Cognitive behavioural therapy

Written by Katherine Nicholls
Katherine Nicholls
Counselling Directory Content Team

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Last updated 11th July 2024 | Next update due 11th July 2027

Cognitive behavioural therapy (CBT) is a talking therapy that helps you manage problems by encouraging you to recognise how your thoughts can affect your feelings and behaviour. CBT combines a cognitive approach (examining your thoughts) with a behavioural approach (the things you do). It aims to break overwhelming problems down into smaller parts, making them easier to manage.


What is cognitive behavioural therapy (CBT)?

CBT combines two approaches for a practical and solution-focused therapy. The aim of CBT is to help us understand how our thoughts and behaviours influence each other. The premise is that, by changing the way we think or behave in a situation, we can change the way we feel about life. The therapy explores learnt behaviours, habits and negative thought patterns and helps us adapt them to become more supportive.

Counsellor Marian Hanson explains CBT in this short video:

Unlike some other therapies, CBT is rooted in the present and looks to the future. While past events and experiences are considered during the sessions, the focus is on current concerns. During a CBT session, your therapist will help you understand any negative thought patterns you have. You will learn how they affect you and, most importantly, what can be done to change them.

CBT looks at how both cognitive and behavioural processes affect one another and aims to help you get out of negative cycles. The emphasis on behavioural or cognitive approaches will depend on the issue you are facing. For example, if you are experiencing anxiety or depression, the focus may be on the cognitive approach. If you have a condition that causes unhelpful behaviour (such as obsessive-compulsive disorder), the focus is likely to be the behavioural approach.


What conditions can CBT help with?

This type of therapy is particularly helpful for those with specific issues. This is because it is very practical (rather than insight-based) and looks at solving the problem. Some of the concerns that may benefit from CBT include:

  • depression and/or anxiety
  • post-traumatic stress disorder (PTSD)
  • eating disorders
  • addiction
  • sleeping problems, such as insomnia.
  • fears or phobias
  • obsessive-compulsive disorder (OCD)

In some cases, CBT is used for people with long-standing health problems, such as chronic pain or irritable bowel syndrome (IBS). While the therapy cannot cure physical illness, it can help people cope better with the symptoms and lower stress levels.

Sometimes, CBT is adapted to support a specific issue. An example of this is trauma-focused CBT. This approach may be offered to those who have experienced trauma and have PTSD. By integrating family therapy elements and looking through a trauma-informed lens, the standard CBT approach is enhanced to help with this particular issue.

CBT has become one of the most popular forms of talk therapy and is recommended by the National Institute for Health and Care Excellence (NICE) for common mental health conditions, such as depression and anxiety. During the treatment, your therapist will work with you to help you focus on the "here and now". They will help you recognise how past events may have shaped your thinking and behaviours, teaching you how to not only adapt your thoughts but manage them.


What to expect from CBT

CBT can be provided on a one-to-one basis, or as part of group therapy. Whichever format you choose, the relationship you have with your therapist should be a collaborative one. This means that you will take an active involvement in the therapy and have a voice when it comes to future progression. The issues you discuss with your cognitive behavioural therapist will be in confidence and without judgment to help you gain a new perspective.

The course of CBT can be anywhere from six weeks to six months, depending on your circumstances. Usually, you will attend one session a week, with each session lasting between 50 minutes to an hour. At the start of your treatment, you will meet your therapist and discuss why you are seeking CBT. You will be able to outline what you hope to gain from CBT and set goals for the future.

Together with your therapist, you will work on the content and structure of your sessions. Your therapist may also set you certain tasks to do after the sessions at home.

As your therapy progresses, you will take a more prominent role in the sessions. You will start to decide on the content and structure of the session, without the help of your cognitive behavioural therapist. The idea is that once your treatment is over, you should feel confident and comfortable enough to continue the work on your own.

CBT helps me to recognise my negative thoughts, to break the habit of these thoughts, and to find a more positive way of thinking. So far, it’s helped me greatly, and I am grateful I’ve had the chance to go through with my sessions. I have almost finished my sessions now and am using the techniques learned daily. 

- Happiful magazine reader.

How does CBT work?

Cognitive behavioural therapy aims to help you make sense of what can feel like an overwhelming problem by breaking it down into more manageable parts. These smaller parts are your thoughts, feelings, actions and even physical sensations. These elements are interconnected and can often trap you in a negative spiral.

For example, if your marriage or relationship has ended, you may think you have failed and are not capable of being in a functional relationship. These thoughts can result in you feeling lonely and lacking energy. When you feel like this, you are unlikely to want to socialise or go out and meet new people. This negative spiral can then trap you into feeling isolated and unhappy.

Rather than accepting the negative thought patterns, CBT aims to show you other ways of reacting so you can break out of negative cycles. Instead of thinking that you are a failure when a relationship ends, you can choose to learn from your mistakes and move on. This new way of thinking may result in you feeling more energised and confident, helping you meet new people and one day, start a new relationship.

While this is a simplified example, it does show how easy it is to get trapped in negative cycles and how changing the way you think and behave can affect you in a significant way. In CBT, you will learn to recognise your thoughts, behaviours and feelings while learning other, potentially more helpful ways of thinking and behaving.

As well as identifying negative thought patterns, CBT can teach you the skills you need to help you deal with different problems. The hope is that once you develop these coping skills, you will be able to use them in the future, whenever you may need them.

For example, if you have a phobia or suffer from anxiety, you may discover that avoiding certain situations can actually increase your fears. Confronting the fears in a gradual and manageable way can help you gain faith in your ability to cope. If you have depression, your therapist may ask you to note down your thoughts so you can explore them in a more realistic way. This can help you gain perspective and start to break the negative cycle.

What is guided discovery in CBT?

Guided discovery is a technique some cognitive behavioural therapists use to help you reflect on the way you process information. This can encourage more open thinking which helps pave the way for changing unhelpful perceptions and behaviours.

Used by cognitive therapists, guided discovery is a two-way, collaborative process that can help clients learn to develop different interpretations of their problems. Through collaboration, this can assist in creating and fostering a positive therapeutic relationship, whilst getting clients to focus on not only the problem, but also the solution. 

- Learn more about guided discovery in CBT

Is CBT for me?

Just like all psychological therapies, CBT may not be a suitable treatment for everyone. Now that you know a little more about the therapy, you should be in a better position to decide whether or not CBT is right for you. The therapy will be more useful to those who relate to the ideas behind it. This includes the solution-focused approach, ideas about behaviour, thinking patterns and the importance of completing at-home tasks.

Being committed and doing the assignments set for you is an integral part of CBT. While the sessions offer support and space to explore your concerns, it is the work you do outside of your sessions that is likely to have the most impact. By staying focused and completing assignments, you will help yourself progress. This way you will hopefully start to develop a stronger sense of self-confidence and self-belief.

If you're interested in trying CBT, connect with a counsellor today using our search tool.

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