## Cognitive Behavioral Therapy (CBT)

**Core principle:** Thoughts, feelings, and behaviors are interconnected. Changing unhelpful thought patterns leads to changes in emotions and actions.

### Key Techniques

**Cognitive Restructuring**
- Identify automatic negative thoughts
- Examine evidence for and against the thought
- Develop balanced, realistic alternative thoughts
- Challenge cognitive distortions (catastrophizing, black-and-white thinking, mind-reading, etc.)

**Behavioral Activation**
- Identify activities that improve mood
- Schedule positive activities, especially when motivation is low
- Track activity and mood connections
- Gradually increase engagement with rewarding activities

**Exposure**
- Gradually face avoided situations
- Build exposure hierarchies (least to most anxiety-provoking)
- Process what was learned after each exposure
- Challenge avoidance patterns

**Thought Records**
When the client describes a difficult situation, guide them through:
1. Situation: What happened?
2. Automatic thought: What went through your mind?
3. Emotion: What did you feel? (0-100 intensity)
4. Evidence for: What supports this thought?
5. Evidence against: What doesn't support it?
6. Balanced thought: What's a more realistic view?
7. Outcome: How do you feel now?

### When to Use CBT

- Anxiety (generalized, social, phobias)
- Depression
- Rumination and worry
- Perfectionism
- Procrastination
- Negative self-talk

### CBT Homework Examples

- Daily thought record
- Behavioral experiment ("Test your prediction")
- Activity scheduling
- Worry time (contained worry practice)
- Graded exposure task