Cognitive Behavioral Therapy Techniques And Practices

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated April 16, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

Cognitive behavioral therapy (CBT) has been around since the early 1960s and was developed by psychiatrist Dr. Aaron T. Beck at the University of Pennsylvania. Passing in 2021, Dr. Beck has provided significant advancements to the field of psychology, as CBT is one of the world's most widely used forms of therapy for mental health conditions.  

Dr. Beck developed his idea for CBT after noticing that many of his clients had internal dialogues, with their thoughts impacting their feelings and actions. He called the process cognitive behavioral therapy counseling since it considered a client's cognitive thought processes and how they interacted with behavioral patterns. Dr. Beck, nicknamed the father of CBT, also founded the Beck Institute, a center dedicated to education on CBT and addressing automatic negative thoughts and negative thought patterns. 

Understanding how CBT functions can help you decide whether trauma-focused cognitive behavioral therapy, a specific form of therapy, can be valuable for treating your symptoms or concerns related to trauma.

Not sure if cognitive behavioral therapy is for you?

The history of Dr. Aaron Beck 

During his studies of cognitive therapy for depression, Aaron Beck noticed that his depressed clients had streams of spontaneous negative thoughts that seemed to impact their depressive symptoms and emotional control. He called them automatic thoughts and organized them into three categories: negative ideas about the future, the world, and themselves.
These thoughts played a significant role in maladaptive behaviors and contributed to mental health issues, highlighting the importance of addressing them through CBT treatment and coping strategies.

Aaron believed that these automatic thoughts would directly impact an individual's behavior patterns and behavioral responses. For example, if a person believed they were inherently unlikeable, they might feel anxious and experience low self-esteem, prompting them to avoid others. Due to their avoidance, they might miss out on meaningful relationships, which might reinforce their thoughts. CBT challenges these thoughts and teaches clients new methods of coping with them. Cognitive behavior therapy not only challenges these beliefs but also provides clients with coping mechanisms. Furthermore, CBT therapy assists in dealing with overwhelming life stressors in a constructive manner by dissecting methods of thinking into different aspects.

Although Dr. Beck founded CBT, talk therapy was developed by Dr. Sigmund Freud in the 1890s. Soon after, Carl Jung and Alfred Adler also introduced conceptions of psychological findings. Carl Jung and Alfred Adler were associated with the development of psychodynamic therapy. 

In the early 1920s, behaviorism was the primary type of psychology used and continued to be the focus until the late 1950s, when cognitivism and existential-humanistic therapy became widespread. Humanism became the focus for the next decade, consisting of empathic, positive therapeutic relationships and rational therapy of Albert Ellis, now referred to as rational emotive behavior therapy (REBT). With the advent of online therapy and various mental health treatment options, these approaches have become more available to people seeking help for psychological distress.

The history of cognitive-behavioral therapy (CBT) 

When Dr. Beck started his tenure at the University of Pennsylvania, he conducted the depression research clinic. After several years of practicing and teaching psychoanalysis, Beck found it challenging to use the standard approaches for treating depression and started searching for a more successful method to treat his clients, particularly in cases involving negative feelings and panic disorder. As he gained more insight into human emotions and unconscious drives, Dr. Beck found that the cognitive approach, often employed in short term therapy and CBT sessions, was more reliable and developed the Beck Depression Inventory (BDI). 

BDI became a universal tool for diagnosing depressive disorders. He also started noticing a theme in which his clients were experiencing negative thoughts that had a negative influence on their emotions as well as their behaviors. He then began to utilize cognitive-behavioral therapy techniques, which were studied and utilized by many other professionals worldwide during therapy sessions. This approach has been particularly helpful in addressing issues such as stress management and substance use disorder.

What cognitive-behavioral therapy techniques are used today? 

In modern psychology, cognitive-behavioral therapy is used successfully for treating more than depression. CBT is widely used to treat anxiety, eating disorders, chronic pain, substance use disorders, phobias, panic attacks, post-traumatic stress disorder (PTSD), relationship issues, grief, sleep disorders, and bipolar disorder, among other concerns. Below are several techniques utilized in these treatments, which often involve dialectical behavior therapy as well. The therapy involves determining how many sessions are needed, depending on the individual's needs and health insurance coverage.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Untangling thought distortions

One of the main goals of CBT is untangling cognitive distortions, which are unwanted or unhelpful thought patterns. Understanding what cognitive distortions look like and learning to label them can help you challenge them when they occur. 


Studies have found that expressive writing through a technique like journaling can help individuals express emotions and improve mood. By paying attention to and keeping track of your moods and emotions, you can trace them to common causes. You can also use the journal to track the times and dates of these occurrences and how you responded to them. If you want to, you can discuss these entries with your cognitive behavioral therapist to further understand how your mind processes thoughts.

