Cognitive Behavioral Therapy-CBT Guide

“The greatest discovery of my generation is that human beings can change the quality of their lives by changing the attitudes of their minds.” – William James

The basic idea of cognitive behavioral therapy is that your thinking determines your quality of life. If you change your thinking, you will improve your life. External factors influence your life to some degree, but it is mostly how you interpret external factors that has the greatest impact.

If you think that you have to be perfect, small disappointments will feel like major failures. If you dwell on your worries or fears, you will eventually feel overwhelmed. If you hold on to disappointments or resentments, you will sap the joy out of life. Your interpretation of events has a big influence on your life. It is the power of mind over mood.

Ask your therapist or doctor if cognitive therapy is right for you. These techniques can complement the work you do with your therapist or doctor, but they are best done in combination with professional guidance.

Table of Contents

  1. What is Cognitive Behavioral Therapy?
  2. Negative Thinking
  3. CBT Worksheet-Thought Record

What is Cognitive Behavioral Therapy?

It is a step-by-step method for identifying your negative thinking and replacing it with healthier thinking. It changes your inner dialogue. Numerous studies have shown that cognitive behavioral therapy is effective for treating anxiety, depression, addiction, and life’s many challenges.[1, 2]

Research has also shown that cognitive behavioral therapy is more effective than other forms of therapy for treating anxiety and depression.[3]

Cognitive therapy helps to change the wiring of your brain. When you challenge your negative thinking, you create new neural pathways. The more you practice your new way of thinking, the more you strengthen those neural pathways.[4, 5, 6]

MRI studies have confirmed that cognitive therapy changes the wiring of your brain. Your brain begins to reflect your new way of thinking. This is why the benefits of cognitive behavioral therapy are not just temporary. Cognitive therapy changes your brain pathways and has a more permanent effect on your thinking and behavior.[7, 8]

A review of recent variants of cognitive behavioral therapy, including mindfulness-based cognitive therapy, acceptance therapy, and commitment therapy, has shown that they are no more effective than CBT, and that they work through the same underlying mechanisms.[9]

The principles of cognitive behavioral therapy are so sound that it can be used effectively in a number of settings. Cognitive behavioral therapy has been shown to be effective when delivered in primary care, via computer, and through internet-based self-help programs.[10]

Negative Thinking

Negative thinking is any type of thinking that leads to negative consequences. Negative thinking is usually rigid, absolute, and not supported by the facts.

When your thinking is rigid and absolute, you tend to take an all-or-nothing approach in your thinking and you are resistant to change. For example, you may think that you’re a failure at everything, and you may be resistant to hearing encouraging advice from your friends. Mind over mood works both ways. Negative thinking leads to negative consequences.

It can be hard to recognize negative thinking sometimes. You may only recognize that your life isn’t working. Cognitive therapy is designed to help you recognize your negative thinking and discover healthier thinking.

These are the common types of negative thinking. There is some overlap among them. But giving each a name makes it easier to remember them.

The Big Four Types of Negative Thinking

  • All-or-Nothing Thinking: “I have to do things perfectly, and anything less is a failure.”
  • Focusing on the Negatives: “Nothing goes my way. It feels like one disappointment after another.” A variation is being overly judgmental: “The world is falling apart. I don’t like what I see around me.”
  • Negative Self-Labeling: “I’m a failure. If people knew the real me, they wouldn’t like me. I am flawed.”
  • Catastrophizing: “If something is going to happen, it’ll probably be the worst-case scenario.”

Other Common Types of Negative Thinking

  • Excessive Need for Approval: “I can only be happy if people like me. If someone is upset, it’s probably my fault.”
  • Mind Reading: “I can tell people don’t like me because of the way they behave.”
  • Should Statements: “People should be fair, and when they are not they should be punished.”
  • Disqualifying the Present: “I’ll relax later. But first I have to rush to finish this.”
  • Dwelling on the Past: "If I dwell on why I'm unhappy and what went wrong, maybe I’ll feel better."
  • Pessimism: "Life is a struggle. I don't think we are meant to be happy. I don't trust people who are happy. If something good happens in my life, I usually have to pay for it with something bad."

Consequences of Negative Thinking

All-or-nothing thinking can lead to anxiety because you think that any mistake is a failure. You worry that any mistake may expose you to criticism or judgment. Therefore you don’t give yourself permission to relax and let down your guard.

All-or-nothing thinking can lead to depression because when you think you have to be perfect, you feel trapped by your own unrealistic standards. Feeling trapped is one of the known causes of depression.

All-or-nothing thinking can lead to addiction because anxiety or depression feels so uncomfortable that you may turn to drugs or alcohol to escape.

Negative thinking not only leads to unhappiness, it is also an obstacle to self-change. When you think in an all-or-nothing way, then any change feels like a big deal. You can’t see the small steps, and you don’t have the energy to take big steps, therefore you feel stuck.

Causes of Negative Thinking

Negative thinking is learned thinking. You weren’t born thinking this way. You learned to think this way by watching the people around you. You learned through imitation. You then turned that way of thinking into a habit through repetition.

