The B in CBT

The cognitive side of cognitive behavioral therapy (CBT) targets automatic, negative thoughts and core beliefs, but a common misconception about cognitive behavioral therapy is that it focuses exclusively on negative, automatic thoughts. I believe this is one of the more harmful myths about cognitive behavioral therapy, as it can lead to potential clients believing that CBT only involves "thought exercises" and not seeking out a treatment that could help them. But there is a whole other side, focused on changing behavior, or what people do. The behavioral side of cognitive behavioral therapy encompasses multiple techniques depending on the client’s primary problem. Here are a few examples:

1. Behavioral activation. This treatment is mostly for depression. It asks clients to track activities to discover which are pleasant and which help them feel accomplished. Clients then schedule pleasant activities and activities that help them feel accomplishment.
2. Exposure therapy. Exposure therapy treats anxiety. Clients gradually engage in situations that cause anxiety so they learn that they can cope with what previously triggered anxiety.
3. Problem-solving. Sometimes a situation just needs to be changed. Problem-solving is a systematic way to find the best possible solution.
4. Assertive communication. Many triggers for depression or anxiety could be addressed by setting boundaries or talking to others. Assertive communication helps people do that respectfully.
5. Pacing. This is useful for people with chronic illness that causes pain, fatigue, or other physical symptoms. Pacing asks clients to be active for at least a small amount of time each day but not overly active on days with low symptoms, as being overactive on low symptom days can sometimes lead to worse symptoms on the next day.

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These are just some of the examples from the behavioral side of CBT. Behavioral therapy is expansive and includes a variety of approaches to address depression, anxiety, and other mental health concerns.

Often, the behavioral and cognitive sides of CBT can be used synergistically. For example, sometimes negative thoughts can impede clients from the actions that will help them feel better. A client might feel stressed due to her mother calling every day and need to use assertive communication to set boundaries. But the client might have a belief that “I should always talk to my mother even if it stresses me out.” Cognitive therapy could be used to reframe that belief to help the client set boundaries. Success using the techniques from behavioral therapy can also help challenge negative thoughts. As an example, someone with social anxiety might think they cannot socialize. Successfully completing some exposure therapy exercises could help them see that they can socialize.

The behavioral side of cognitive behavioral therapy uses a range of approaches to address mental health concerns, alone or in concert with cognitive techniques. The key is knowing that CBT is not just about changing negative thoughts, but changing what clients do.