CBT vs. Behavioral vs. Other Approaches

Cognitive Behavioral Frame of Reference (CBT)

Core idea: thoughts drive feelings and behaviors.

Target = faulty or distorted thinking (automatic negative thoughts).

Keywords: thoughts, beliefs, cognitive restructuring, thought records, challenging negative self-talk, reframing, homework.

Behavioral Frame of Reference

Core idea: behavior is learned and can be unlearned.

Target = observable behavior only, NOT thoughts.

Keywords: reinforcement, shaping, token economy, extinction, modeling, desensitization, behavior contract.

Question mentions thoughts, beliefs, or self-talk =

CBT.

Question mentions rewards, consequences, or observable behavior

behavioral

Cognitive restructuring

CBT technique. Client identifies a negative automatic thought, examines the evidence for and against it, and replaces it with a more realistic thought.

Positive reinforcement

Adding something desirable after a behavior to increase it (praise, token, privilege).

Negative reinforcement

Removing something unpleasant after a behavior to increase it. NOT punishment.

Token economy

Client earns tokens for target behaviors and trades them for rewards. Common in inpatient and group settings.

Flooding

Immediate full exposure to the most feared stimulus with no gradual hierarchy. Do NOT confuse with systematic desensitization (gradual).

Exposure therapy

Gradual exposure to the feared stimulus until anxiety decreases. Used for phobias, PTSD, OCD.

Dialectical Behavior Therapy (DBT)

CBT-based.

Skills: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.

Best match = borderline personality disorder, self-harm, emotional dysregulation.

Motivational interviewing

Client-centered, non-confrontational approach to build internal motivation for change. Used for substance use and ambivalence. Uses open questions, reflective listening, and rolling with resistance.

Psychodynamic / psychoanalytic approach

Unconscious conflicts and early experiences drive behavior.

Keywords: defense mechanisms, insight, unconscious, early childhood.

Splitting

Seeing people as all good or all bad. Classic in borderline personality disorder.