Cognitive behavioral therapy (CBT) is one of the most effective and evidence-based approaches for managing mental health challenges such as anxiety, depression, trauma, and substance use. Additionally, it has been shown to improve self-esteem and mental health outcomes for individuals without mental health challenges because of its focus on building strengths and teaching relaxation techniques.

In addition to relaxation techniques, some of the most effective tools learned in CBT are cognitive restructuring, behavioral activation, guided discovery, and successive approximation. These tools help individuals identify and change negative thought patterns, gain better self-awareness and problem-solving skills, and learn how to set practical goals for their mental health. Additionally, these tools have been shown to be effective when delivered in both in-person and online formats.

1. Cognitive Restructuring

One of the core principles of cognitive behavioral therapy is that our thoughts, emotions, and behaviors are intricately connected, and by reshaping negative thoughts, we can influence the impact of negative emotions and behaviors. Cognitive restructuring is a direct tool to identify and replace negative thoughts.

Often, many of our thoughts and beliefs are automatic and unconscious, influencing how we perceive ourselves in the wider world without us evaluating the validity of these beliefs. Cognitive restructuring is a step-by-step process where psychotherapists help you:

• Identify maladaptive thought patterns
• Evaluate them critically, looking at the evidence for and against these thoughts
• Formulate alternative, more balanced perspectives
• Practice these new thought patterns

For example, consider a woman studying for her medical exams. Despite months of studying and receiving positive feedback from her professors, she’s convinced she won’t pass. She might tell herself, “I’m not good enough,” or “I’ll fail no matter how much I study.”

With cognitive restructuring, she would identify these thoughts and evaluate the evidence for them. She may realize that there’s a chance she might fail, but realistically, she has a solid chance of passing, that she can always retake the exam: that failing isn’t the end of her journey. Rather than having a failure mindset, she learns to shift her mindset to “I’ve prepared well and will do my best regardless of the outcome.”

2. Guided Discovery

Another way that CBT addresses the relationship between thoughts, feelings, and behaviors is through guided discovery. Guided discovery is a collaborative process involving Socratic questioning by the therapist to help individuals identify and critically think about their thought processes and why they have specific thoughts or beliefs.

Whether in academic, philosophical, or therapeutic settings, Socratic questioning aims to evaluate why we think the way we do. It involves asking thoughtful, open-ended questions to challenge assumptions, expose contradictions, and lead to new insights. In the context of CBT, it allows individuals to critically evaluate their thought processes and determine their validity.

Guided discovery is similar to cognitive restructuring in that it aims to evaluate and change negative thought processes, but the process is slightly different. In guided discovery, the therapist acts more as a facilitator, asking successive open-ended questions and allowing individuals to reach their own conclusions. In cognitive restructuring, the therapist takes a more direct role in helping to reshape thoughts.

3. Behavioral Activation

An additional core principle of CBT is promoting individual strengths and personal interests to build confidence and self-esteem. Behavioral activation aims to increase engagement in productive activities by increasing environmental positive reinforcement. In this context, environmental reinforcement refers to positive experiences and subjective awards from doing an activity, as opposed to systematic rewards such as praise, money, or grades from doing an activity.

For example:

• If you enjoy playing guitar, environmental rewards could be the gratification of making a new song or performing publicly, whereas systematic rewards might include money from performing.
• If you enjoy working out, environmental rewards could be “gains” in strength, mobility, or cardiovascular endurance, whereas systematic rewards might include direct praise from others.
• If you enjoy socializing and hanging out with friends, environmental rewards could be the feelings of comradery and fun you have with others, whereas systematic rewards might include likes on social media posts.

The above definitions of environmental and systematic rewards are not meant to suggest that all reinforcement be environmental, but to establish a framework for individuals to learn to love activities that bring them joy. Behavioral activation aims to increase the naturally occurring environmental awards associated with joyous activities, which in turn helps promote intrinsic self-worth, positive self-esteem, and situational confidence.

4. Successive Approximation

For many individuals, setting and achieving goals is tricky. Successive approximation is a step-by-step process to help individuals achieve larger goals by breaking them down into smaller, more manageable steps. It’s particularly effective for individuals who feel overwhelmed or discouraged by tackling a challenging task all at once.

For example, a teen may have the goal of performing in a play despite severe social anxiety and fear of being in front of an audience. He’s passionate about acting and performing, but the idea of opening up to an audience terrifies him. In CBT sessions, the teen might learn to begin by practicing in a mirror, gradually work up to performing for close friends, and eventually work towards a goal of auditioning for the school play. At each stage of approximation to the goal, his current progress is reinforced, and his total progress is evaluated, allowing him to feel competent in his success and know that he is on the track for future success.

In CBT, therapists help individuals identify the goals they desire and then break them down into smaller steps, with systematic rewards built to help reinforce progress. This process helps reduce frustration, builds confidence, and provides a personalized approach to behavior modification.

5. Stress Reduction and Relaxation Exercises

A significant aspect of CBT is building self-awareness. Techniques such as cognitive restructuring and behavioral activation are collaborative approaches to building self-awareness, while mindfulness and stress reduction techniques are individual techniques learned in therapy that can be practiced at any time. These techniques include:

• Deep Breathing: Practicing diaphragmatic breathing in a controlled rhythm, often counting the breaths.
• Progressive Muscle Relaxation: Purposefully tensing muscle groups, then un-tensing them, and allowing the feeling of tension release to continue indefinitely. This technique is one of the best ways to reduce physical tension directly and works by “letting go” of tension rather than “trying” to relax muscles.
• Guided Imagery: A guided meditation that involves imagining a serene or peaceful environment in coordination with deep breathing.

Relaxation techniques affect both psychological and physiological processes Relaxation techniques can be used on a day to day basis to facilitate self-awareness and mindfulness. With guidance from a mental health professional, relation techniques can also be used to reduce panic attacks, anxiety, and specific phobias.

Begin Your Journey to CBT With Start My Wellness

Cognitive behavioral therapy offers a range of evidence-based techniques that help individuals understand and change their negative thought patterns, behaviors, and emotional responses to more realistic ones. Additionally, a significant portion of CBT is directed toward building self-awareness, promoting individual strengths, and providing individuals with tools that will last them a lifetime.

At Start My Wellness, we understand the challenges that come with managing mental health and achieving behavior change. Our team of experienced cognitive-behavioral therapists is committed to providing personalized and lasting care whether you’re facing anxiety, depression, or just want to improve your overall mindset.

Take the first step today. Contact us at (248)-514-4955 or schedule an appointment so we can support you on your journey to mental wellness.

Sources

1. Medical News Today: Cognitive Restructuring
2. Positive Psychology: Socratic Questioning in Psychology
3. Cochrane Library: Behavioral activation therapies for depression in adults
4. Start My Wellness: Starting Slow: How to Set (and Keep) Realistic Goals
5. Start My Wellness: Top 5 Benefits of CBT For Anxiety and Depression