CBT Techniques: Cognitive and Behavioural
In CBT, verbal techniques are used to bring forth the client’s automatic thoughts, analyse the logic behind the thoughts, identify unhelpful assumptions, and examine the validity of the assumptions. Assumptions, once identified, are open to modification, which can occur by asking the client if the assumption seems reasonable, by having the client generate reasons for and against maintaining the assumption, and by presenting evidence contrary to the assumptions. Specific cognitive techniques include the following:
Decatastrophising: the “what-if” technique which helps clients prepare for feared consequences. This is helpful in decreasing avoidance.
Reattribution: a technique which tests automatic thoughts and assumptions by considering alternative causes of events. This particularly helps when clients perceive themselves as the cause of problem events.
Redefining: helps clients mobilise when they believe problems are beyond personal control; these techniques may make problems more concrete, stating them in terms of the client’s own behaviour.
Decentring: used chiefly to help clients who erroneously believe that they are the focus of everyone’s (usually negative) attention.
Behavioural techniques are also used to modify automatic thoughts and assumptions. These employ behavioural experiments designed to challenge specific maladaptive beliefs and promote new learning. A client might, for example, (1) predict that a certain outcome will obtain, based on automatic thoughts, (2) carry out the agreed behaviour, and then (3) evaluate the evidence in light of the new experience. Some of the chief behavioural techniques used to foster cognitive change are:
Homework: opportunities to apply CBT principles between sessions. Assignments typically focus on self-monitoring, structuring time effectively, and implementing procedures for dealing with actual situations.
Hypothesis testing: with both cognitive and behavioural components, this technique must make the hypothesis both specific and concrete.
Exposure therapy: thoughts, images, bodily symptoms, and levels of tension are experienced by, say, an anxious client. Exposure to the anxiety triggers provides data for the client, who can examine specific thoughts and images for distortions.
Behavioural rehearsal and roleplaying: used to practice skills or techniques which are later applied in real life. Role-playing may be taped in order to provide objective feedback with which to assess performance.
Diversion techniques: Activities such as social contact, work, play, visual imagery, and physical activity are used to reduce strong emotions and decrease negative thinking.
Activity scheduling: provides structure and encourages involvement. By rating, say, the degree of mastery and pleasure of an activity, depressed clients, for example, are able to see that they were not depressed at the same, unvarying level all day. They are able to contradict a belief that they cannot enjoy anything, and are further shown that activity takes some planning, so someone does not come to be an inert “couch potato” due to an inherent defect.
Graded task assignment: the client initiates an activity at a “safe” level and the therapist gradually increases the difficulty of assigned tasks (Beck & Weishaar, 1995).