Cognitive behavior therapy involves a variety of treatment strategies. Depending on a particular client’s concerns and goals, therapy is likely to involve some of the following:
Strategies for unhelpful thinking:
Cognitive coping involves identifying and challenging limited thinking patterns that are currently maintaining distorted thoughts and beliefs about oneself, others, and the world. For example, someone with depression could be taught to challenge the assumption that all attempts to connect with friends lead to rejection.
Mindfulness techniques help clients develop a non-judgmental, observational relationship with their thoughts. This is also used for managing difficult feelings.
Problem solving and decision making skills are helpful in connecting a client with what matters to them and identifying a realistic course of action.
Strategies for problem maintaining behaviors:
Exposure is a strategy that involves learning how to gradually begin to participate in situations or activities that clients have been avoiding due to anxiety, feelings of worthlessness, or loss of hope that anything could change. This strategy is carefully planned and carried out in a collaborative fashion; clients gain confidence in being able to have their thoughts and feelings and in turn begin to face previously avoided situations. For example, someone who previously avoided driving for fear of having a panic attack, might learn to confront (rather than simply cope) by gradually getting behind the wheel, then taking small trips in town, and overtime increasing the amount of miles driven, until they meet a goal that is meaningful to them. At the same time, the therapist and client will work on facing the physical feelings of anxiety or panic.
Pleasant activity scheduling involves starting small and building from there by engaging in a set amount of activities that promote enjoyment and / or mastery.
Learning new skills for communicating more effectively or being more assertive are additional strategies that might be taught.
Strategies to address difficult feelings:
Acceptance of emotions is a skill that is often taught to help clients face more effectively the painful emotions that are an inevitable part of life.
Distress tolerance is another strategy helpful in managing extreme emotional reactions and self-harm urges.
Relaxation exercises are taught to help reduce overall physical tension or to help retrain effective breathing.
Putting it all together
Drawing from the strategies above, therapists who use CBT help clients identify and focus on the interplay between beliefs about their lives, related feelings, and corresponding behaviors. Understanding the relationship of these components allows the therapist and client to devise therapeutic exercises for particular points in this connected cycle. For instance, challenging negative thoughts about oneself or a situation, can lead to less fear or hurt, and more willingness to try new behaviors and activities. This, in turn, might lead to the desired change of improving relationships.