CBT: Cognitive Behavioural Therapy and its Techniques

Let’s say someone is experiencing symptoms of depression and has stopped engaging in activities they used to enjoy, such as going for walks in the park or meeting friends for coffee. A therapist using behavioral activation might guide the individual through the following steps:

1. Activity monitoring: The therapist and individual might work together to identify the activities the person used to enjoy and any patterns of avoidance or withdrawal.
2. Setting achievable goals: Based on the identified activities, the individual would set small, achievable goals to start reintroducing these activities back into their routine. For example, the goal might be to take a short walk around the block three times a week.
3. Scheduling activities: The individual would schedule these activities into their week, ensuring they have specific times set aside to engage in them.
4. Problem-solving barriers: If any barriers are preventing the person from engaging in these activities (such as low energy levels or negative thoughts), the therapist would help them problem-solve ways to overcome these barriers. This might involve challenging negative thoughts or finding alternative ways to approach the activity.
5. Reinforcement: As the individual begins to engage in the activities, they would reflect on any positive experiences or feelings that arise from doing so. This helps to reinforce the connection between activity and mood.
6. Review and adjust: Over time, the therapist and individual would review progress, adjust goals as necessary, and continue to build upon successes.

Through this process, behavioral activation helps individuals to gradually increase their engagement in meaningful activities, leading to improvements in mood and overall well-being.

EXPOSURE THERAPY

Exposure therapy involves gradually exposing individuals to feared or avoided situations or stimuli in a controlled and safe environment. Through repeated exposure, individuals can learn to tolerate and eventually overcome their anxiety or fear responses.

Here’s an example of exposure therapy, a technique commonly used in Cognitive Behavioural Therapy (CBT) to treat anxiety disorders

Let’s consider someone who has a specific phobia of spiders. The therapist might use exposure therapy to help them overcome their fear. The process typically involves gradual and controlled exposure to the feared stimulus (in this case, spiders) in a safe environment. Here’s how it might work:

1. Education and Preparation: Initially, the therapist would educate the individual about anxiety and how exposure therapy can help. They would discuss the rationale behind the therapy and what to expect during the process. The therapist and individual would also work together to develop coping strategies, such as relaxation techniques or deep breathing exercises, to manage anxiety.
2. Hierarchy of Fear: The therapist and individual would create a hierarchy of fear related to spiders. This involves ranking situations involving spiders from least anxiety-provoking to most anxiety-provoking. For example, seeing a picture of a spider might be at the bottom of the hierarchy, while holding a spider might be at the top.
3. Exposure Exercises: Starting from the least anxiety-provoking situation in the hierarchy, the individual would gradually expose themselves to spiders. This might involve looking at pictures of spiders, watching videos of spiders, or even being in the same room as a spider in a terrarium.
4. Systematic Desensitisation: The exposure is done systematically and repeatedly until the individual’s anxiety decreases in response to the stimulus. They are encouraged to stay in the situation until their anxiety naturally reduces (habituation). The therapist provides support and guidance throughout the process.
5. Progression: As the individual becomes more comfortable with each step, they gradually move up the hierarchy, facing increasingly anxiety-provoking situations involving spiders. The exposure exercises continue until the individual feels confident in their ability to cope with spiders without experiencing overwhelming anxiety.
6. Maintenance and Relapse Prevention: Once the individual has completed exposure therapy, the therapist may provide strategies to maintain their progress and prevent relapse. This could include continued practice of coping techniques and regular exposure to spiders to reinforce the learning.

Through exposure therapy, individuals can learn to confront their fears in a controlled and supportive environment, ultimately reducing their anxiety and improving their quality of life.

