Cognitive-behavioral therapy (CBT) is one of the more popular therapeutic modalities and can be used to treat a wide range of common mental health conditions and concerns. First developed in the 1960s, CBT has been adapted to suit a variety of populations and disorders, with a wide body of research demonstrating its efficacy. As such, it may be advisable for clinicians to incorporate CBT techniques into their practice.
Whether you specialize in CBT or offer a multimodal approach, your practice may benefit from integrating CBT techniques and tools. Here, we will explore some of the most common CBT techniques and offer suggestions for weaving them into your sessions. We will also cover some CBT-specific resources for clinicians, including books, worksheets, and online platforms. With these tools, you can deepen your understanding of CBT, enhance your therapeutic approach, and improve client outcomes.
Whether you’re an emerging therapist or looking to expand your therapeutic toolkit, this guide can serve as a comprehensive resource for harnessing the power of CBT in your practice.
Key CBT Techniques And How To Implement Them
CBT is founded on our understanding of the interplay between emotions, thoughts, and behaviors. Each of the following CBT techniques offers a way to help clients address mental health concerns through this cognitive-behavioral framework.
- Cognitive Restructuring
As the cornerstone of CBT, cognitive restructuring might be one of the more familiar techniques utilized by therapists. Your master’s program may have introduced you to the basics, but delving deeper into its nuances can help you create a more impactful experience for your clients.
To implement this technique, you might begin by offering your client a brief explanation of how CBT works. Then, walk them through the cognitive restructuring process, which involves identifying the situation, evaluating their feelings and thoughts, and making decisions based on the resulting insights.
Once your client understands the process, you might consider assigning CBT worksheets as homework. You can find downloadable CBT worksheets online or create them yourself. Consider sending worksheets specific to the challenge the client is experiencing (e.g., eating disorders, relationship concerns, depression).
You may also advise clients to use the cognitive restructuring process by writing everything out in a journal. Both cognitive restructuring and journaling can be easily adapted to suit most clients.
- Behavioral Activation
While cognitive restructuring focuses primarily on feelings and thoughts, behavioral activation addresses the behaviors that result from unhelpful thought patterns. Behavioral activation can help clients break the unhealthy cycles that characterize many mental health concerns. Clients living with depression and anxiety may find behavioral activation particularly beneficial.
Behavioral activation begins with identifying the causes of one’s behaviors and then changing the behaviors to help “activate” the brain in a more helpful way. The goal is to create an adaptive cognitive response that leads to healthier behavior patterns.
To this end, therapists can equip clients with tools that help them understand the causes behind their behaviors and allow them to adopt new systems that encourage adaptive behavior. If you decide to utilize behavioral activation in your practice, search for or create worksheets that help clients:
- Identify vicious cycles of emotions, thoughts, and behaviors
- Track moods and behaviors
- Identify positive and negative activities
- Set goals, schedule, and monitor activities
- Explore and understand values
- Identify activities that align with their values
With time, clients can develop resilience and self-confidence, spurring them to engage with healthier thoughts and feelings and ultimately allowing them to choose more productive behaviors.
- Distraction
For individuals learning to manage compulsions, addictions, or intense emotions, distraction can be a powerful tool. Help your client brainstorm a list of activities they might engage in to help them move through challenging emotional states while avoiding problematic behaviors or interactions.
Alongside this list of positive distractions, you might also have them identify their current coping mechanisms. By contrasting the two lists, clients can visualize the choices available to them in moments of distress, which may be a powerful motivator in promoting positive behavioral change.
- Exposure Therapy
For clients experiencing anxiety and phobias, exposure therapy may be an especially helpful form of CBT to integrate into your practice. There are several different types of exposure therapy, making it easy to adapt your treatment for each client and alter your approach over time. Variations include:
- Imaginal exposure: This type of exposure therapy takes advantage of the power of imagination to help clients face their fears. You might, for instance, ask the client to picture a distressing situation, then help them disentangle the upsetting stimuli of that situation from the reality of the present.
- Virtual reality (VR) exposure: VR offers a way to introduce a client’s fear in a safe and controlled environment. This type of exposure requires VR technology, such as a headset, and may be appropriate for therapists specializing in anxiety and phobias.
- In vivo exposure: In vivo exposure involves helping individuals directly face a feared object or situation. For example, you may work with your client to confront their fear of social situations by having them attend an event.
- Interoceptive exposure (IE): IE involves inducing physical sensations to help desensitize clients’ responses to fear. It is often used to treat panic disorder, chronic pain, health anxiety, and other conditions in which the body’s sensations play a role.
Because exposure therapy can be adapted to suit the unique needs of each of your clients, it may be a useful technique to learn. Taking continuing education courses or receiving certification in this approach can be crucial to ensure you’re using this method correctly.
