CBT Cheat Sheet

Cognitive Behavioral Therapy (CBT) focuses on identifying and challenging negative thought patterns and behaviors to improve emotional regulation and develop healthier coping mechanisms. Thoughts (cognitions), feelings (emotions), and behaviors are interconnected, meaning that changing one influences the others. So, by modifying maladaptive thinking, the client experiences positive changes in their emotions and behaviors. CBT is highly structured and goal-oriented and involves practical strategies to help clients manage and overcome issues such as anxiety, depression, and stress.

This “cheat sheet” describes commonly used interventions.

1. Automatic thoughts are spontaneous, often negative thoughts that occur without conscious deliberation.

Example: "I’m such an idiot!" after making a minor mistake at work.

Intervention: Help the client become aware of repetitive, automatic thoughts, understand their impact, and develop alternative, healthier, more balanced thoughts.

2. Cognitive distortions are systematic thinking errors that reinforce negative thoughts and unhealthy emotions. Recognizing and correcting these distortions is a crucial skill. Here are common types of cognitive distortions:

• All-or-Nothing Thinking: Viewing situations as binary or the world in extremes. It's a habitual thinking pattern that negatively affects experiences and leads to anxiety and pessimism.
  • Example: "If I don’t pass this exam, I’m a total failure."

• Overgeneralization: Making broad assumptions from very limited information or a single event.
  • Example: "I wasn’t offered the job. I’ll never get hired anywhere!"

• Catastrophizing: Assuming the worst possible conclusion, usually with very limited information or reason for despair. When a situation is upsetting but not catastrophic, an individual believes they are in a crisis.
  • Example: "I made a mistake at work, and I just know I will be fired."

• Mind Reading: Assuming what someone else is thinking without having much to go on. Relying too much on mind-reading leads to mistakes about what others think, often leading to depression or anxiety (especially social anxiety).
  • Example: "They didn’t say hi, so they must hate me."

• Fortune Telling: Predicting adverse outcomes.
  • Example: "I just know I’m going to mess up when I’m on stage!"

• Personalization: Blaming yourself for something that isn't entirely your fault.
  • Example: "I made a stupid comment and messed up the entire presentation."

3. Core beliefs are deeply held beliefs about oneself, others, and the world that influence thoughts and behaviors. Here are some examples:

• Unlovability: "I’m unworthy of love."
• Helplessness: "I can’t change my situation."
• Worthlessness: "I’m not good enough."

Therapists help clients identify and challenge these beliefs by gathering evidence contradicting them while reinforcing healthier and more adaptive beliefs.

4. Cognitive restructuring involves identifying and challenging distorted thoughts and replacing them with more balanced and accurate thoughts. Follow these steps:

• Identify the Negative Thought. "I’ll never be good enough."
• Challenge the Thought. Ask, "What evidence supports this? What evidence contradicts it?"
• Reframe the Thought. "I have experience, and everyone makes mistakes. I will continue learning and growing, ultimately improving my skillset."

5.Behavioral Activation encourages clients to engage in healthy activities to improve mood and disrupt the cycle of inactivity.

Example: A depressed client is assigned to walk outside in nature daily. After one month, the client noticed an improvement in her mood and reduced feelings of loneliness.

6. Exposure Therapy is the gradual exposure to feared situations in a controlled manner to reduce avoidance and anxiety. Here are the steps:

• Hierarchy Development. Generate a list of feared situations, ranked from least to most anxiety-provoking.
  • Example: For social anxiety, start with making small talk with a bank teller, then progress to attending a party.

• Gradual Exposure. Begin with the least feared situation and gradually work up the hierarchy.
  • Example: A client afraid of flying starts by visiting an airport, then watches videos of flights, and eventually takes a short flight.

7. Thought Records are a structured way for clients to record their thoughts, feelings, and behaviors associated with specific events, allowing them to identify and challenge negative thoughts.

Example:

• Situation. Didn’t get invited to a friend’s party.
• Automatic Thought. "They must hate me."
• Emotion. Sadness, disappointment, rejection.
• Behavior. Withdrawn, avoiding contact with the friend.
• Alternative Thought. "Maybe they assumed I was busy or didn’t think I’d be interested."
• Outcome. Reduced sadness, more likely to reach out to the friend.