Cognitive restructuring

Cognitive restructuring (sometimes called cognitive reframing) is used after you have identified cognitive distortions. You and your therapist may discuss how the distorted thinking pattern started and how it makes you feel about yourself. In doing so, you may be able to target negative beliefs about yourself that could be affecting your self-esteem. It's just one of many cognitive psychology examples of a potentially effective treatment for those experiencing mental health challenges.

Exposure and response prevention (ERP) 

There are several types of exposure therapy utilized in CBT. If you are experiencing a phobia, fear, or compulsive pattern, your therapist can help you reduce fear by repeatedly exposing you to stimuli that scare you. They can start small and build up to more significant fears over time. Exposure therapy is especially effective in treating obsessive-compulsive disorder (OCD). 

Progressive muscle relaxation

For those familiar with mindfulness, progressive muscle relaxation (PMR) is similar to the body scan mindfulness process. As you go through, you can identify each muscle group and relax them one at a time until your whole body is relaxed. PMR can be done at home or in a therapist's office. 

Relaxed breathing

Breathwork is often used in mindfulness practice, meditation, and yoga. There are many ways to relax your breathing, including guided imagery, audio recordings, YouTube videos, or therapy. Relaxed breathing can be used alone or with PMR. 

Common CBT exercises used by therapists 

There are many CBT exercises that therapists teach their clients to help them cope with their thoughts and emotions. While specific exercises are structured for certain issues, many can be used to target unwanted thought patterns or behaviors, including the following. 

Cognitive pie charts 

Cognitive pie charts help clients re-examine how they think by allowing them to write down their thoughts in a visual pie chart. They can assign a certain percentage to each thought to see which has the most power over their behaviors and mood. 

Constructive worrying 

For clients who experience anxiety, worry, or frequent fear, the constructive worrying exercise allows them to focus on the worry for a specific timeframe before putting it out of their minds. For example, they could fill out a worksheet of what they're worrying about and draft three solutions for each worry. After 30 minutes of writing, they must put the worksheet away and commit to putting the worries out of their mind until the next worry session. 

Treating thoughts as guesses 

Cognitive-behavioral therapy or cognitive psychotherapy often teaches clients to consider their thoughts a guess instead of a fact. For example, if you want to learn to dance but have trouble in your first dance class, tell yourself you're guessing that you struggle to dance but that it may be possible with work. Adding a positive spin on it can be more effective than deciding you can't dance as a fact and not trying. 

Not sure if cognitive behavioral therapy is for you?

How does CBT work?

CBT functions on the premise that how you think and what you believe impacts your actions. It treats specific symptoms by choosing goals you want to achieve to succeed. This type of therapy can be in the form of individual face-to-face therapy, group sessions, couples therapy, or family therapy.  

CBT is structured and teaches skills and strategies to target negative thoughts and behaviors. Although many believe that feelings are directly caused by how others treat us, our thoughts and behaviors may also drive our feelings. CBT shows us strategies to take control of our thoughts and, in turn, change our reactions

CBT for relationship, family, and youth counseling 

Cognitive-behavioral therapy is not only used to support individuals. The practice of CBT can be valuable in marriage or family therapy, as well. In addition, it can be utilized for children and adolescents. 

Young people are commonly affected by anxiety disorders. Treating adolescent anxiety can be challenging because hormonal changes, peer pressure, and new relationships can cause stress. However, CBT has proven effective in doing so. 

Counseling options

If you're considering CBT, you're not alone. According to The New York Times, 69% of all therapists use or are trained in CBT for their clients. As a heavily researched form of psychotherapy, it can benefit various symptoms, diagnoses, and stressors, making it a versatile option. However, despite its popularity, many individuals face barriers to in-person CBT due to cost, availability, or a lack of availability, but you can search for "cognitive therapy near me" and find a licensed therapist in your local area.

You can also consider online CBT if you have been considering CBT but don't know how to make in-person therapy work. One recent study found that online CBT is effective in treating long-term exposure to stress. Another study found it as effective as in-person therapy for treating symptoms of anxiety and depression. 

When you sign up for an online platform like BetterHelp for individuals, Regain for couples, or TeenCounseling for teens aged 13 to 19, you can get matched with one of over 30,000 therapists. Many of these therapists are trained in CBT and other popular therapy methods. You can reach out to your therapist anytime through the messaging option for advice throughout the week. 


Cognitive behavioral therapy (CBT) is a popular form of therapy used to treat a variety of mental health problems, including anxiety, depression, eating disorders, bipolar disorder, and obsessive-compulsive disorder. CBT is generally based on the idea that people can learn to recognize and challenge inaccurate thoughts, which may lead to more desirable thoughts and behaviors. 

If you’re interested in learning more about CBT treatments but don’t feel comfortable with traditional therapy at this time, you may benefit from speaking to an online therapist. With BetterHelp, you can be matched with a therapist who has experience using CBT to treat your specific areas of concern. Take the first step toward finding an online therapist who practices CBT and reach out to BetterHelp today.
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