What is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy (CBT) is a popular and effective psychotherapy for many types of psychological problems, so it is important to have an understanding of this approach.

CBT is a ‘talk therapy’ that emerged from earlier forms of psychological treatments developed through the 20th century. Behavioural therapy (Behavioral Therapy) and Rational Emotive Behavior Therapy (REBT) are two examples of these background influences.

CBT meaning

Because it is also influenced by Cognitive Therapy, CBT emphasises the role of thinking in determining our emotional responses to events and situations. In other words, thoughts are the link between events and our reactions to them. Losing a job and thinking ‘Great, I hated that job’ is going to produce a very different response to ‘This is the worst thing that could ever happen to me’.

We also consider the mutual relationships between thoughts, behaviours, emotions, and the physical body (physiological reactions) in CBT. We assume that altering one of these elements can have an impact on others.

The connections between these four aspects of our lives can be represented in this simple diagram:

There are other important features of CBT. For instance, there is also a focus on addressing psychological distress in the present, rather than attempting to address difficulties in a person’s past. We also see psychological problems as normal processes that have been intensified for some reason. For example, anxiety is a very normal experience that we all encounter on occasion. The brain sometimes starts to over-estimate the number of dangers in our life, thereby triggering numerous false alarms in the body (i.e., excessive anxiety).

CBT is used to successfully treat many problems, particularly depression and anxiety. However, this approach is also used as trauma therapy and anger management therapy to name just a couple of additional examples. CBT can also be used as part of a holistic therapy or combined with other forms of psychotherapy as ‘intergrative therapy’.

CBT techniques

The process of CBT first involves identifying why a person has experienced this intensification of normal processes, and to understand what is maintaining this unwanted change. This stage is known as developing a ‘formulation’ of someone’s difficulties. CBT sessions then involve the development of several skills designed to target the factors that caused and maintain the problems a person wants to address.

Strategies used in CBT relate to the four aspects represented in the above diagram. For example, unhelpful thinking patterns are identified through the use of thought diaries, then addressed through various ‘thought challenging’ techniques. Clients are often asked to change behaviours in some way to address issues such as avoidance and counterproductive ‘safety behaviours’.

How long does it take for cognitive behavioural therapy to work?

CBT is generally a short-term intervention, but the number of sessions completed for a given issue can vary greatly (6–12 appointments is typical).

When using CBT in my practice, I often agree on an initial block of sessions with a client (usually 4–6) followed by a review of progress and discussion about whether further work should take place. However, treatment should be flexible and accommodate your needs and circumstances.

It isn’t straightforward to make predictions about how effective CBT will be or how long it will take to work. Overall, CBT is an effective treatment on average (2), but not everyone will respond in the same way (or at the same speed).

In my practice, I commonly see people experiencing positive effects after about 4–6 sessions, but this varies. Commitment to appointments and making a genuine effort with techniques (including practice tasks) is crucial to maximising the chance of a quick response.

Cognitive behavioural therapy examples

Low mood and anxiety are difficulties often addressed through CBT. Applying CBT to low mood, we often use the following techniques:

• Keeping a mood diary to understand the problem better
• Introduce an ‘activity schedule’ where depression-causing behaviours are eliminated while mood-improving activities are introduced
• Develop a person’s problem-solving skills
• Identify depression-causing thoughts, then responding to them with more accurate alternative statements.

CBT for anxiety

For social anxiety, we might undertake these tasks:

• Teach physical relaxation techniques
• Identify anxiety-causing thoughts, then generate more helpful, realistic counter statements
• Identify anxiety-provoking situations, then enter these repeatedly in a controlled, gradual way
• Conduct ‘experiments’ to test the accuracy of anxious thoughts.
• Here are some more tips for social anxiety

CBT nuggets

Here are some questions you can ask in response to difficult and unpleasant thoughts.

CBT Test

There are many questionnaires used by CBT practitioners to assess various aspects of thinking/cognition. For instance, one questionnaire examines drinking motives amongst people who have alcohol use problems (Cooper et al., 1992).

Cognitive behaviour therapy near me

CBT is a therapy that is now widely available online. People have automated and live therapy options. I would recommend working with a live CBT therapist (virtual or in-person), then reinforcing this work with good quality self-help resources. Here are a couple of options:

• Moodgym
• The book ‘Mind Over Mood’ by Greenberger & Padesky (published by Guilford)

If you live in the UK, there is the possibility of receiving NHS CBT via your GP.

References

(1) Padeskey, C. A., & Mooney, K. A. (1990). Clinical Tip: Presenting the cognitive model to clients.

(2) Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T. & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy Research, 36(5), 427–440. doi: 10.1007/s10608–012–9476–1

Note: There are two spelling variations for CBT: Cognitive Behavior Therapy (US) and Cognitive Behaviour Therapy