CBT is a structured and collaborative treatment. Your therapist will begin your work by reviewing your history and assessing your key concerns. Then, together, you will decide on your treatment goals. In a sense, you will eventually learn how to act like your own therapist by using some of the following techniques:
Cognitive Restructuring
Cognitive restructuring (also known as reframing) is a significant part of CBT. This technique allows you to identify and challenge negative thoughts into more realistic ones. Practicing it consistently will enable you to improve your overall mental health.
Some therapists use thought records to help you practice cognitive restructuring. A thought record is a visual graph that allows you to chart the triggering situation, original emotion, and thought, and then identify a new thought. You might fill in these thought records in session, or your therapist may assign them as homework.
You can also practice cognitive restructuring by learning how to examine the evidence (on a scale from 0 to 100%, how positive are you that this thought is real?). You can also learn how to identify exceptions (when did something good happen when you assumed the worst-case scenario would occur?)
Role-Play Interventions
Many people enter therapy to improve their social skills. Role-play exercises can help you practice setting boundaries and rehearse other challenging situations. Your therapist will pretend to play the other person, and you will practice what you want to say.
Mindfulness Skills
Mindfulness is a crucial concept in CBT (and in many other therapies). In fact, mindfulness-based cognitive therapy (MBCT) blends cognitive techniques with meditation.
Mindfulness allows you to become more conscious and aware of the present moment. Over time, integrating more mindfulness can help you strengthen how well you respond to various situations.
Progressive muscle relaxation: Progressive muscle relaxation entails constricting and then releasing different body parts systematically.4 You will tighten and release as you also focus on deep breathing. Many therapists use an audio recording to help you practice this skill.
Guided imagery: Guided imagery entails focusing on a particular scene (often described in an audio recording) as a way of meditating. This technique can help lower stress levels and boost concentration.
Daily mindfulness: You can also be mindful during everyday interactions and tasks. For example, you may practice more active listening when speaking to others, or you might eliminate distractions when you focus on a specific chore.
Activity Scheduling
Depression or anxiety can make prioritizing important tasks difficult. Activity scheduling requires you to indicate which activities you want to complete in a day or week. You will then write them down on a calendar.
Activity scheduling essentially takes the guesswork out of your schedule. You know what lies ahead of you—it’s your job to complete those tasks! Your therapist may have you rank how you felt before and after each task. This allows you to track any thoughts or feelings that arise.
Fear Hierarchy/Successive Approximation
A fear hierarchy (also known as successive approximation) can be helpful for clients with certain anxieties or phobias. This intervention allows you to confront your fear slowly. You will essentially take many baby steps before addressing whatever scares you the most.
For example, let’s say you have an immense fear of driving. Yet, you want to conquer this fear because your new job requires a car commute. Your therapist may have you list several steps before actually driving the car:
- Researching and educating yourself about staying safe while driving.
- Sitting in the car with other people while they drive you.
- Finding a driving instructor who can validate your fears.
- Sitting in the car with your driving instructor as they drive.
- Sitting in the car and holding the wheel (without turning the car on).
- Driving around the block with your instructor in the car.
- Driving three blocks with your instructor in the car.
- Driving across town with your instructor in the car.
- Driving on the highway with your instructor in the car.
- Driving to work alone (and calling a supportive friend afterward).
As you can see, the sequence of steps may look extensive (and you may add more as you work down the list). But mastering one skill at a time can help you feel empowered, and it will likely encourage you to keep going.