What is CBT?
CBT stands for Cognitive Behavioral Therapy. It is a common, evidence-based psychotherapy practice used to help people cope with everyday, stressful situations such as work or relationship challenges. It can also be used in conjunction with other therapy techniques to treat various mental health struggles, such as anxiety, depression, eating disorders, addiction, PTSD, and more. The techniques focus largely on thought identification, nervous system relaxation, coping, resilience, and stress management. CBT often also involves brief homework exercises to apply the skills to day-to-day life and strengthen them with practice.
How does CBT Work?
The CBT process begins with a therapist teaching several structured exercises and specific techniques. Specifically, these practices are oriented to help the client recognize how their thoughts impact their emotions and behaviors. Learning these skills further helps the client become more aware of their negative or irrational thinking patterns in order to shift their perceptions of stressful situations and respond to them much more effectively.
Three of the most helpful CBT techniques are:
- Identifying Cognitive Distortions: This technique involves learning about what cognitive distortions are and to identify when you are thinking them. More specifically, cognitive distortions are irrational negative thoughts that lead to further negative thinking or uncomfortable emotional states.
- An example of a cognitive distortion is binary thinking (black/white; either/or; all/nothing), which does not allow for any shades of gray or wiggle room in our thoughts. This would look like a partner thinking in one moment “my partner is the best and I love them so much,” and then in the moment after an argument thinking “how awful their partner is and how much they hate them.” This is either/or thinking and does not hold space for the entirety of the partner’s strengths and limitations.
- Another example of a cognitive distortion is catastrophizing, which in common terms is known as making a mountain out of a molehill. For instance, this would look like making one small mistake at work and jumping to the conclusion that you are going to lose your job.
- A third example of a cognitive distortion that I hear in clinical practice often is “Shoulding” on ourselves and others. This is when we have thoughts about how we and others should behave. We can get stuck on these expectations, resulting in disappointment, guilt, or frustration.
- Exploring + Reframing Thoughts: Once we gain awareness of our cognitive distortions, we then want to explore where they came from and practice reframing them to be more rational and grounding.
- Journaling is a skill that helps us get our thoughts out, explore where they came from, and gain clarity on the thoughts we want to change. There is no right or wrong way to journal. A CBT therapist will give their clients journal prompts to follow, but it is also very effective to free journal on your own.
- Labeling + Replacement is a helpful CBT skill that involves labeling every time we have a cognitive distortion and then challenging it by replacing it with a new, healthier thought. For instance, if one of our cognitive distortions is catastrophizing when we think, “Oh, now I’m going to get fired!”, we would practice labeling that thought as catastrophizing, and then replace it with a grounding thought such as “That isn’t true. I only made one mistake.”
- Relaxation Coping Skills: Learning coping skills to foster relaxation is another powerful element of Cognitive Behavioral Therapy. Deep breathing, progressive muscle relaxation + visual imagery are examples of coping skills. Check out our Mindfulness Page to learn more about these coping skills in greater detail.
Helpful CBT Resources
Here are suggestions for my top three resources related to Cognitive Behavioral Therapy:
- The Beck Institute is founded by Dr. Aaron Beck, who is known as the father of CBT. It is a premier training and research institution with the most up-to-date clinical information on CBT.
- The Trauma Focused-CBT Workbook is a free, valuable tool full of CBT exercises with a focus on trauma healing.
- The Cognitive Behavioral Workbook for Anxiety provides a step-by-step program you can follow to manage anxiety symptoms with CBT skills.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
Clark, D. A., & Beck, A. T. (2012) The Anxiety and Worry Workbook: The Cognitive Behavioral Solution New York: The Guilford Press.
Cuijpers, P., Cristea, I., Karyotaki, E., Reijnders, M., & Huibers, M. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3):245–58.
Hofmann, S., Asmundson, G., & Beck, A. (2013). The science of cognitive therapy. Behavioral Therapy, 44:199–212.
Riggenbach, J. (2013). The CBT toolbox: A workbook for clients and clinicians. Pesi Publishing and Media.
What is DBT?
DBT stands for Dialectical Behavior Therapy. It is a form of CBT that focused strongly on mindfulness and emotional regulation skill development. The goal is to provide new skills to manage painful emotions, navigate stressful situations, and reduce conflict in relationships. It was originally created by Dr. Marsha Linehan for people with Borderline Personality Disorder, however, it has been successfully used to treat many mental health struggles, including depression, anxiety, food issues, and more. Since the skills taught are based on mindfulness and emotional tolerance and regulation, they can be helpful to anyone who learns them.
How Does DBT Work?
DBT works by teaching the client a number of skills that help them to step back from a situation to have enough space to pause and view it in a more balanced way. In fact, Dialectical means to balance opposites, and that is the main function through which DBT works. The therapist teaches the client how to balance, or hold space for multiple perspectives, rather than viewing experiences through a black/white or either/or lens. Learning how to change stuck, extreme thinking results in more grounded emotional states and balanced behavioral choices.
Three of the most helpful DBT techniques are:
- Wise Mind: Accessing and acting from our wise mind is a powerful technique. DBT explains that we each have a rational mind, in which we operate from an intellectual place, and an emotional mind, in which we operate impulsively from our emotions. The Wise Mind is the overlapping space between these two minds. When we access the Wise Mind we learn to recognize and honor our feelings, and simultaneously respond to them in a grounded, rational way. In order to access the wise mind, it is necessary to become more flexible and less rigid in our thinking.
- Create a Pros and Cons List: When conflicted over a situation or decision, this technique involves writing down the pros and cons of a decision. When we do this we can begin to see the situation more clearly and mindfully choose to act from a grounded place, that both honors our emotions and is a rational choice for ourselves.
- TIPP: This is a technique we can use to help ourselves calm down and re-ground when feeling emotionally out of control. The steps are:
- T = Temperature: Use something cold to decrease your heart rate, like splashing water on your face
- I = Intense exercise: Increase your heart rate for a short amount of time (10-15 minutes), which will automatically change your body’s reaction to the situation
- P = Paced breathing: Take slow, deep breaths in for 4 and out for 6-8 seconds, to bring down your emotional arousal
- P = Progressive muscle relaxation: Squeeze and relax each muscle group in your body from head to toe, to help you relax
Helpful DBT Resources
Here are suggestions for my top three resources related to Dialectical Behavior Therapy:
- Free Online DBT Skills Workbook: This Workbook teaches many of the DBT skills and you can access it for free. https://adoeci.com/sites/default/files/grupos/dbt-skills-workbook.pdf
- Behavioral Tech: A teaching and research organization developed by the creator, Linehan, which puts out current research and training. https://behavioraltech.org/
- Tara Brach: Is a psychologist and mindfulness teacher and many of her teachings are in alignment with DBT principles. https://www.tarabrach.com/
Koerner, K. (2011). Doing Dialectical Behavior Therapy: A Practical Guide, Guilford Press
Linehan, M. (2014). DBT Training Manual. New York, NY: The Guilford Press.
Linehan, M. & Dimeff, L. (2001). “Dialectical Behavior Therapy in a nutshell” (PDF). The California Psychologist. 34: 10–13.
Astrachan-Fletcher, E. (2009). The dialectical behavior therapy skills workbook for bulimia using DBT to break the cycle and regain control of your life. New Harbinger Publications.
Panos, P., Jackson, J., Hasan, O. & Panos, A. (2014). Meta-analysis and systematic review assessing the efficacy of Diabletctical Behavior Therapy (DBT). Research on Social Work Practice, 24(2).