Experiential techniques in CBT

“I understand it logically. I know it doesn’t make sense, but I still feel the same fear.”

This is a phrase that falls extremely often in a psychotherapist’s office. Patients coming to cognitive behavioral therapy (CBT) rightly expect to work on changing their thinking. However, both clinical practice and research show that mere change at the intellectual level (“cold cognition”) is sometimes not enough to permanently change emotional reactions (“hot cognition”).

Modern cognitive-behavioral therapy is increasingly moving away from the simplistic image of therapy based solely on “rational talk.” In response to the phenomenon of the rift between head and heart, this current is systematically integrating experiential techniques. They are not a departure from the cognitive model, but a powerful extension of it, allowing to “prescribe” not only thoughts, but also physiological and emotional reactions.

Why is conversation alone sometimes not enough?

The foundation of CBT is the assumption that the way we interpret experiences influences emotions and behavior. Classical cognitive restructuring (evidence analysis, Socratic discussion) works well with declarative beliefs – those that the patient is able to verbalize and logically process.

The problem arises when dealing with so-called emotionally rooted beliefs ( hot cognitions). These are memory structures that are experienced as true, even if they contradict existing knowledge. Experiential techniques are used precisely to “convince” the limbic system of new knowledge that the prefrontal cortex is already aware of.

1. The difference between “knowledge” and “conviction”

CBT has long made a distinction:

• declarative beliefs (knowledge) – what the patient knows and can logically justify,
• emotionally rooted beliefs – what is felt to be true, even if it contradicts knowledge.

2. Access to “hot” cognitive processes

In many disorders (depression, social anxiety, personality disorders, PTSD) a key role is played:

• strongly emotional self-evaluations,
• automatic predictions of danger,
• fixed interpretations of relationships with others.

Key experiential tools in CBT

Modern cognitive-behavioral therapy has a set of precise tools that engage attention, body, imagination and autobiographical memory. Here are the three pillars of experiential work in CBT:

1. Chairwork – dialogue in space

Although this technique has historically been associated with Gestalt therapy, it is currently experiencing a renaissance in CBT, largely due to the work of Dr. Matthew Pugh. In cognitive-behavioral terms, the technique is strictly subordinated to cognitive goals. It is not about catharsis per se, but about cognitive restructuring in motion. As the patient physically moves between positions, he or she utters arguments from each perspective. This movement:

• strengthens selective attention,
• facilitates a change in point of view,
• promotes greater cognitive flexibility.

Physically changing places and “playing” different perspectives allows for external representation of internal conflicts. In CBT, we most often use:

• Cognitive restructuring in the form of dialogue. In classical CBT, restructuring involves analyzing the evidence for and against a belief. In the experiential version:
• one chair represents the problem belief (e.g., “If I speak up, I will be criticized”),
• the other chair represents an alternative, more realistic interpretation.

• Two-chair dialogue (resolving ambivalence): Ideal for working with conflicts like “I want change” vs. “Change is dangerous.” Allows you to isolate conflicting lines of thought and bring them into integration, rather than getting stuck in ruminations.

• Empty chair dialogue (interpersonal perspective): Used to activate meanings associated with important people or to personify a negative belief (e.g., an internal critic).

• Entering into roles (Role-play): Allows new behaviors and beliefs to be tested “in the heat of the moment,” in a safe office setting.

2. Imagery Rescripting (ImRs)

This is currently one of the most promising techniques, especially for treating social anxiety, PTSD or eating disorders.

In classic CBT, Imagery Rescripting focuses on modifying specific, distorted meanings given to difficult memories. If a patient has a memory that is the source of his or her core belief (e.g., “I am weak”), the therapist helps him or her enter that imagery and introduce new, corrective information – such as the perspective of an adult “I” who can defend himself or herself or interpret the situation differently.

3. The behavioral experiment as an experience

We often forget that the classic behavioral experiment is a pure experiential technique. If a panic-anxiety patient is afraid that an accelerated heartbeat will lead to a heart attack, simply explaining the physiology is not very effective.

Asking the patient to deliberately induce symptoms in the office (e.g., by hyperventilating or running in place) and experience that a heart attack is not happening is a powerful tool for change. This is learning through the body – the most profound and enduring form of hypothesis verification.

Mechanisms of change – why does it work?

Why does incorporating the body and imagination accelerate the therapeutic process? The literature (Pugh, 2017; Bell et al., 2020) points to several key mechanisms:

1. Activation of “hot” structures (Emotional activation): To change an emotional structure, it must first be activated. Experiential techniques allow you to work with beliefs in a state of real emotional arousal, not just “cold”.

2. Cognitive Decentration: physically “separating” thoughts from the person (e.g., planting a critical thought on an empty chair) promotes noticing that thoughts are merely mental events, not facts.

3. Retrieval competition (Retrieval competition): By creating a strong pictorial new experience (e.g., a victorious defense in imagination), we create a new memory trail. In future stressful situations, this new trace has a chance to “win” the competition with the old, fearful pattern.

For whom are experiential techniques particularly helpful?

From a CBT chairwork perspective, it can be particularly useful when:

• cognitive change remains purely intellectual,
• strong, entrenched core beliefs are present,
• ruminations or rigid thinking styles predominate,
• emotions are avoided or overly controlled,
• standard techniques have limited effect.

CBT as a therapy that engages the whole experience

Contemporary CBT is increasingly moving away from the simplistic image of “rational talk” therapy. It is an approach that:

• respects the role of emotions,
• uses experience as a tool for change,
• remains at the same time precise, empirical and structured.

Experiential techniques – including chair work – are not a departure from CBT. They are a natural extension of it, responding to the real needs of patients. If you are interested in developing experiential techniques in your psychotherapeutic work, I invite you to contact me – CBT supervision

Bibliography:

1. Bell, T., Montague, J., Elander, J., & Pugh, M. (2020). “It’s a lot more powerful than just talking”: The experience of chairwork from the perspective of the client. The Cognitive Behaviour Therapist, 13, e15.

2. Janssen, H. (2025). Imagery-Focused Cognitive Behavioral Therapy: Feasibility and Effectiveness. Journal of Behavior Therapy and Experimental Psychiatry, 86, 101-112.

3. Pugh, M. (2017). Chairwork in cognitive behavioral therapy: A narrative review. Cognitive Behaviour Therapy, 46(6), 439-457.

4. Pugh, M. (2019). Cognitive Behavioural Chairwork: Distinctive Features. Routledge.

5. Pugh, M., Bell, T., & Waller, G. (2021). Attitudes and applications of chairwork among CBT therapists: a preliminary survey. The Cognitive Behaviour Therapist, 14, e21.

6. Vyskocilova, J., & Prasko, J. (2012). Emotional processing strategies in cognitive behavioral therapy. Activitas Nervosa Superior Rediviva, 54(4), 143-152.