
This process might involve writing a comprehensive account of the traumatic event, reliving the experience through imagination, or revisiting the location where it happened creating an element of “exposure.” This exposure opens a window to use cognitive restructuring that alters the problematic thinking associated with the trauma.
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4 Best Cognitive Therapy Techniques for Practitioners
CT is a short-term and solution-oriented approach to change maladaptive thoughts and behaviors. A variety of practical cognitive therapy techniques (some previously touched on) are used depending on the client’s needs and goals for therapy.
1. Exposure therapy
Exposure therapy is an effective CT technique used for anxiety and phobias. It involves exposing the client to a person, place, situation, or object that creates fear. The idea is to confront fears in a safe setting and overcome negative emotions and reactions.
2. Thought recording
Creating a thought journal is a cornerstone for CT. Clients capture, evaluate, and restructure negative or anxious automatic thoughts. Our article What Is a Thought Diary? provides more information and prompts for starting a thought journal.
Role-play is an effective technique in CT. A therapist can help a client practice or experience a situation/event in a safe space by acting out the interaction.
For example, if a client is anxious about an upcoming interview, the therapist can act as the future employer and walk through questions and responses. With practice, experience, and reassuring feedback, the client’s anxiety may subside, and confidence can increase.
4. Pleasurable activity scheduling
Activity scheduling and behavioral activation are methods of putting action before thoughts or motivation. Scheduling positive activities and doing them results in more positive thoughts and feelings.
For example, scheduling a morning walk or evening bath can provide energy in the morning and relaxation at night. In the same way that thoughts and emotions influence behavior, behavior can influence our thoughts and feelings.
4 Exercises & Games for Your Sessions
Using games and exercises in sessions allows for more interaction during therapy and helps clients overcome fears and challenge their own thoughts in a nonthreatening manner.
1. Thought-challenging games
As mentioned, challenging automatic thoughts is a core component of CT. It is fun to make a game of this to help individuals tangibly recognize and challenge negative thoughts.
For example, use a small ball to play the game “Catch That Thought.” Throw the ball and have the client catch it, then identify and challenge a negative thought associated with a given situation. Once the thought is identified, the client can come up with a challenge to the thought and throw the ball back.
2. Exposure games
Help clients confront fears and phobias in a safe and controlled environment.
For example, the game “Spider Phobia” involves gradually exposing the individual to pictures of spiders either through a computer screen or with drawings. The pictures will become more realistic, and the client will receive a prize or reward for remaining calm (low heart rate, steady breathing) while viewing the pictures.
3. Three Cs exercise: Catch, check, change
The three Cs exercise has a client catch the thought, check the thought, and then change the thought through verbal dialogue and writing the answers on paper.
4. Three columns exercise
The client will make three columns on a sheet of paper or a spreadsheet. It is best to do this when the client feels most anxious.
The first column is the “automatic thought” or the negative self-talk (for example: I am such a loser for messing up the presentation!).
Look for a cognitive distortion to label the thought in the second column (overgeneralization, all-or-nothing thinking, making assumptions, catastrophic thinking, etc.).
In the third column, write a rational response or a replacement for the automatic thought.
5 Questions to Ask Your Therapy Clients
Questioning faulty assumptions, cognitive distortions, and automatic thoughts is a foundational component of CT.
Examples of these questioning methods include the following:
In order to refine your viewpoint to make it accurate, it’s important to challenge it occasionally to consider whether there are reasons it might not be true. What do you think the strongest argument against this perspective is?
What would you have to learn or experience to change your mind about your current belief?
What initially convinced you that your current thought is accurate?
What are three pieces of evidence that contradict this thought or idea?
Can you describe specific benefits you receive from holding this belief or thinking this way?
Helpful Worksheets & Assessment Methods
Worksheets and assessments can be very helpful in cognitive therapy. They provide concrete guides to identifying, understanding, and changing thoughts, which is the premise of CT.
ANTS are automatic negative thoughts. The Identifying ANTS worksheet walks clients through identifying them, writing them out, and challenging them. This exercise enables clients to do this daily, outside of sessions, to catch the automatic thought and make changes before it leads to a negative emotional or behavioral response.
