Principles of Cognitive Behavioral Therapy

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There are plenty of reasons for people to feel anxious, worried, and upset these days. Just take a look at the news.

But too many people’s brains are making things worse. They are caught up in negative thought patterns that can compound emotional problems, anxiety, and depression. These thoughts can contribute to negative, or harmful, behaviors.

A promising form of treatment for anxiety, depression, and other mental health challenges is called cognitive behavioral therapy (CBT).

What are the principles of cognitive behavioral therapy? 

What Is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a form of talk therapy that is used by behavioral health professionals to address a number of mental health issues, including anxiety, depression, substance use disorders, eating disorders, panic attacks, anger, phobias, and severe forms of mental illness.

When it is working, CBT can be effective immediately in helping people make changes in their thoughts and actions; treatments often last a few weeks or months.

The American Psychological Association (APA) says CBT is based on the following principles:

  1. Some psychological problems are based on faulty or unhelpful ways of thinking.

  2. Psychological problems are based, in part, on learned unhelpful behavior.

  3. People experiencing psychological problems are able to learn better ways of coping with them to relieve symptoms and become more effective in their lives.

The APA includes CBT in its guidelines for treating post-traumatic stress disorder, emphasizing that many studies have shown CBT to be one of the more effective forms of therapeutic interventions.

That’s why CBT is being used by psychiatrists, psychologists, psychiatric nurse practitioners, social workers, marriage and family therapists, and other behavioral health professionals.

All of these clinicians are using CBT-based therapies to help individuals identify negative thought patterns and transform them to positive ones.

Retraining Our Thoughts

When a clinician is conducting a session using CBT they will help the person identify and challenge negative thought patterns — sometimes called distortions — that affect their mood. 

The idea is to replace the negative with positive. There are various ways to help people do this.

Several approaches and techniques fall under the umbrella of CBT. This article lists the following types of CBT:

  • Cognitive therapy — identifying and changing distorted thinking, emotions, and behaviors.
  • Dialectical behavioral therapy (DBT) — addressing thoughts and behaviors and incorporating strategies like emotional regulation and mindfulness.
  • Multimodal therapy — using 7 different modalities to approach the issue: behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological factors.
  • Rational emotive behavior therapy (REBT) — identifying irrational beliefs, challenging them, and learning to recognize and alter the thought patterns.

CBT Techniques

Because the goal is to both identify and reframe negative thought patterns, clinicians have several techniques they use to help individuals achieve this.

  1. Cognitive restructuring or reframing. Patients take a deep look at their negative thought patterns and the clinician helps them identify negative thought patterns, offering ways to reframe them to become more productive and helpful.

  2. Guided discovery. This is when a therapist asks questions about a person’s beliefs to understand their thought patterns. They might challenge beliefs, broaden thinking, or ask for evidence to support assumptions.

  3. Exposure therapy. This is a treatment sometimes used to address phobias. Exposure to something that elicits fear or anxiety can be done in increments until people feel more able to cope with them.

  4. Journaling and thought records. Many people benefit from writing down their negative thoughts and reframing or replacing them with positive ones. It can also help to record new behaviors and thoughts to become more aware of progress.

  5. Activity scheduling and behavior activation. When people are avoiding something because of fear and anxiety, sometimes just putting it on the calendar is a first step to establishing positive habits.

  6. Behavioral experiments. This is often a way to approach clients with anxiety disorders that include catastrophic thinking. A clinician will ask them to predict what will happen before they embark on a task that makes them feel anxious. Afterward, they can follow up to see if the prediction came true.

  7. Relaxation and stress reduction techniques. Relaxation techniques such as deep breathing exercises, muscle relaxation, and guided imagery can help lower people’s stress levels and increase their feeling of control.

  8. Role playing. This is a helpful technique for problem solving, gaining confidence, or improving social skills. It helps when people can work through difficult or anxiety-producing situations and behaviors.

  9. Successive approximation. This is a way of breaking down large, overwhelming tasks into small, achievable steps. It is a way of building confidence as people work toward goals.

More Tools for Behavioral Health Professionals

There’s a reason why many clinicians are using CBT techniques to address some of the most pervasive mental health disorders.

We all benefit from more understanding of our own thought patterns and behaviors. And learning how to gain a sense of control over our thoughts is an empowering action.

CBT has proven especially effective for treating anxiety disorders. In the virtual Connecticut Women’s Consortium Training, Cognitive-Behavioral Therapy for Anxiety Disorders, clinicians are taking a deep look at anxiety disorders. They explore several of the most effective techniques, including exposure, relaxation training, cognitive restructuring, and acceptance.

The National Alliance of Mental Illness (NAMI) reports that 40 million adults in the US are suffering from anxiety. When more of them receive effective and compassionate treatment to improve their quality of life, the ripple effect extends into entire communities.


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