CBT Techniques: Behavioral Experiments

Behavioral experiments is one of the main and most effective methods of intervention in Cognitive behavioral therapy (CBT).

A behavioral experiment is a CBT technique for testing beliefs under realistic conditions. Behavioral experiments are commonly used in treatment of anxiety and affective disorders to test unrealistic predictions and the patient's assessment of situations or themselves in general.

We often make predictions about the world based on our internal models of how the world works. However, the way we think the world works is not always the same as reality. In science, such things are tested by choosing the right setting and conducting an experiment to purposefully gather evidence that can either confirm or disprove the hypothesis. A behavioral experiment is the same thing.

The process begins by choosing a belief to test and assessing the strength of that belief. If it is useful, you can divide that assessment into how much you believe in it cognitively and emotionally; often the emotional credibility of the assessment persists even when it is cognitively evident that it may not match reality.

The next step is to choose a setting/context and a way to test. You need a setting that allows you to actually test the belief without significant difficulty.

Examples of behavioral experiments

• See what happens if you give up safety behaviors (safety behaviors are things we do to feel safer, but they don't actually increase physical safety and only end up increasing anxiety).
• Intentionally doing things you fear (such as staggering or dropping something) to see if the consequences match your predictions.
• To intentionally expose yourself to a situation of anxiety to see if the outcome you fear will occur.
• To test a situation that causes fear by role-playing or replaying some elements of the context, but in a controlled situation.
• If you are working on adopting new beliefs, test them in a real-life situation.
• Interviewing other people to see if they think the way you assume.
• Searching for information that can confirm or disprove the belief.
• Testing two different predictions to see which one is closer to the actual outcome.
• Having someone else conduct the experiment and seeing directly what happened.

Evaluating the results

After the experiment is completed, the next step is to compare the expected and actual results and determine if the strength of belief has changed. If the result differs from what was expected, it becomes grounds for admitting that the belief is unrealistic or decreasing faith in it. We have a natural cognitive predisposition to pay more attention to the negative, and evaluating the results of a behavioral experiment can be a way to rationally work through experiences that are not negative.

If the outcome does meet expectations, it may indicate that the problem is not with the belief itself. In this case, it is better to focus on developing strategies to solve the problem. For example, if I'm worried about people noticing my tremor, and people sometimes notice it (which is true in my case), you can shift the focus from "what if they notice" to "how will I most effectively cope when they notice?"

The usefulness of behavioral experiments

For beliefs that have been formed over years, doing one or two behavioral experiments obviously won't make them change overnight. A behavior experiment is just a tool in a toolbox that may be useful to some people and may not be useful to others.

General Behavior Experiment Technique Instructions

1. Identify the issue: Start by pinpointing the specific thought or belief that you want to test. This could be an irrational fear, a negative assumption, or an unhelpful behavior that causes distress or hinders your daily life.
2. Formulate a hypothesis: Develop a hypothesis or prediction about what might happen if you were to challenge the thought or belief. For example, if you fear social situations, your hypothesis could be: "If I attend the party, I will feel extremely anxious and people will judge me."
3. Design the experiment: Design a real-life situation or task that will allow you to test your hypothesis. In the example above, attending a social gathering would be an appropriate experiment.
4. Determine the measures: Decide how you will measure the outcomes of the experiment. You can use a scale (e.g., from 0 to 10) to rate your emotions, thoughts, or behaviors before and after the experiment. It's also helpful to note the specific evidence supporting or refuting your hypothesis.
5. Conduct the experiment: Carry out the experiment while trying to remain as objective as possible. Make sure to follow through with your plan, even if you feel anxious or uncomfortable.
6. Record the results: After completing the experiment, record your observations, emotions, thoughts, and behaviors. Compare these findings with your initial hypothesis and expectations.
7. Analyze the results: Reflect on the outcomes of the experiment and determine whether they support or contradict your hypothesis. Evaluate your beliefs and assumptions in light of the evidence. Did your predictions come true, or were they disproven?
8. Draw conclusions: Based on the results, draw conclusions about the validity of your initial thoughts or beliefs. If the results contradict your hypothesis, consider revising your beliefs and assumptions accordingly.
9. Plan future experiments: If necessary, design and conduct additional experiments to further challenge and test your thoughts and beliefs. This may involve increasing the difficulty of the task or exploring different aspects of the issue.
10. Apply the insights: Use the insights gained from the experiments to modify your thoughts, beliefs, and behaviors. You can use coping cards to help applying your insights. Continue practicing CBT techniques to reinforce these changes and improve your overall emotional well-being.

