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claude-inner-dialog/personas_active/Sage/.therapy/library/modalities/cbt.md
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2026-05-29 15:55:37 +02:00

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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