Cognitive behavioural therapy

Written by Katherine Nicholls
Katherine Nicholls
Counselling Directory Content Team

Reviewed by Diane Masterson
Last updated 8th November 2022 | Next update due 7th November 2025

Cognitive behavioural therapy (CBT) is a talking therapy that helps you manage problems by encouraging you 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.

Living with a mental health condition can be difficult. While the topic of mental health and the importance of speaking up is becoming normalised, stigma still exists and this can make it difficult to know where to turn for support. If you're not comfortable talking to friends or family, you may want to speak to a professional - like a doctor or counsellor.

What is CBT?

CBT combines two approaches for a practical and solution-focused therapy.

Counsellor Marian Hanson explains CBT in this short video:

The idea behind CBT is that 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 examines learnt behaviours, habits and negative thought patterns with the view of adapting and turning them into a positive.

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 more 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 suffering from 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.

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 people that may benefit from CBT include:

  • Those with depression and/or anxiety.
  • People with post-traumatic stress disorder (PTSD).
  • Those with an eating disorder.
  • People who have an addiction.
  • People who are experiencing sleeping problems, such as insomnia.
  • People who have a fear or phobia.
  • Those with obsessive-compulsive disorder.
  • Those who want to change their behaviour.

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.

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, like 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 therapist will be in confidence and without judgement to help you gain a new perspective.

The course of CBT can be anywhere from six weeks to six months, depending on your circumstance. 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 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. I would highly recommend CBT.

- Read more on Happiful.

How does CBT work?

Cognitive behavioural therapy looks 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 come to an end, you may think you have failed and that you 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.

Learn more about relationship issues and how counselling can help.

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 illustrate 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 suffer from 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.

Just like all psychological therapies, CBT may not be a suitable treatment for everyone. Speaking to a professional, such as a counsellor or doctor, will help you decide which therapy type is right for you and which approach to consider.

What is guided discovery in CBT?

Guided discovery is a technique some 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?

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, the 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 quicker. This way you will hopefully start to develop a stronger sense of self-confidence and self-belief.

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