Having a repertoire of positive thoughts makes it easier to replace negative ones quickly. The Positive Replacement Thoughts worksheet guides clients to review potential positives and have them on hand when difficult situations or triggers arise in life.
Validated rating scale
The Cognitive Therapy Rating Scale is a widely used and validated measure to assess the effectiveness of CT from a client’s perspective. Both clients and supervisors can use this scale to identify areas of weakness and potential areas of growth and maximize every aspect of CT for optimal effectiveness.
Cognitive Therapy Books & Apps for Psychologists
The evidence-based nature and effectiveness of CT has made it a popular topic for books and apps that can be useful for both clinicians and their clients.
1. Feeling Good: The New Mood Therapy – David D. Burns
The book Feeling Good is based on CBT principles created by Aaron Beck.
It provides practical guidelines to navigate difficult situations and reframe stressors by simply catching and changing thoughts. It helps individuals with depression, anxiety, difficult relationships, and low self-esteem to “feel good” every day.
2. Cognitive Therapy and the Emotional Disorders – Aaron T. Beck
This book was created to help with a variety of emotional disorders.
It is based on the premise that mood disorders are due to faulty assumptions of ourselves and the world. Recognizing this and changing thoughts and beliefs leads to better moods and more stable emotions.
Clarity, a CBT thought diary app allows clients to track moods, provides guided journals to reframe thoughts, and offers quick assessments and videos related to CT concepts.
MoodKit is a mental health app in the iOS App Store that provides practical strategies to identify and change thoughts, moods, and behaviors. It highlights how shifting thoughts and actions has a direct impact on levels of anxiety and depression.
Resources From PositivePsychology.com
As mentioned previously, exposure therapy is a great technique used in CT. The Imagery Based Exposure worksheet uses imagery to create a hierarchy of fear-based situations and helps clients imagine overcoming each step. This can be an effective way of dealing with fear and anxiety in a safe and secure setting.
Our automatic thoughts are generally false opinions rather than facts. The Facts or Opinions worksheet provides examples of these automatic thoughts (or cognitive distortions) and asks the client to label each statement as either true or false. This can provide a concrete look at how our thoughts are not reality.
If you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.
A Take-Home Message
Cognitive therapy is an evidence-based approach to treating a variety of mental health conditions. It has been around for decades, and cognitive therapy techniques remain an effective way to improve mental, physical, and emotional wellbeing.
CT is based on the cognitive model, which links our thoughts, behaviors, actions, and emotions. A fundamental principle behind CT is that a thought precedes a mood, and both are interrelated with an individual’s environment, physical reaction, and subsequent behavior (Rupke et al., 2006).
Our minds are incredibly powerful and can determine the quality of our relationships, careers, health, and emotional state. Learning to use the mind in a positive way can ultimately improve every aspect of life.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. Guilford Press.
Beck, J. S. (2017). Questions and answers about cognitive therapy. Beck Institute Newsletter, 32, 12–20.
Beck, A. T., & Haigh, E. P. (2014). Advances in cognitive therapy and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24.
Berger, D. (2013). Cognitive behavioral therapy: Escape from the binds of tight methodology. Psychiatric Times, 30, 49–62.
Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 319–345.
Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G., & Morgan, C. (2002). Psychological treatments in schizophrenia: Meta-analysis of randomized controlled trials of social skills training and cognitive remediation. Psychological Medicine, 32, 783–791.
Robertson, D. (2010). The philosophy of cognitive-behavioral therapy: Stoicism as rational and cognitive psychotherapy. Karmac.
Rupke, S., Blecke, D., & Renfrow, M. (2006). Cognitive therapy for depression. American Family Physician, 73(1), 83–86.
Valderhaug, L., & Gotestam, P. (2007). An open clinical trial of cognitive-behavior therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics. Behavioral Research Therapy, 45, 577–589.
About the author
Dr. Melissa Madeson, Ph.D., believes in a holistic approach to mental health and wellness and uses a person-centered approach when working with clients.
Currently in full-time private practice, she uses her experience with performance psychology, teaching, and designing collegiate wellness courses and yoga therapy to address a range of specific client needs.