10 Key Principles

1) CBT is based on an ever-evolving formulation of the patient and her problems in cognitive terms.
2) CBT requires a good client-therapist relationship.
3) CBT emphasizes collaboration and active participation.
4) CBT is goal-oriented and problem focused.
5) CBT initially emphasizes the present.
6) CBT is educative; it aims to teach the client to be his/her own therapist, and emphasizes relapse prevention.
7) CBT aims to be time limited.
8) CBT sessions are structured.
9) CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.
10) CBT uses a variety of techniques to change thinking, mood, and behavior.

Cognitive Behavioral Therapy values and empowers the individual to take control of his/her life through psycho-
education with a vast array of techniques specific to individual diagnosis. Unconditional self-regard is extended to
include the unconditional regard of others, which is congruent with social work’s strength-based values. The goal of
CBT is to allow a client to take control of his/her problems and to manage life in a healthy adaptive way.

Cognitive Behavioral Therapy assumes that both the individual and the environment are of fundamental importance
and that therapy outside of a holistic approach would be an injustice to the client. Fixing cognitive dysfunctions is
not possible without the involvement of behavior and fixing behavioral dysfunctions is not possible without the
involvement of cognition.

The cognitive model hypothesizes that people’s thoughts and feelings are not determined by a situation, but by their
interpretation and construction of the situation. Recognizing this discrepancy, CBT seeks to modify the
dysfunctional core beliefs that result in automatic thoughts which trigger emotion in any given situation. Behavioral
methods are often used to accomplish this task and education components are often coupled with client homework
for successful treatment

5 Common Techniques of the Cognitive Behavioral Therapist

During Cognitive Behavioral Therapy the client and therapist collaborate through an open dialogue to develop a
problem definition and goal. Goals can be behavioral, cognitive, or physical in nature and can be defined by
problem or process. Cognitive Behavioral Therapy uses a range of therapeutic techniques to achieve these goals.
Ultimately, however, despite the vast toolbox of techniques, client change is related to his/her investment in the
process of CBT.

5 Common Cognitive Behavioral Techniques:

1. Socratic Questioning: Questioning allows the therapist to stimulate the client’s self-awareness, focus in on
the problem definition, expose the client’s belief system, and challenge irrational beliefs while revealing
the clients cognitive processes.
2. Homework: To assist with cognitive restructuring, clients are often assigned homework. Typical CBT
homework assignments may include activities in behavioral activation, monitoring automatic thoughts,
reviewing the previous therapy session, and preparing for the next therapy session.
 3. Self-Monitoring: Also called diary work, self-monitoring is used to record the amount and degree of
thoughts and behaviors. This provides the client and therapist information regarding the degree of a client’s
negative affirmations.
4. Behavioral Experiments: The experiment process includes experiencing, observing, reflecting, and
planning. These steps are conducted through thought testing, discovery, activity, and/or observation.
5. Systematic Desensitization: Systematic Desensitization pairs relaxation with exposure to something
stressful. Clients are taught to relax in anxiety producing situations.

ognitive behavioral therapy may be done one-on-one, or in groups with family members or with people who have
similar issues.

Your first therapy session

At your first session, your therapist will typically gather information about you and determine what concerns you'd
like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a
deeper understanding of your situation. Your therapist will also want to know whether you might benefit from other
treatment, such as medications. It might take a few sessions for your therapist to fully understand your situation and
concerns, and to determine the best course of action.

The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match for
you. Make sure you understand:

 His or her approach

 What type of therapy is appropriate for you
 The goals of your treatment
 The length of each session
 How many therapy sessions you may need
If you don't feel comfortable with the first therapist you see, try someone else. Having a good "fit" with your
therapist can help you get the most benefit from cognitive behavioral therapy.

Confidentiality

Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may
break confidentiality if there is an immediate threat to safety or when required by state or federal law to report
concerns to authorities. These situations include:

 Threatening to immediately or soon (imminently) harm yourself or commit suicide

 Threatening to immediately or soon (imminently) harm or take the life of another person
 Abusing a child or a vulnerable adult (someone older than age 18 who is hospitalized or made vulnerable by a
disability)
 Being unable to safely care for yourself
During cognitive behavioral therapy
Your therapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if
you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.

Cognitive behavioral therapy generally focuses on specific problems, using a goal-oriented approach. As you go
through the therapy process, your therapist may ask you to do "homework" — activities, reading or practices that
build on what you learn during your regular therapy sessions — and encourage you to apply what you're learning in
your daily life.

Steps in cognitive behavioral therapy 9PROCEDURE

Cognitive behavioral therapy typically includes these steps:

 Identify troubling situations or conditions in your life.These may include such issues as a medical condition,
divorce, grief, anger or symptoms of a mental illness. You and your therapist may spend some time deciding
what problems and goals you want to focus on.
 Become aware of your thoughts, emotions and beliefs about these situations or conditions. Once you've
identified the problems you want to work on, your therapist will encourage you to share your thoughts about
them. This may include observing what you tell yourself about an experience (your "self-talk"), your
interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your
therapist may suggest that you keep a journal of your thoughts.
 Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be
contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and
behavioral responses in different situations.
 Challenge negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether
your view of a situation is based on fact or on an inaccurate perception of what's going on. This step can be
difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful
thinking and behavior patterns will become a habit and won't take as much effort.
Your therapist's approach will depend on your particular situation and preferences. Your therapist may combine
cognitive behavioral therapy with another therapeutic approach — for example, interpersonal therapy, which focuses
on your relationships with other people.

