Are There Different Kinds of Cognitive Therapies?

Cognitive-behavioral therapy (CBT) is one of the world's most popular and common types of psychological treatment. Combining aspects of cognitive and behavioral theories allows clients to target thought patterns, learn new behaviors, and make changes in their lives. Clients may seek support from a cognitive-behavioral psychologist when managing a mental illness, stress, life transitions, relationships, and other topics. 

What is cognitive therapy?

Cognitive therapy is a short- or long-term treatment that targets thought patterns, beliefs, and reactions. In basic terms, this treatment is based on the idea that people can work to recognize and change ways of thinking to improve their overall mental and emotional health. This is because those practicing cognitive theory may believe that thoughts and beliefs drive all aspects of human behavior and emotion. Like cognitive therapy, cognitive-behavioral therapy showcases how thoughts and beliefs can impact behavior and how that behavior can be modified by modifying the thought pattern behind it (hence the names behavior therapy and cognitive therapy being combined). This is a popular form of therapy for many psychologists. 

The mental health benefits of cognitive therapy

Cognitive treatment can help clients shift focus, perception, and self-esteem, allowing them to shift their behaviors and reactions to certain situations. Dr. Aaron Beck is known as the father of cognitive behavior therapy (CBT), and he became widely known for replacing Freudian analysis in the world of therapy and in many international universities.  

These therapies can also treat mental illness, including anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and borderline personality disorder, and eating disorders, among others. They do this by focusing on how thoughts might contribute to symptoms. Although thoughts may not be the cause of mental health concerns, they can worsen symptom severity for many. By addressing negative thoughts, cognitive distortions, and irrational beliefs, therapists can help patients decrease maladaptive behaviors and boost overall mental health. 

The different kinds of cognitive therapies available to clients

Cognitive-behavioral play therapy

Cognitive-behavioral play therapy is a common variant of cognitive behavior therapy that is used when treating children. A cognitive therapist can gain insights into a child's mental health and well-being by watching them play, having conversations about play, and learning about their imagination. Children may feel uncomfortable expressing themselves verbally, and play therapy can allow them to act out or imagine what they feel. The therapist can take note of this information to develop a treatment plan. 

This type of cognitive behavioral therapy may involve asking a child to choose toys out of a toy box and telling them to play freely or techniques where a therapist may ask a child to draw a picture or use the toys to communicate specific scenarios. The therapist can start recognizing behavioral patterns and developing techniques to help the child or their family. 

Parents may also partake in cognitive play therapy through family sessions. It can be used to teach parents how to communicate with their children by playing with them. In this way, this version of behavior therapy (CBT) is appropriate for all ages even if it is most commonly used for children.

Exposure and response prevention (ERP)

Exposure therapy is a cognitive therapy developed to treat phobias, compulsions, and obsessive fears. Those experiencing an intense fear of any type may benefit from this therapy, whether it is an irrational fear with an unknown cause, fears associated with obsessive-compulsive disorder, or one brought about by post-traumatic stress. Cognitive treatment involves changing your cognition to eliminate your fear responses by addressing any associated cognitive distortions such as catastrophizing. During exposure therapy, clients are exposed to safe and controlled fearful situations that allow them to learn that they are not in danger. 

For example, a client with a fear of needles may start exposure therapy by watching a video of someone getting a shot, then talking about getting a shot, then looking at a needle. At the end of the exposure, after many sessions, they might go to a clinic to get a saline solution through an IV or get a vaccine they've been avoiding while their therapist accompanies them. 

Learning how to breathe and relax your mind can be part of exposure therapy. During the exposures, panic may arise. The CBT therapist can help the client take deep breaths, control their nervous system, and tolerate fear. Through these exercises, the client may see that their fear is not harming them. Exposure therapy has been found especially effective in treating obsessive-compulsive disorder (OCD). 

Exposure therapy or desensitization therapy is often paired with cognitive-behavioral talk therapy, allowing the client to talk about their experiences with their therapist after the exposure. 

