Cognitive behavioral therapy, or CBT for short, is currently considered the best form of psychotherapy. As an extensively researched treatment, it addresses a wide variety of conditions, such as anxiety, substance abuse, anger, depression, ADHD, and physical pain[*].
But which principle underlies cognitive therapy? In this article, we discuss ten principles of CBT that you can use whether you’re trying to help yourself, a child, student, or patient through a psychological, psychiatric, or medical problem.
I’ve based the CBT principles from Judith S. Beck’s book “Cognitive Behavior Therapy: Basics and Beyond, Second Edition” and explained the meaning of each principle in the simplest possible way. (Note: Judith S. Beck is the daughter of Aaron Beck, the “father of cognitive therapy.”)
What is Cognitive Behavioral Therapy?
CBT was developed by Aaron Beck in the 1960s. It was originally called cognitive therapy before it became known as cognitive behavioral therapy, although many people use these terms interchangeably.
CBT was originally meant to treat depression by changing a person’s thoughts and beliefs; however, it’s now being applied for a diverse range of issues. In her book, Judith mentions the following conditions that can be successfully treated by CBT, which underlie many thinking errors or cognitive distortions:
- Personality disorders
- Bipolar disorder
- Substance abuse
- Habit disorders (biting one’s fingernails, teeth grinding, etc.)[*]
- Couple and family problems
- Back pain
- Chronic fatigue syndrome
One key component of CBT is the cognitive triangle, which tells us that our thoughts influences our emotions and behaviors[*]. For example, entertaining the thought of failing in a test makes you feel anxious, which then causes you to get distracted and perform poorly as a result.
The 10 Principles of Cognitive Behavioral Therapy
While using these basic principles of CBT, keep in mind that therapy should be customized to the needs of a person.
1. CBT requires a sound therapeutic relationship.
Before starting therapy, it’s important to establish trust and rapport with a patient. This entails changing your tone of voice and body language in such a way that you’ll convey warmth and care. Additionally, you should share your treatment plan with them and seek feedback at the end of each session.
2. CBT is goal-oriented and problem-focused.
Goals will be based on the problems that a patient shares during your first session. For instance, if a depressed patient conveys that they feel disorganized, you can guide them towards setting a goal, which could be “Sticking to a daily routine.” Along the way, you’ll also be helping the patient identify obstacles that prevent them from reaching their goals.
3. CBT aims to teach the patient to be their own therapist.
Patients do “homework” outside their therapy sessions. This entails answering CBT worksheets at home that allow them to understand their triggers and practice coping strategies to defeat negative thoughts. Doing this benefits the patient for months or years to come.
4. CBT aims to be time-limited.
It’s a short-term therapy which usually ranges from 6 to 14 sessions for patients with anxiety and depression, according to Judith S. Beck’s book. Yet, it’s important to note that not all patients progress the same, which is why some patients may need additional sessions, especially those who have long suffered from dysfunctional beliefs.
5. CBT emphasizes collaboration and active participation.
Although a therapist is more active at the beginning of a therapeutic relationship, patients should be active participants in their care. This is especially true as they continue to feel better. For example, you can ask them to decide which problems to discuss during a session.
6. CBT uses a variety of techniques to change thinking, mood, and behavior.
CBT can incorporate techniques from other therapies since patients vary in their personal challenges, intellectual level, background, and willingness to change, among other factors. For example, to modify a person’s negative thinking pattern, a therapist may use socratic questioning which helps them to think critically[*]. “Can you provide an example that supports what you’ve just said?” “Is there an alternative viewpoint?” “What are the long-term implications of this?”
7. CBT sessions are structured.
Each therapy session starts with checking the patient’s mood and choosing a goal for that particular session. For the middle part of the session, you’ll be reviewing the patient’s previous homework and assigning them new homework. The session ends with you and the patient summarizing what you’ve discussed.
8. CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.
To improve a patient’s feelings and behaviors, and ultimately their quality of life, a therapist helps them learn how to evaluate their thoughts. A CBT strategy called “behavioral experiments” may also be used to put a patient’s assumptions to the test.
9. CBT is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms.
As a therapist, you base your understanding of the patient on the information they provide at the beginning. However, you continue to refine this knowledge as they share further information about themselves during their therapy sessions.
10. CBT initially emphasizes the present.
This means that cognitive therapy focuses on the “here and now” problems instead of the past[*]. However, therapists can sometimes discuss the past if a patient shows a desire to do so or if getting into the past is necessary because the patient has trouble overcoming their cognitive distortion.
These principles and approaches of CBT allow mental health professionals, regardless of their experience and skill level, to understand cognitive therapy. Having this knowledge hopefully improves your own therapy work.
Looking for resources to support your patients? Mental Health Center Kids offers worksheets for stress management, trauma, anger management, anxiety, and more. Check out our complete collection.
- David D, Cristea I, Hofmann S. Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. 2018 January 29
- Hansen D, Tishelman A, Hawkins R et al. Habits with potential as disorders. Prevalence, severity, and other characteristics among college students. 1990 January
- ScienceDirect. Cognitive Triad
- Braun J, Strunk D, Sasso K et al. Therapist Use of Socratic Questioning Predicts Session-to-Session Symptom Change in Cognitive Therapy for Depression. 2015 May 05
- Fenn K, Byrne M. The key principles of cognitive behavioural therapy. 2013 September 06