8. Behavioral Experiments test the validity of beliefs and predictions to gather evidence and challenge cognitive distortions.

Example:

• Prediction. "If I ask my teacher for feedback, she will think I’m stupid."
• Experiment. The client asks their teacher for feedback.
• Outcome. The teacher provides constructive feedback, and the client realizes asking for feedback is a positive choice.

9. Activity Scheduling involves planning positive or meaningful activities to improve mood and reduce avoidance.

Example: A client who feels overwhelmed might schedule daily activities that bring them joy, such as reading, exercising, or socializing, to create a sense of accomplishment and pleasure.

10. Problem-solving is a step-by-step approach to identifying, evaluating, and implementing solutions to problems that cause distress. Follow these steps:

• Identify the Problem. "I’m struggling to balance work and family life."
• Generate Possible Solutions. Delegating tasks, setting boundaries at work, and scheduling family time.
• Evaluate Solutions. Weigh the pros and cons of each solution.
• Implement the Best Solution. Set work hours and schedule family activities in advance.
• Review and Adjust. If the solution isn’t working, revisit and modify it.

11. Socratic Questioning uses guided questioning to help clients explore and challenge thoughts and beliefs.

Example:

• Client Thought: "I’m a failure because I was fired from my job."
• Socratic Questions: "What does 'failure' mean to you? Are there other areas where you’ve succeeded? What might you say to a friend in this situation?"
• Outcome: The client may begin to see the situation more realistically and recognize potential opportunities while acknowledging past achievements and successes.

12. Mindfulness-Based CBT integrates mindfulness practices to help clients observe thoughts and feelings without judgment, promoting acceptance and reducing reactivity.

Example:

• Practice Mindfulness Exercises. Guide clients to focus on their breath, noticing each inhale and exhale, allowing thoughts to come and go without attachment.
• Application. An anxious client uses mindfulness to observe worries without getting caught up in them, leading to reduced anxiety over time.

13. Relaxation Techniques help clients manage stress, pain, or anxiety symptoms, promoting relaxation and calm.

Examples:

• Progressive Muscle Relaxation. Instruct clients to tense and relax different muscle groups, helping them learn the difference between tension and relaxation.
• Deep Breathing. Teach clients to take slow, deep breaths, focusing on filling the belly and releasing tension with each exhale.
• Visualization. Guide clients to imagine a peaceful scene, such as a forest, to promote relaxation.

14. Coping Skills Training teaches clients practical skills to manage stress, anxiety, or depression more effectively.

Examples:

• Stress Management. Clients learn time management techniques, assertiveness training, and how to prioritize tasks.
• Emotion Regulation. Techniques like distraction, self-soothing, or engaging in pleasurable activities to manage distress.

15. Self-Monitoring involves tracking thoughts, feelings, and behaviors to identify patterns and triggers.

Example: A client with binge eating disorder keeps a log of food intake, emotions, and situations to identify triggers for binge eating episodes, leading to more targeted interventions.

16. Assertiveness Training helps clients learn to express their needs and desires confidently and respectfully.

Example: A client struggling with saying “no” practices assertive communication techniques, such as using "I" statements and setting boundaries in role-play scenarios.

17. Thought Stopping is a technique to interrupt and stop unwanted or intrusive thoughts.

Example: A client who tends to ruminate says, "Stop!" mentally or out loud, then refocuses on a positive or neutral activity.

18. Role-playing is a technique in which clients practice handling challenging situations in a safe and controlled environment by acting out scenarios. This allows them to increase confidence, rehearse new behaviors, and explore different outcomes.

Example: A client who struggles with social anxiety might role-play a conversation with a coworker, practicing initiating small talk or responding to compliments. This helps them feel more prepared and reduces anxiety in real-life interactions.

19. Imagery Rescripting uses guided imagery to alter distressing memories or scenarios' meaning and emotional impact.

Example: A client visualizes a past event in which they felt powerless and reimagines it with themselves as strong and in control – reducing the emotional intensity of the memory.