RELAXATION TECHNIQUES

Relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation, are used to help individuals manage stress, anxiety, and physical tension. Here’s an example of a relaxation technique called progressive muscle relaxation

Progressive Muscle Relaxation

1. Find a Comfortable Position: Sit or lie down in a comfortable position, with your arms and legs uncrossed. Close your eyes if it helps you to relax.
2. Deep Breaths: Begin by taking a few deep breaths in through your nose, holding for a moment, and then exhaling slowly through your mouth. Focus on the sensation of your breath as it enters and leaves your body.
3. Progressive Muscle Tension: Start with your toes and gradually work your way up through your body, tensing each muscle group for about 5-10 seconds before releasing. For example:
   • Curl your toes tightly and hold for a few seconds, then relax.
   • Tense the muscles in your calves by flexing your feet upward, then release.
   • Clench your thighs and buttocks tightly, then let go.
   • Tighten your stomach muscles by drawing them in towards your spine, then release them.
   • Make fists with your hands and tighten your arms, then relax.
   • Scrunch your facial muscles tightly, then release with a big sigh, letting all the tension melt away.
4. Focus on Sensations: As you tense and release each muscle group, pay attention to the difference between tension and relaxation. Notice the sensations of warmth and heaviness as the muscles relax.
5. Continue Upward: Work your way up through your body, repeating the process with each muscle group, including your chest, shoulders, neck, and face. Take your time and try to let go of any lingering tension with each release.
6. Deep Relaxation: Once you’ve tensed and released all the major muscle groups in your body, take a few moments to enjoy the deep sense of relaxation. Focus on the feeling of calm and peace spreading throughout your body.
7. End with Breathing: Finally, take a few more deep breaths, inhaling deeply through your nose and exhaling slowly through your mouth. With each exhale, imagine releasing any remaining tension or stress from your body.

Progressive muscle relaxation can be practiced regularly to promote relaxation, reduce stress, and increase overall well-being.

PROBLEM-SOLVING SKILLS

CBT teaches individuals effective problem-solving skills to address challenging situations and overcome obstacles in their lives. By breaking down problems into manageable steps and generating potential solutions, individuals can develop more adaptive coping strategies.

Let’s say someone is facing a common problem like being frequently late for work.

1. Identify the Problem: The first step is to clearly define the problem. In this case, the problem is being consistently late for work.
2. Set Goals: The individual might set a goal to arrive at work on time every day for the next month.
3. Brainstorm Solutions: Next, they would brainstorm potential solutions to the problem. This could include setting an earlier alarm, preparing things the night before, using a different route to avoid traffic, or adjusting their morning routine.
4. Evaluate Solutions: After generating a list of possible solutions, they would evaluate each one based on its feasibility, potential effectiveness, and any potential obstacles. For example, setting an earlier alarm might be effective but could be difficult if they struggle with waking up early.
5. Choose a Solution: Based on the evaluation, they would choose the solution that seems most practical and likely to be effective. In this case, they might decide to set an earlier alarm and lay out their clothes and breakfast the night before.
6. Implement the Solution: The individual would put their chosen solution into action by setting their alarm earlier and making any necessary adjustments to their morning routine.
7. Monitor Progress: They would then monitor their progress over the next few weeks to see if the chosen solution is helping them to arrive at work on time.
8. Adjust as Necessary: If the chosen solution isn’t working as well as expected, they would go back to the brainstorming stage and consider other options or adjustments to their chosen solution.

By using problem-solving skills in this way, individuals can effectively tackle challenges and make positive changes in their lives.

HOMEWORK ASSIGNMENTS

Homework assignments are often given between therapy sessions to reinforce learning and practice new skills. These assignments may include keeping thought records, conducting behavioral experiments, or practicing relaxation exercises.

Here’s an example of a homework assignment that might be given to reinforce learning and practice new skills:

Keeping a Thought Record

1. Instructions: Over the next week, keep a thought record to track your thoughts, emotions, and behaviors in response to challenging situations. Use the following format:
   • Date and Time: Record the date and time of the situation.
   • Situation: Describe the situation that triggered your thoughts and emotions.
   • Thoughts: Write down the thoughts that went through your mind during the situation. Be as specific as possible.
   • Emotions: Identify the emotions you experienced in response to these thoughts.
   • Behaviors: Describe any behaviors or actions you engaged in as a result of these thoughts and emotions.
   • Alternative Thoughts: Challenge your initial thoughts by coming up with more balanced or realistic alternatives.
   • Outcome: Reflect on how your emotions and behaviors might have been different if you had approached the situation with these alternative thoughts.
2. Example:
   • Date and Time: Monday, 8th February, 9:00 AM.
   • Situation: During a meeting at work, my boss asked me a question I didn’t know the answer to.
   • Thoughts: “I must be incompetent if I can’t answer this question. Everyone is going to think I’m useless.”
   • Emotions: Feeling anxious and embarrassed.
   • Behaviors: Avoided making eye contact with colleagues and became tense.
   • Alternative Thoughts: “It’s okay not to know everything. I can admit when I don’t have an answer and offer to find out. That’s how I learn and grow.”
   • Outcome: By reframing my thoughts, I felt less anxious and was able to focus on finding a solution rather than dwelling on my perceived incompetence.
3. Reflection: At the end of the week, reflect on your thought records. Identify any patterns or common triggers for negative thoughts and emotions. Consider how challenging and reframing these thoughts can help you to cope more effectively in similar situations in the future.

This homework assignment encourages individuals to become more aware of their thoughts and emotions, practice cognitive restructuring techniques, and develop more adaptive coping strategies.

SOCIAL SKILLS TRAINING

Social skills training focuses on improving interpersonal communication and relationship-building skills. By learning effective communication techniques and assertiveness skills, individuals can enhance their relationships and navigate social interactions more successfully.

Here’s an example of a social skills training exercise focused on assertiveness:

Assertiveness Role-Play

1. Instructions: Practice assertive communication skills through role-play scenarios. Find a partner or friend to participate in the role-play exercises with you.
2. Scenario 1: Requesting a Change in Behaviour
   • Role: You are a student sharing a flat with a roommate who often plays loud music late at night, disturbing your sleep.
   • Objective: Practice assertively expressing your needs and requesting a change in your roommate’s behavior.
   • Role-play: Approach your partner and explain the situation, then assertively communicate your request for them to lower the volume of their music during late hours. Use “I” statements and express your feelings and needs clearly and respectfully.
3. Scenario 2: Handling Criticism
   • Role: You are a team member at work and have received criticism from a colleague during a meeting for a mistake you made on a project.
   • Objective: Practice responding assertively to criticism without becoming defensive or aggressive.
   • Role-play: Have your partner act as the colleague who delivers the criticism. Listen actively to their feedback, acknowledge any valid points, and assertively address any misunderstandings or offer explanations for your actions. Maintain a calm and confident tone throughout the interaction.
4. Scenario 3: Setting Boundaries
   • Role: You are invited to a social event by a friend, but you have prior commitments and cannot attend.
   • Objective: Practice assertively declining the invitation while maintaining the relationship with your friend.
   • Role-play: Have your partner act as your friend inviting you to the event. Assertively decline the invitation, expressing appreciation for the invitation but explaining your prior commitments. Offer to spend time with your friend on another occasion to maintain the relationship.
5. Feedback and Reflection: After each role-play scenario, provide feedback to each other on communication style, tone, and effectiveness. Reflect on what went well and areas for improvement. Discuss strategies for applying assertive communication skills in real-life situations.

This social skills training exercise helps individuals to develop assertiveness skills, which are essential for effective communication and building healthy relationships. Through practice and feedback, individuals can become more confident and skilled in navigating various social interactions.

Conclusion

As you embark on your journey of self-discovery and growth with Cognitive Behavioural Therapy (CBT), remember that change is within your reach, one thought at a time. Embrace the power of CBT techniques and watch as your life unfolds with newfound clarity and resilience. Here’s to a brighter, more empowered tomorrow.

ALSO READ: Depression: Everything You Need To Know About It