Dialectical behavior therapy (DBT) 

Dialectical behavior therapy is a type of behavioral therapy. However, it also includes aspects of cognitive therapy, as it involves techniques such as mindfulness and changing thought processes through cognitive restructuring. Dialectical behavior therapy, or DBT, differs from cognitive behavior therapy (CBT) in that it involves four models, including: 

• Emotional control

• Mindfulness

• Distress tolerance

• Interpersonal effectiveness

These modules help clients experience painful emotions, distressing behavioral patterns, and confusing thoughts. It was developed to treat borderline personality disorder (BPD) but can be effective for many mental health concerns. 

Rational emotive behavior therapy

This type of cognitive behavioral therapy was developed by a psychologist named Albert Ellis. This cognitive model focuses on the intersection of cognition, emotions, and behavior. Your therapist during REBT sessions would help facilitate a rational response to negative and unrealistic thoughts by adhering to their three main principles: 

• You, as a patient, are worthy of self-acceptance, no matter what mistakes you make

• Other people are also worthy of acceptance, even if their behavior involves things you don’t like

• Sometimes negative things happen in life, there is no rational reason to believe that life is always a positive experience. 

Like other cognitive behavioral therapies, REBT helps an individual recognize automatic negative thoughts, and develop coping skills that combat emotional responses to treat depression and other psychological disorders. 

This is not a comprehensive list of cognitive therapies. There are types available such as Beck’s cognitive therapy, commitment therapy, and others. If you are interested in learning more about all of the different forms of CBT, a search on Google Scholar is a good place to start. 

Cognitive therapy techniques

A cognitive therapist may use various cognitive therapy techniques during sessions, regardless of the type of therapy they practice, including the following. 

Cognitive restructuring

The cognitive restructuring technique involves helping clients identify unwanted thought patterns and emotions. Once these have been identified, cognitive clients are prompted to replace those patterns with optimistic thoughts or facts about the situation. For example, the following could be seen as a way to restructure cognitive distortions (unwanted thought patterns): 

• Unwanted Thought: "My friends don't like me because they didn't invite me to dinner."

• Cognitive Restructuring: "My friends have told me they like me many times. I'm sad I wasn't invited to dinner, so I'll let them know I want to come next time." 

• Unwanted Thought: "I am going to fail my class because I'm not smart."

• Cognitive Restructuring: "I have been struggling with class because math has been difficult for me lately. I think I will get a tutor."

Cognitive restructuring often involves coming up with a solution, validating yourself, and checking the facts of the situation you're confused about. This technique can be especially helpful for those with post-traumatic stress disorder (PTSD), as it can help to reframe post-traumatic experiences and thoughts to help prevent flashbacks and other symptoms.

Approximation

Approximation is another cognitive therapy technique. Many individuals may procrastinate due to feeling overwhelmed by a specific task. A cognitive therapist can teach clients to make use of approximation to break tasks down into more manageable chunks or to master a similar task before moving on to the task that they are stressed about. 

For example, it might seem like reading an entire book is a daunting task. Reading one chapter might feel more manageable. Reading one chapter every few days can feel more manageable than reading all chapters at the last minute before a school book report is due. Approximation teaches clients to change how they approach their fears and challenges. 

Mindfulness

Mindfulness is a well-known cognitive-behavioral therapy technique. There are also mindful forms of therapy, such as mindfulness-based cognitive therapy (MBCT). Mindfulness involves focusing on the present moment, practicing acceptance, and increasing sensory awareness. These practices are used during and outside of sessions in mindfulness-based cognitive therapy. In addition, mindfulness has been proven effective in reducing stress, anxiety, and depression in many. 

To set up your first appointment, ask the therapist if you can meet for a consultation to discuss your goals for therapy. You can ask questions during the consultation about the therapist's approach to therapy, how cognitive therapy might help you, and their experience level. 

Online cognitive-behavioral therapy (CBT) 

For many, cognitive behavioral therapy CBT may be out of reach due to common barriers to in-person therapy, such as financial burden, availability challenges, or other reasons. In these cases, CBT and other forms of cognitive therapy can be found online. 

For many people, online therapy is convenient, cost-effective, and high-quality. Studies have found that online CBT can be as effective as in-person therapy in treating anxiety, depression, stress, and social anxiety. When you sign up for a platform, you can connect with a therapist licensed and qualified to provide CBT through phone, video, or live chat sessions. Many platforms also offer messaging with your provider.