Length of psychotherapy

Cognitive behavioral therapy is generally considered short-term therapy — about 10 to 20 sessions. You and your
therapist can discuss how many sessions may be right for you. Factors to consider include:

 The type of disorder or situation

 The severity of your symptoms
 How long you have had your symptoms or have been dealing with your situation
 How quickly you make progress
 How much stress you're experiencing
 How much support you receive from family members and other people
Cognitive-behavioral therapy (CBT) is a form of talk therapy. This means that you discuss your thoughts, feelings,
and behaviors with a mental health professional. CBT focuses on how the way you think affects the way you feel
and act.

Your therapist helps you identify negative thoughts and evaluates how realistic these thoughts are. Then, he or she
teaches you to unlearn negative thought patterns and learn new, helpful ones.

CBT is a problem-solving approach. While you cannot control other people or situations, you can control the way
you perceive and react to a particular situation. CBT teaches you the skills to change your thinking. It can also help
you manage your reactions to stressful people and situations

What to Expect
Prior to Procedure

There is no specific preparation for CBT. You may be asked to fill out a questionnaire about your feelings.

Description of the Procedure

You may receive CBT in one-on-one therapy sessions or in a group format. CBT can be divided into two
parts:functional analysisand skills training.

Functional Analysis

You and your therapist will identify stressful situations. You will also determine the thoughts that lead to or worsen
these situations. These thoughts will then be analyzed to see if they are realistic and appropriate. For example, your
therapist may point out negative thought patterns, such as “I cannot handle this” or "people are laughing at me.”

Skills Training

Next, your therapist guides you to reduce unhealthy ways of thinking and to learn healthier ways. Instead of thinking
“I cannot handle this,” you will learn to draw on your strengths: “I have handled difficult situations before, so I can
handle this one.”

You will also learn to ask more questions about yourself before making a conclusion. For example, “Could those
people be laughing at something other than me?” The goal is to replace irrational thought patterns with better ones.
Skills training takes a lot of practice. You will often be given “homework.” You might practice deep-breathing
exercises or role-play how to act in certain social situations. For example, a person dealing with substance abuse
might practice ways to decline an alcoholic drink.

Homework is vital to the success of CBT. You must practice new, rational responses until they replace your
previous, unhealthy responses. Homework also allows you to try new skills. You will then be able to give feedback
on which works best for you.

How Long Will It Take?

The length of an individual session is usually 50-100 minutes. Group sessions may last longer. Treatment sessions
may occur 1-2 times per week for 12-16 weeks.

This is a general guideline. Depending on your situation, treatment may be longer or shorter. Keep in mind that it
may take several tries to unlearn poor habits and to learn healthy ones.

Post-therapy Care

You may be given homework between sessions. You will need to practice the strategies you and your therapist have
discussed.

Some therapists advise that you return for a check-up about three, six, and twelve months after therapy has ended. In
addition, you may call your therapist whenever the need arises.

Outcome

The goal of CBT is to change your thought process. This will allow healthy and realistic responses to difficult
situations. Many patients notice an improvement in their symptoms within 3-4 weeks of beginning CBT.

CBT is structured and directive.

Cognitive-behavioral therapists have a specific agenda for each session. Specific techniques / concepts are taught
during each session. CBT focuses on the client's goals. We do not tell our clients what their goals "should" be, or
what they "should" tolerate. We are directive in the sense that we show our clients how to think and behave in ways
to obtain what they want. Therefore, CBT therapists do not tell their clients what to do -- rather, they teach their
clients how to do.

ognitive behavior therapy involves both a “cognitive” and a “behavior” component, so there are intervention
strategies addressing both.

Cognitive component:
1. Identify automatic negative thoughts, intermediate beliefs, core beliefs (fears). This formulation is from Beck;
another commonly used one is the “cognitive triad” of beliefs about self, future and world.

a. Have client keep a thought log/record/journal to record automatic negative thoughts several times per day. This
will demonstrate how dysfunctional beliefs contribute to symptomatology.

b. Use mindfulness exercises.

c. Develop lists of problems to solve; concrete treatment plans; identify treatment obstacles.

d. Assign homework.

e. Use the downward arrow technique to move from automatic negative thoughts to core beliefs and excavate
characteristic modes of thought that are creating cognitive distortions (Beck) or irrational thinking
(Ellis). Examples: overgeneralization; catastrophizing; mislabeling; negative attribution bias.

2. Change beliefs by cognitive restructuring.

a. Challenge automatic thoughts – search for discrepant evidence to disconfirm pathogenic cognitions; lower the
subjective probability belief is true.
b. This will reduce reactivity to triggers and sensitivity to alarms.

c. Replace negative thought patterns – raise the cognitive accessibility of alternative belief formulations. This is the
main point of CBT.

d. Use psychoeducation.

e. Use skills training (Linehan – DBT).

f. Focus on a valued ideal (Hayes – ACT).

g. Engage in role plays, role modeling, behavioral rehearsal.

Behavioral component: