Cognitive Behavioural Therapy (CBT) Exercises and Techniques

Life can be challenging sometimes. We’re constantly faced with problems, big and small. As we experience these challenges, it’s normal to become fearful or default to negative thinking. Sometimes patterns of negative thinking are learned in childhood, when we’re first developing our cognitive skills.

Without good problem-solving skills, a strong belief system in ourselves, and tools to keep a clear perspective on what’s happening around us, we can quickly become our own worst critics. Without knowing how to give ourselves a reality check, we might assume the worst of our abilities and let our negative internal dialogue guide our future decision-making. 

This can have a real impact on our mental health and weaken our coping skills for future challenges—from handling the ebbs and flows of friend and family relationships, to work stress, to navigating grief. 

It’s not that our challenges are not real or bad (sometimes they are!), it’s more that we have greater control of our reactions to them than we might realize.

What is cognitive behavioural therapy (CBT)?

Cognitive behavioural therapy (CBT) is a form of psychotherapy or counselling therapy that centres on our thought patterns and how they affect our attitudes, our emotions and our behaviours.

CBT was first developed over 60 years ago by Dr. Aaron T. Beck at the University of Pennsylvania when he observed his patients seeing him for depression would have consistent streams of negative thoughts that were rather spontaneous. By helping them re-evaluate those thoughts about themselves, the world or their future, they became more resilient to everyday life. 

While we might address your personal history working with a therapist (your past might inform why you have certain thought patterns now), CBT is really about the present moment—the here and now. It’s about understanding what’s going on around us, how we’re making sense of those events, and how they make us feel.

According to the Centre for Addiction and Mental Health (CAMH) in Toronto, CBT comes down to the relationship between thoughts and behaviours. They’re intertwined and influence one another. They outline three levels of cognition that are helpful when understanding how our thoughts are formed:

• Automatic thoughts: like what Dr. Beck observed, these flow without full awareness, without that check for accuracy or relevance to the present situation
• Schemas: Shaped by our childhoods and life experiences, these are pervasive beliefs we’ve decided are true about ourselves, which can be dysfunctional
• Conscious thoughts: these are rational and made with the ability to see a situation clearly

CAMH and the American Psychological Association (APA) outline a few ways CBT helps to reduce emotional distress with strategies to change thinking and behaviours, such as:

1. Identifying if certain thoughts or thinking patterns are distorted
2. Understanding that our thoughts are just our ideas, not facts
3. Taking a step back to see our situation from different viewpoints
4. Gaining a greater understanding of the behaviour and motivations of others
5. Facing fears, or using role playing to learn how to anticipate and prepare for potentially problematic interactions
6. Building confidence in our actual abilities
7. Learning to calm our minds and bodies

Examples of thought distortions

“My friend didn’t text me back. She hates me!”

“My boss gave me a lot of feedback on my work. I’m terrible at this job.”

“Bad things always happen to me.”

It’s very human and normal to have negative thoughts—we’re ultimately trying to protect ourselves from dangerous situations or to cope with stress. If we expect the worst, we’ll be prepared for it. The problem is, it doesn’t always help us live a full and happy life.

Distorted thinking becomes a problem when it’s habitual—our default—and it shapes how we operate in our lives and how we feel about ourselves. Eventually, it can increase anxiety, symptoms of depression, or negatively impact our relationships.

Some themes of cognitive distortions include:

• Catastophizing: We consistently think that the very worst scenario is the only possible reality. It can come from experiencing real negative situations—we start to be fearful. If you’ve lived in financial strain before and you have a small work hiccup today, it might lead to thinking you’ll lose your job and won’t be able to pay rent. With some guidance, you can work through the facts of the current situation, how you handled something similar before, and how you can handle it now.
  
• Fortune-telling: Similar to catastrophizing, we predict a negative future without considering the likelihood of that outcome. Usually, these beliefs about the future lean negative. If we think that’s set in stone, we’ll make decisions based on that assumed outcome. This can actually create a self-fulfilling prophecy—we take steps that make the negative assumption true, instead of steps to make a positive assumption true.
  
• Mind reading: As we gain experiences in life, we tend to take mental shortcuts to simplify and understand a situation that is similar to one we went through before. Sometimes, this can distort our thinking. Mind reading happens when we assume we know what others are thinking and feeling without any real information to back it up. This can cause anxiety and stress, particularly deepening social anxieties.
  
• Labelling: Negative experiences do happen, but one stumble doesn’t define us. Labelling occurs when we generalize one characteristic or one event to define a whole person—including ourselves. If you fail one test, you’re not “a failure.” We might then unfairly misunderstand or underestimate ourselves or others.
  
  
• “Should”ing: Making a lot of “should” statements might be a clue that we’re engaging in unfairly negative views about your life. This could arise from deep cultural, family, or work expectations (that may be toxic) that chip away at our sense of self worth with our real accomplishments, our real goals, and increase anxiety.

How does CBT work?

CBT is usually time based and takes place over a set number of sessions, with “homework” exercises in between. Over the course of these sessions and exercises, you’ll learn to identify problems clearly, examine your automatic thought patterns and challenge underlying assumptions about yourself that motivate those thoughts, become more aware of your emotions in different situations, establish some goals, and focus more on how things are instead of how they should be—which is a much more manageable reality to live in.

Here are three commonly used exercises and techniques for CBT:

• Challenging cognitive distortions: Distorted thinking develops over time as a reaction to life’s challenges. We start to form thinking habits that are inaccurate and negatively biased. Once you start to learn and identify these distortions, you can start to challenge them. Over time, they become less automatic.
• Journaling: Related to cognitive distortions, journaling is a common exercise used in CBT to help track thought patterns. You’ll keep a record of negative thoughts, when and why they occurred, and eventually you’ll include jotting down new thoughts to challenge old ones. 
• Activity scheduling: Putting off activities we enjoy is a common outcome of anxiety or depression. Part of CBT may include putting a new event in your calendar and sticking to it. This also helps break negative cycles, helps establish new habits and provides a positive sense of accomplishment. 

According to the American Psychological Association, there is an emphasis on helping people “become their own therapists” with CBT. With new tools in your toolbox, you can continue to challenge your own thought patterns on your own and control your own behaviour to maintain more balanced emotions.

You’ll likely come across CBT on many of First Session’s partner therapist profiles under their modalities. It’s so commonly used by counsellors, in part, because it’s one of the most well-researched techniques out there—meaning there is a lot of scientific evidence that proves it’s effective, with good funding behind it, and therefore a lot of training available to help counsellors offer CBT.

There is even evidence that CBT can help with physical ailments like back pain!

While CBT is very common and is proven to help relieve symptoms associated with anxiety and depression, it’s not always the right choice for everyone. If you need help working through trauma or more support working on past issues, this might not be for you (or, not the only thing for you).

There are other models like dialectical behavioural therapy (DBT), mindfulness therapy, or body-focused therapy (somatic therapies) that can be effective for working through mental health issues as well.

Book an appointment or free therapy consultation today with Canadian therapists and counsellors who specialize in CBT.