Cognitive Behavioral Therapy (CBT) is one of the most popular therapies offered in the UK today. Because of CBT’s success, some of its tenants have become well-known. You might already have heard, for example, that thoughts affect feelings, or that behavioural change can affect negative thoughts.
But what other Cognitive Behavioral Therapy techniques and tools are there, and how do they help you? How are these CBT techniques used in a session?
Agenda Setting in CBT
This is a collaborative process between your therapist and you to determine how to best make use of each session. At the start of each appointment both you and your therapist suggest items you’d like to discuss. A decision is then made on the order the points will be discussed, and how much time each one needs.
The point of agenda setting is to make sure that the session is well spent, and that the hour isn’t lost to something that isn’t of itself productive, like simply rehashing the events of the week. It is always a good idea to be thinking before your session about what you want to put on the agenda, so you don’t walk away feeling something important was missed.
In the first few sessions your therapist will model for you how to set agendas. So you don’t have to instantly feel comfortable enough to add items to the agenda yourself, but can learn over time. This is itself a valuable process, helping you take charge of your problems and their solutions.
Goal-Setting in CBT
Again, this is a collaborative process designed to maintain structure and focus. The point is to make the goals for your therapy those that are relevant to you, with input from your therapist to make sure they are clear and are what you actually want as opposed to what you think you should want. Goal-setting makes CBT productive by highlighting the possibility of change, making insurmountable problems appear more manageable, and increasing your hope of overcoming them.
While there are many different approaches to goal setting, one of the more common techniques used by CBT therapists is the SMART way.SMART goal setting creates a clear and vivid picture of your goal and helps you maintain your motivation for achieving it.
This is what the acronym stands for:
Specific: Avoid generalisation. Be clear and focused on exactly what you want. A specific goal has a much greater chance of being accomplished than a general goal.
Measurable: Establish concrete criteria for measuring progress toward the attainment of each goal you set. Ask yourself questions such as, “How much?” and “How many?” “How will I know when I have met my goal?”
Achievable: Make your goals attainable and feasible! How are you going to make this goal a reality? What can you do to make it more achievable?
Realistic: Is your goal realistic given your skills, time frame, etc? While setting high goals can be a great way of increasing motivation, it can also be disheartening when they are so high that you cannot reach them. This can leave you feeling like a failure.
Timely: Set realistic time-frames to avoid procrastination or giving up on your goal.
An example of a CBT SMART goal in action:
Let’s say a depressed client wishes to exercise more frequently despite not presently doing any exercise. This is what they might come up with.
Specific: I want to walk in the park next to my house every day for 30 minutes.
Measurable: I can make a diary to record how often I have been out for and for how long.
Achievable: I can take the dog with me so that I have to go out.
Realistic: 30 minutes is about the time it takes to walk around the park, so it’s not too much and not too little. Plus, walking is quite cheap so it won’t affect my lack of money.
Timely: I will aim to do this for one month, and then review to see if I have achieved this goal.
The SMART approach thus becomes a step-by-step, easy to follow, yet concise plan.
To some people even seeing the word ‘homework’ can bring back old memories from school where you were forced to do something you didn’t want to do. But homework is one of the essential Cognitive Behavioral Therapy techniques. So think of it as ‘tasks’ or ‘assignments’, or whatever works for you.
Weekly tasks set by your therapist provide fantastic opportunities for you to be practicing what you have learned in sessions and chipping away at your low mood. While the therapy room is a useful environment, it doesn’t reflect the world in which you spend your life. By taking what you learn in sessions and applying it in the ‘real world’ you can have a much better understanding of how to realistically change your thoughts and behaviours.
If you want results from CBT it’s imperative to put in this work between sessions, including doing the CBT worksheets your therapist may give you. Can you imagine going to your local gym, having one session a week with your instructor, then expecting a Jessica Ennis style six-pack at the end of 4 weeks? If you want the six-pack you have to be practicing what you learn with your gym instructor all the time, and it’s exactly the same in Cognitive Behavioural Therapy.
Examples of homework which can be given during CBT include keeping a ‘thought record’ (keeping track of what thoughts trigger your moods to identify negative thinking and the links between behaviour and thoughts) and timetabling (planning time for resting, working and leisure each day).
Socratic Questioning in CBT
Named after the ancient Greek philosopher, Socratic questioning is a form of open questioning where as the client you take on the role of investigator, helped by your therapist. You look at any unhealthy beliefs you may hold, scrutinise them by looking at the evidence, and begin to discover more balanced and healthier perspectives. Your therapist helps by asking gentle questions that get to the heart of your problem.
An example of a Socratic question might be “Can you see this another way?’ or, “What is the evidence for thinking that?’”. The point of this sort of questioning is to be able to look at the evidence and make a more balanced and logical decision.
The Therapeutic Relationship in CBT
A cornerstone of CBT is the collaborative relationship between you and your therapist, called ‘the therapeutic relationship’. Your therapist works more like a guide or mentor than an instructor telling you what to do. Their role is to support you to explore new options for feeling and behaving.
CBT regards such factors as empathy, warmth, and respect as key ingredients to a successful relationship and sees any difficulties as something that can be collaboratively worked with in the same way as other problems are worked with in CBT. While it does consider the therapeutic relationship as important, unlike psychodynamic psychotherapy CBT does not see the relationship between yourself and the therapist as therapeutic in and of itself.
Further Reading on Cognitive Behavioral Therapy Techniques
Briers, S. (2012). Brilliant CBT: How to Use Cognitive Behavioural Therapy to Improve Your Mind and Your Life. Pearson.
Grant, A. (2010). Cognitive Behavioural Interventions for Mental Health Practitioners. Learning Matters.
Papworth, M., Marrian, T., Martin, B., Keegan, D., & Chaddock, A. (2013). Low Intensity Cognitive Behavioural Therapy. SAGE Publications.
Westbrook, D., Kennerley, H., & Kirk, J. (2007). An Introduction to CBT: Skills and Applications. SAGE Publications.
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