CBT Workbook for Therapists: Essential Cognitive Behavioral Therapy Strategies to Treat Mental Health

By Tiffany Loggins

Retrain the brain and regulate behavior with CBT
Cognitive behavioral therapy (CBT) can be transformative in the treatment of many mental health disorders. The CBT Workbook for Therapists shows both clinicians and patients how CBT can be used to develop healthy coping skills, alter thinking patterns, and ultimately help people live happier lives.
What sets this CBT workbook apart:

- Overview of CBT—Delve into the fundamental principles of CBT and discover the vital connections between thoughts, feelings, and behaviors.
- Effective exercises—Explore 100 different strategies and exercises proven to be highly constructive in helping individuals learn how to shift their perspective and replace unhealthy behaviors.
- A range of clinical issues—From anger management to anxiety, this workbook addresses a variety of mental health concerns and allows readers to tailor these strategies to specific diagnoses.
Harness the power of CBT and improve your mental health treatment starting today.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Mar 1, 2022
• ISBN: 9781638075998

Book preview

CHAPTER 1

Introduction to CBT

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This chapter will equip you with basic knowledge of CBT, including its theoretical background, its fundamental principles, and major characteristics that differentiate CBT’s efficacy from that of other therapeutic approaches. You’ll get a preview of each clinical issue that will be addressed in subsequent chapters, plus a general overview of the different types of exercises you will find throughout this workbook. We’ll end the chapter with some guidelines on how to optimize the use of techniques and ensure that new skills stick in daily life and for the long term.

CBT Explained

CBT is a highly structured, short-term, solution-focused approach that uses different strategies to help people gain more control over their feelings and behaviors to reduce symptoms and improve their ability to manage life stressors. CBT’s theoretical underpinning combines early theories of behaviorism and cognition, or how people act and how people learn and think, respectively. It seeks to explain that our thoughts—not events—influence feelings and behaviors, and therefore that we can have better control over them. The idea is that people and circumstances do not make us feel bad, but our interpretations do.

To grasp this concept, pretend three separate individuals receive an email requesting them to schedule a job interview. Employee one reads the email and thinks, I don’t have enough experience. I didn’t get the last job offer, so what’s the point? As a result, he feels sad, dejected, and fatigued, and deletes the email. Employee two says to herself, I don’t really have the qualifications, but even if I don’t get the job, it’ll be good practice for future interviews. With less concern, she schedules her interview. Employee three thinks, My previous job was similar to this one. I think I have a good chance. They feel optimistic, motivated, and reinvigorated as they schedule and prep for their interview. Although each of these individuals received the same exact email, their thoughts played a significant role in their subsequent emotions and behaviors.

CBT is evidence-based, goal-oriented, and time-limited. It requires the active participation of the client and focuses on the present moment. Let’s break down these defining features of CBT.

Evidence-Based

Evidence-based practices have become an important standard for determining the efficacy of psychotherapy, and they are a major influence in the growing popularity and use of CBT. This approach has been tested and proven in research and real-world settings to produce desired outcomes for clients. There are now more than 325 clinical trials of CBT for various clinical populations, including people with mood disorders, anxiety disorders, marital distress, anger, childhood disorders, and chronic pain. It is continually improving its efficacy because it is constantly evolving as a result of further research, and has become a commonly used treatment for a variety of clinical issues. Exercises in chapters 3 through 11 apply evidence-based techniques to address specific diagnoses.

Goal-Oriented

American psychiatrist Aaron Beck pioneered CBT in the 1960s as a reaction to criticism of psychoanalysis that argued it was not goal-oriented and did not focus enough attention on private thoughts. Beck asserted that thoughts and perceptions were key to shaping feelings and behaviors. The ultimate goal of CBT is to help clients identify unhelpful thinking patterns that lead to problematic behaviors. Therefore, goal-setting is essential to determining which thoughts and behaviors should be the focus, to ensure the client attains the change they envision for themselves. Because CBT is goal-oriented and client-focused, goals are determined based on the client’s needs and circumstances. The effectiveness of CBT lies in how it moves the client toward their goals with each session. Goal-setting is interwoven throughout different exercises to ensure the creation of attainable and meaningful goals.

Time-Limited

CBT is cost-effective and offers quick relief, because a typical course of treatment is limited to a specific number of sessions, typically 12 to 16. In contrast, other modalities, like psychoanalysis, can include multiple sessions per week for several years! CBT effectively maximizes the client’s time by relying on action-oriented at-home assignments and practice, similar to the exercises you will encounter in this workbook. Occasional follow-up sessions can be useful. The skills taught usually improve people’s ability to solve problems, socialize, and manage their emotions and time. CBT leads to long-term results that are often generalizable to other areas in life, beyond the issues that originally led you or your client to seek help. Because clients are aware that CBT therapy has an end point and goals are specific and time-limited, this can be highly motivating and encouraging.