- Thought Records And Journals
Clients often benefit from writing down their thoughts and feelings, a process that can play an integral role in achieving positive outcomes in therapy. Because CBT hinges on awareness of one’s emotions and cognitions, it can be beneficial to implement homework including thought records, mood trackers, journals, and other similar written exercises.
Thought records can help the client understand how their immediate response to a given stimulus may be informed by underlying irrational beliefs. By identifying these false beliefs, clients can then choose healthier, more productive thoughts and responses. A relatively easy process, thought records involve writing out the cognitive restructuring process in order:
situation→thought→emotion(s)→behavior(s)→adaptive thought/behavior
Freeform journaling may be a helpful way to vent and develop self-awareness, though clients often benefit from more structured approaches. Consider providing prompts or worksheets designed to help track one’s thoughts, emotions, behaviors, and even time. You may search for downloadable resources online or invest in specialized CBT workbooks.
- Mindfulness
While not strictly a CBT technique, mindfulness deserves a place in every therapist’s toolkit—by engaging meaningfully with the present, individuals can overcome thought and behavior patterns based on irrational past- and future-oriented concerns. This can be a crucial skill for clients experiencing depression, anxiety disorders, addictive or compulsive behavior, and even trauma.
Guided mindfulness meditations can be useful for introducing clients to the concept of mindfulness. There are many guided meditations available online, both free and paid. Deep breathing exercises and mindful activities such as drawing or painting may also be worth recommending to clients. Be sure to stress the importance of exercising these mindfulness skills in everyday life, as mindfulness can often be the bridge between understanding cognitive distortions and actively changing one’s behavior.
CBT Resources For Therapists
Effective CBT often involves a multi-modal approach that relies on different techniques and tools catered to the individual client being treated. Consider pursuing professional development opportunities that help you understand the theory behind these practices, implement them in your sessions, and evaluate treatment success. To master CBT, you might seek professional manuals, books, courses, and even training and certification programs that align with your practice’s needs.
Books And Manuals
Therapists of all experience levels may benefit from keeping a CBT book nearby for reading and reference. There are a number of manuals available, including some which are tailored to particular populations and mental health concerns. In addition to in-depth theoretical knowledge and case studies, many CBT books include helpful worksheets to offer to clients. The following books may serve as a helpful starting point for understanding and implementing CBT effectively:
- Cognitive Behavior Therapy, Second Edition: Basics and Beyond by Judith S. Beck
- CBT Made Simple: A Clinician’s Guide to Practicing Cognitive Behavioral Therapy, 2nd Ed. by Nina Josefowitz PhD and David Myran MD
- The CBT Handbook by Pamela Miles
Continuing Education
Your required continuing education (CE) hours can be a valuable opportunity to pursue CBT as an area of specialization, helping set you apart in a growing field. No matter your specialization, however, it may be worth exploring CBT more deeply as it is both highly adaptable and in-demand. This can make it useful for growing your client base and addressing the unique needs of each individual client.
You can find a diverse array of online CE courses on CBT, including some geared toward different types of mental health issues or populations. Browse CE providers, professional organizations, and academic institutions to find a course that aligns with your needs. One option for accessing free CEUs is signing up to become a provider for BetterHelp, an online therapy platform. With online therapy, you can choose when and where you offer support to clients while also expanding your skills and knowledge.
You might also join BetterHelp’s sister site, Therapists.com, which provides resources and information to mental health professionals all in one online space. Here, you can exchange practical advice with other professionals, learn crucial tips for building a thriving practice, and pursue valuable CE opportunities. With these resources at your disposal, you may be more equipped to meet the needs of your clients and market your services in the competitive landscape of mental health.
Training And Certification Programs
For therapists looking to specialize in CBT, it may be worth considering training and certification programs. These in-depth, structured programs can enhance your understanding of CBT principles and provide hands-on practice with supervised feedback. Upon completion of the certification program, you’ll be equipped with the skills to confidently integrate CBT into your practice and can display your certification on business and marketing materials to demonstrate your mastery of CBT.
Look for certification programs offered by reputable organizations such as:
- The Beck Institute
- National Association of Cognitive Behavioral Therapists
- Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program
Takeaway
Effective CBT often involves taking a multi-faceted approach to therapy, addressing cognitive distortions and maladaptive behaviors while helping clients deepen self-awareness and self-efficacy. In addition to providing your clients with resources such as worksheets, journal prompts, guided meditations, and psychoeducational materials, you may also consider pursuing specialized training in this area. In doing so, you can hone your skills, improve outcomes for patients, and pursue your niche with confidence.