What you have learned you can unlearn and relearn something new in its place. You can learn new coping skills, a new way of thinking, and create a new life.

CBT Worksheets / Thought Record

A CBT worksheet (also called a thought record) helps you think about your thinking. It is the basic tool of cognitive therapy. It is a series of questions that lead you through the process of identifying your negative thinking and changing it. A thought review is also called a thought record.

A CBT worksheet/ thought record gives you a chance to reflect on your thinking after the fact, when you’re not reacting out of fear or anger, helps you replace negative thinking with healthier thinking.  

A thought record helps you see that your negative thoughts are based on untested beliefs. For example, you may believe that you are a failure because you were told you were a failure growing up. You may believe it even though other people consider you successful or may praise your work.

This is a classic example of an untested belief. You haven’t stopped to challenge your old way of thinking. CBT worksheets and thought records help you see that there may be new information that you haven’t considered. This information may have been staring you in the face, but because it disagreed with your childhood beliefs, you couldn’t see it.

Cognitive therapy helps you change your thinking and include helpful facts you may have ignored. Your thinking can be changed. Once you realize that and get into the habit of challenging your thinking, you will begin to change your life.

How to Write a CBT Worksheet or Thought Record

Read an example of how to write a CBT worksheet-thought record.

CBT Worksheet-Thought Record Template

An online version of a CBT worksheet-thought record template and a pdf version that you can print without restrictions.

Behavioral Therapy

CBT is really two forms of therapy: cognitive and behavioral therapy. Behavioral therapy is sometimes used initially with individuals who are too anxious or too depressed to even acknowledge that their thinking is part of the problem.

Behavioral therapy encourages you to try simple tasks, and as you succeed, you gradually improve your belief in yourself. Once you see that you can change your behavior, you may be more willing to change your thinking. In most cases, individuals who are ready to change are encouraged to start directly with cognitive therapy rather than begin with behavioral therapy.

History of Cognitive Behavioral Therapy

In the 1950s, American psychologist Albert Ellis introduced Rational Therapy in which people were taught the A-B-C approach for dealing with uncomfortable situations. When a person is confronted with an adversity A, their beliefs B, will influence the way they respond to that adversity and lead to emotional and behavioral consequences C.

If the beliefs B, are rigid, absolute, and unrealistic, the consequences C, will likely be self-defeating and destructive. If the beliefs B, are flexible and constructive, the consequences C, will likely be positive. People can change their thinking and their lives by D, disputing and challenging their beliefs.

Rational therapy was partly developed as a reaction to psychoanalysis, which was considered inefficient because individuals went through years of therapy but were not explicitly directed to change their thinking. Psychoanalysis was based on the approach that understanding your subconscious thoughts would eventually lead to self-change. Rational therapy takes a more directive approach. You are encouraged to challenge your beliefs in order to achieve faster and more efficient change.

In the 1960s, American psychiatrist Aaron T. Beck introduced Cognitive Behavioral Therapy partly based on the ideas of Albert Ellis and used it as a treatment for depression. Beck developed the idea of the thought record, in which individuals could challenge their thinking through writing their thoughts down and looking for healthier ways of thinking. He also developed self-reporting measures for anxiety and depression including the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI).

References

  1. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., et al., The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res, 2012. 36(5): p. 427-40. PMC3584580.
  2. Driessen, E., & Hollon, S. D., Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators. Psychiatr Clin North Am, 2010. 33(3): p. 537-55. PMC2933381.
  3. Tolin, D. F., Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin Psychol Rev, 2010. 30(6): p. 710-20.
  4. Brooks, S. J., & Stein, D. J., A systematic review of the neural bases of psychotherapy for anxiety and related disorders. Dialogues Clin Neurosci, 2015. 17(3): p. 261-79. PMC4610611.
  5. Porto, P. R., Oliveira, L., Mari, J., Volchan, E., et al., Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders. J Neuropsychiatry Clin Neurosci, 2009. 21(2): p. 114-25.
  6. Paquette, V., Levesque, J., Mensour, B., Leroux, J. M., et al., "Change the mind and you change the brain": effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Neuroimage, 2003. 18(2): p. 401-9.
  7. Beutel, M. E., Stark, R., Pan, H., Silbersweig, D., et al., Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients. Psychiatry Res, 2010. 184(2): p. 96-104.
  8. Linden, D. E., How psychotherapy changes the brain--the contribution of functional neuroimaging. Mol Psychiatry, 2006. 11(6): p. 528-38.
  9. Hofmann, S. G., Sawyer, A. T., & Fang, A., The empirical status of the "new wave" of cognitive behavioral therapy. Psychiatr Clin North Am, 2010. 33(3): p. 701-10. PMC2898899.
  10. Hoifodt, R. S., Strom, C., Kolstrup, N., Eisemann, M., et al., Effectiveness of cognitive behavioural therapy in primary health care: a review. Fam Pract, 2011. 28(5): p. 489-504.
Last Modified: September 10, 2018