Here and Now

While most theoretical approaches focus on past personal history, CBT concentrates on the here and now of current issues. Focusing on the past may help illuminate the origins of problems, but it won’t help solve what’s going on now. For instance, if you drop a glass on the floor, it’ll likely do more harm to focus on why the glass fell compared to cleaning it up to make sure you don’t cut yourself. CBT takes into consideration that current problems are shaped by our early experiences, but the focus is on evaluating the past’s impact on your current thinking and behaviors. CBT identifies the impact of early childhood experiences on current thinking as concrete beliefs—deeply held beliefs about self, others, and the world that keep one stuck. A few exercises in this book help illuminate the impact of these beliefs on overarching themes within current thinking patterns.

Active Participation

Unlike other therapies, CBT has a directive and structured approach, in that a therapist shows clients alternative ways of thinking and behaving. Although a CBT therapist or workbook provides specific techniques and strategies, meaningful progress requires active participation from the client to work collaboratively with the therapist and put in extra effort outside therapy. Of course, in-session experiences are important for reviewing ideas, increasing insight on unhealthy patterns, and checking on progress. But given the time constraint of therapy sessions, it is imperative that homework and exercises are practiced outside therapy to help solidify new patterns of thinking and develop useful coping skills. Therefore, it is highly engaging and holds the clients accountable for their own personal growth. CBT is a big commitment, and it takes persistence to apply newly acquired skills to real-world settings and improve your overall well-being.

The Cognitive Triangle

The underlying assumption of CBT is that the way we feel and behave is not primarily shaped by external events, but influenced by our perceptions. CBT simplifies this principle into a model called the cognitive triangle, which states that thoughts influence feelings, and feelings in turn influence behaviors and reactions, which then influence new feelings, beginning the cycle again. Also, since thoughts, feelings, and behaviors are interconnected, a change in one will influence the others. This model shows that we do not have complete control over whether we will encounter a situation, but we do have control over the way we will perceive or handle it.

Thoughts play a powerful reinforcing role in our lived experiences and actions. However, there is a reciprocal relationship among thoughts, feelings, and behaviors. Feelings and emotions are not directly accessible, but they are greatly affected by changes in thoughts and behaviors. Therefore, CBT focuses on targeting either thoughts or behaviors.

Thoughts

We typically notice how we feel or behave, but being aware of what we think is much more elusive. We are bombarded with a stream of thoughts, as every situation we encounter triggers them. As illustrated by the cognitive triangle, thoughts play a powerful role in our mental health because they heavily color our interpretations, which in turn dictate how we feel and react. We can change the saying to We are what we think.

Fish don’t notice they are swimming in water. Humans don’t notice we are swimming in our thoughts. Fish notice water only once they are out of the water. We notice our thoughts only once we take a moment to intentionally step outside and observe them. A recent integration of CBT that grants access to step outside is mindfulness, a form of meditation. The practice of mindfulness is the ability to be aware of your experiences in the present moment, without judgment.

Humans have about 6,000 thoughts in a day. We don’t have the power to choose all our thoughts. Luckily, the brain filters out information deemed unimportant. But we are often left with intrusive thoughts that suddenly appear and evoke intense negative emotions—these are called automatic thoughts. Although we can’t prevent these thoughts, CBT provides a variety of strategies to help identify unhealthy automatic thoughts, examine them for irrational or maladaptive patterns, and change them to align with rational, realistic thinking.

Feelings

I have encountered countless individuals who believe that if they could just get rid of an uncomfortable emotion, they would be able to change a behavior or thought. For example, an individual who struggles with social anxiety may believe that if their anxiety dissipated, they would be able to make friends. But can you think of a time a friend told you, Don’t worry, and it immediately stopped your anxiety? It doesn’t work like that. My colleagues and I would be out of a job!

If there were a pill that magically eliminated any uncomfortable emotions for the rest of your life, would you take it? I want to convince you not to, that removing unpleasant emotions may not be in your best interest. Emotions play a vital role in influencing our decisions and mobilizing action. For instance, when you’re angry, you may have an urge to yell or withdraw, depending on your interpretation of the situation. This behavior may be adaptive in certain situations where you need to stand up for yourself; all emotions serve an important evolutionary function.

The goal isn’t to change every negative emotion. The goal is to help clients take more control over their emotions by separating and examining their automatic thoughts to determine if their reasons for their emotions are rational. Think about the last time your anxiety alerted you to real danger and kept you safe. CBT is helpful for assessing and changing problematic emotions, behavioral issues, or distorted beliefs.

Behaviors

We don’t have control over every thought that pops into our head, and we cannot wish our uncomfortable emotions away. However, we are mostly in control of our behaviors. It often doesn’t feel that way, because we’re greatly influenced by our thoughts and emotions. Think about the last time you woke up and thought, I don’t feel like working today. You likely felt unmotivated and sluggish, but you got dressed and