Three Common Cognitive Therapy Techniques Therapists May Use

Cognitive therapy (CT) may often get mistaken as a form of cognitive-behavioral therapy (CBT), a popular therapeutic modality for clients seeking mental health support. However, there are a few differences between the two, and cognitive therapists use unique techniques that differ from what might be seen in CBT. It can be helpful to learn more about these techniques when deciding what therapeutic modality you’re interested in trying. 

What is cognitive therapy? 

Cognitive therapy has a similar background to CBT but was developed first by the same psychiatrist, Dr. Aaron Beck, in the 1960s. The purpose of cognitive therapy was to treat the core causes of distressing emotions, such as fear. Dr. Beck found through experience and his research in psychology that patterns could be observed in thought patterns commonly associated with mental illness or challenging feelings. For example, a client facing anxiety might tell themselves, “This situation will never change,” leading to further anxiety. These thought patterns were later called “cognitive distortions,” which can also be seen in CBT. 

Cognitive therapy is based on the cognitive model in psychology, which posits that feelings and behaviors stem from thoughts. It is the underlying theory that eventually led to the development of CBT. However, many therapists still practice cognitive therapy methods to this day, and it can be useful to distinguish between CT and CBT to understand their differences. 

Cognitive therapy vs. CBT

According to The Beck Institute, cognitive therapy is a specific technique aiming to help clients understand and change unhealthy or maladaptive cognitions (thoughts). Contrarily, cognitive-behavioral therapy is an umbrella term for all cognitive and behavioral therapy techniques under this umbrella, also developed by Aaron Beck and his wife, Judith Beck. In CBT, therapists take both a cognitive and behavioral approach to treatment, looking at the causes of thoughts and behaviors and how both connect to emotions and mental illness. 

Cognitive therapy techniques are focused only on working through thoughts instead of changing behavior. For this reason, cognitive and behavioral therapies are often combined into CBT for a more comprehensive approach, as behaviors can be connected to thoughts and vice versa. However, there may be benefits in taking a primarily cognitive approach, especially if a client’s main concerns stem from their mindset or the way they mentally approach problem-solving. 

Exploring three common cognitive therapy techniques 

Below are three of the most widely used cognitive therapy techniques and how these techniques can benefit clients in a therapeutic setting. 

Hypothesis testing 

Hypothesis testing is a technique used in both CT and CBT to test the accuracy of thoughts and start to gain an understanding of which thought patterns are maladaptive. Because thoughts and beliefs are often learned over a lifetime, they may begin to seem like “facts” to the person experiencing them, even if they don’t make logical sense to someone else. For this reason, hypothesis testing can ensure you’ve examined your thoughts in detail before making a decision based on them. 

In a therapeutic session, clients may be asked to consider multiple scenarios regarding their thoughts or beliefs. The therapist may ask questions like:

• What is the statistical likelihood of your thought being correct? 
• If someone else was in your exact situation, would you have similar thoughts about them? 
• If the worst-case scenario occurred, what would you believe it meant about you?
• How would you go about daily life knowing that this self-belief no longer holds you back? 
• In what ways does this thought hinder you? In what ways does it help you? 
• What would your life look like without this thought? 
• What aspects of this thought may be coming from learned beliefs from childhood and harmful generational patterns? 

Thought reframing

Thought reframing is often the second step to cognitive therapy after identifying a thought and testing its healthiness. When a thought is found to be maladaptive, the therapist can guide the client in reframing the thought through various exercises. They may start by identifying a type of distortion that fits the thought and then working through a method like fact-checking or visualization to reduce the thought’s power or to replace it with a more positive or adaptive cognition. 

The following types of distortions may come up in conversation during cognitive therapy:

• Rumination: Obsessive, repeated thoughts about a subject 
• Black-and-White Thinking: Thinking a situation is “all or nothing”
• Mental Filtering: Focusing on only the negative or positive to ignore another aspect of a situation
• Catastrophizing: Believing a situation is doomed or that you are helpless to make changes in your situation 
• Disqualifying: Downplaying your successes to discredit yourself 
• Comparison: Comparing yourself to another person

When reframing a thought, your therapist may ask you to label it as a distortion and then reframe it in a way that makes it productive. Below are a few examples of maladaptive beliefs and distortions, followed by a list of reframing statements:

• Cognitive Distortion: “I will never get into an Ivy League college.” 
• Maladaptive Belief: “I am worthless and unloved.” 
• The Distortion: “It doesn’t matter that I finished second in the marathon because I finished last every other time.” 

Below are reframing statements for these thoughts:

• Reframed Thought: “I am nervous about applying to an Ivy League college and want to develop a plan to increase my chances of acceptance.” 
• Reframed Belief: “It is currently difficult for me to see my worth and love myself, which is why I am proud of myself for going to therapy to change this mindset.”  
• Reframed Thought: “I worked hard to improve in this marathon, allowing me to finish second this time!” 

Thought recording

Thought recording involves tracking your thoughts over a specific period to find patterns and areas for growth. Your therapist can guide you in this process and may assign homework, such as journaling, visualization, or thought-tracking exercises. Some smart device apps may also offer a framework for tracking your thoughts. If you are also working on behavioral techniques in therapy, you can track your thoughts and behaviors to notice any connections between the two. For example, if you notice you commonly think, “I’m a failure,” after experiencing social rejection due to social anxiety, you might benefit from working on social connection techniques with your therapist. 

Who can benefit from cognitive therapy?

Anyone interested in trying therapy can benefit from cognitive therapy methods. Therapy is not only for those living with a mental illness or extreme mental challenge. Distortions and negative thinking can be a common human challenge, and knowing how to disrupt these thoughts and replace them can be critical for all aspects of life, including social, professional, and personal areas. 

People with mental illnesses that impact thought patterns may also benefit from cognitive therapy. However, the current “gold standard” for treatment for many conditions is cognitive-behavioral therapy, as it combines the above therapy methods with behavioral techniques like roleplaying, changing your responses to emotions, and coping with distress. People with conditions like anxiety disorders, depression, eating disorders, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD) may benefit from CT or CBT in the treatment or management of their symptoms. 

If you’re not interested in trying cognitive therapy, hundreds of other therapeutic modalities are available. Consider asking questions when reaching out to prospective therapists to learn more about their unique approach, as each therapist may specialize in a different area. Note that cognitive therapy may not be effective for everyone, especially in cases of severe mental illness or complex trauma. In the case of complex trauma or PTSD, modalities like eye movement desensitization and reprocessing therapy (EMDR) have been found to be more effective for some clients. 

Finding a cognitive therapist

If you’re ready to start therapy, a few starting options are available to you. Some clients may prefer in-person therapy because it offers a close environment to interact with the therapist, whereas others may prefer online therapy. Online therapy can benefit those seeking flexibility, convenience, and cost-effectiveness. Platforms like BetterHelp offer these benefits, allowing clients to connect with a provider from home and choose between phone, video, or live chat sessions at an affordable rate. 

Studies also back up the effectiveness of online therapy. One study looked at online mindfulness-based interventions, including mindfulness-based cognitive therapy (MBCT), which was found to be as effective as in-person methods in reducing symptoms.