Remember, the Behavioral Experiment CBT technique is a process of trial and error. It may take multiple attempts or experiments to arrive at more accurate and helpful beliefs. Be patient and persistent as you work through this technique.

Behavioral Experiment Technique in CopingCard Mobile App and Provider Platform

A behavioral experiment lives or dies on two things: a prediction stated clearly enough to be wrong, and an honest record of what actually happened — ideally more than once. CopingCard is built around exactly that shape: you design the experiment once, then you run it as many times as you need.

In the mobile app

Design step by step. An experiment is planned in four short screens — the situation, the hypotheses you are weighing against each other, how you will test them, and what you predict will happen, with how strongly you believe it. Each step is saved as you finish it, so a plan started on the bus can be completed at home. Half-planned experiments wait in Drafts and reopen at the first empty step.

Run it, then run it again. Once the design is complete, the experiment is ready to be observed. Every time you try it, you record an observation: what happened, which hypothesis held up, how strong the feeling was, and what you learned. A prediction tested once is a data point; tested five times, it is evidence. If you wrote an observation in a hurry, you can go back and correct it.

Close the loop. When you have run the experiment enough, a completion step puts your original prediction next to the whole run — how many observations, over how many days — and asks what it means for the belief you set out to test, and what you would try next.

In the provider platform

Design together in session. Therapists design an experiment for a client in the platform with the same structure — situation, hypotheses, plan, prediction — and can start from AI-generated suggestions based on a few words about the situation, then edit them into the client's own language. What you design in session appears in the client's app.

Follow the run between sessions. Observations the client records at home show up in the platform as they happen; a therapist can also record an observation on the client's behalf, and complete the experiment together at the next session. Experiments that were designed but never activated are listed as unfinished, so nothing is lost between appointments.

One experiment, two views

The app and the platform show the same experiment. A client who shares their data with their therapist gives them the whole record — the design, every observation, the completion — rather than a recollection of it. That is what makes the technique work outside the therapy room: the between-session run is the experiment, and the session is where you make sense of it together.

Relevant research studies and articles:

Here are some research studies and reviews highlighting the effectiveness of behavioral experiments in therapy:

Celina Clément, Jihong Lin, and Ulrich Stangier (2019). Efficacy of Behavioral Experiments in Cognitive Therapy for Social Anxiety Disorder: Study protocol for a randomized controlled trial. This study aims to investigate the impact of enhanced training and the use of behavioral experiments (BEs) on the efficacy of traditional cognitive therapy (CT) for social anxiety disorder (SAD). Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921437/

Jeffrey J. Wood, Amy Drahota, Karen Sze, Kim Har, Angela Chiu, and David A. Langer (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. This study demonstrates the effectiveness of behavioral experiments in treating anxiety disorders and social difficulties in children with high-functioning autism. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231198/

Combs, D. R., & Tiegreen, J. (2007). The use of behavioral experiments to modify delusions and paranoia: Clinical guidelines and recommendations. This study investigates the feasibility and effectiveness of using behavioral experiments to modify delusions and paranoia. Link: https://psycnet.apa.org/fulltext/2014-49514-003.html

Tang, N. K. Y., & Harvey, A. G. (2006). Altering misperception of sleep in insomnia: Behavioral experiment versus verbal feedback. This study found that using a behavioral experiment to show the discrepancy between actigraph data and sleep diaries led to a greater reduction in sleep misperception, insomnia symptoms, and sleep-related anxiety compared to just providing verbal feedback to individuals with insomnia. Link: https://psycnet.apa.org/doi/10.1037/0022-006X.74.4.767

McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 540–547. A controlled comparison in which a single session of behavioral experiments, like a single session of thought records, improved beliefs, anxiety, behavior and symptoms relative to a control condition. Link: https://doi.org/10.1016/j.jbtep.2011.07.003

Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experiments. Behavioural and Cognitive Psychotherapy, 31(3), 261–277. Participants who practised both techniques rated behavioral experiments as more powerful and compelling than thought records for changing beliefs and behavior — consistent with experiments acting through experience rather than argument. Link: https://doi.org/10.1017/S1352465803003035