Cognitive Behavioural Therapy

What is Cognitive Behavioural Therapy (CBT)? – Cognitive Behavioural Therapy (CBT) is a kind of talking therapy during which any unhelpful patterns of thought you may have can be identified and challenged.

How is CBT Useful? – Cognitive behavioural therapy (CBT) has been shown to be as effective as medication in treating some mental health problems.


What is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy (CBT) is a type of talking therapy focuses the idea that thoughts, feelings, and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. During therapy unhelpful patterns of thoughts and behaviour can be identified and challenged, in order to bring about positive change in your life.

The focus of CBT is very much on the present, on the current issues you may have, rather than on your past. In CBT therapy you and your counsellor will work together to uncover and explore the way in which your thinking and behaviour is negatively impacting your life and will work out a programme of change that you can practice between sessions. CBT has been shown to be an effective way of treating a number of different mental health conditions such as:

  • Panic disorder
  • Depression
  • Anxiety
  • Obsessive compulsive disorder
  • Phobias
  • Problems with sleep – insomnia
  • Post-Traumatic Stress Disorder (PTSD)
  • Addictions – both substance and process
  • Eating disorders

CBT can be seen as having six phases:

  1. Assessment or psychological assessment;
  2. Reconceptualization;
  3. Skills acquisition;
  4. Skills consolidation and application training;
  5. Maintenance;
  6. Post-treatment assessment follow-up.

These steps are based on a system created by Kanfer and Saslow. After identifying the behaviors that need changing, whether they be in excess or deficit, and treatment has occurred, the psychologist must identify whether or not the intervention succeeded. For example, “If the goal was to decrease the behavior, then there should be a decrease relative to the baseline. If the critical behavior remains at or above the baseline, then the intervention has failed.”

The steps in the assessment phase include:

Step 1: Identify critical behaviors

Step 2: Determine whether critical behaviors are excesses or deficits

Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)

Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.

The re-conceptualization phase makes up much of the “cognitive” portion of CBT.

Cognitive therapy roots

Alfred Adler

One of the first therapists to address cognition in psychotherapy was Alfred Adler with his concept of basic mistakes and how they contributed to creation of unhealthy or ineffective behavioral and life goals. Afed Adler’s work influenced the work of Albert Ellis, who developed the earliest cognitive-based psychotherapy, known today as rational emotive behavior therapy, or REBT.

Another contributing source of thinking was that of Aaron T. Beck who during free association sessions in his practice noted that actually thought processes were not perhaps as unconscious as previously theorized by Freud, and that these ‘automatic thoughts’ were a source of pain for his clients.

It was these two therapies, rational emotive therapy and cognitive therapy, that started the “second wave” of CBT, which was the emphasis on cognitive factors.

Behavior and cognitive therapies merge – ‘third wave’ CBT[

In initial studies, cognitive therapy was often contrasted with behavioral treatments to gauge which therapy had the best impact,  the 1980s and 1990s, cognitive and behavioral techniques were amalgamated into cognitive behavioral therapy. Key to this merging was the successful development of treatments for panic disorderby David M. Clark in the UK and David H. Barlow in the US.

Over time, cognitive behavior therapy became to be known not only as a therapy, but as an umbrella term for all cognitive-based psychotherapies. These therapies include, but are not limited to,

  • rational emotive therapy (REBT),
  • cognitive therapy,
  • acceptance and commitment therapy,
  • dialectical behavior therapy,
  • reality therapy/choice theory,
  • cognitive processing therapy, EMDR,
  • multimodal therapy.

All of these therapies are a blending of cognitive- and behavior-based elements.This blending of theoretical and technical foundations from both behavior and cognitive therapies constituted the “third wave” of CBT. The most prominent therapies of this third wave are dialectical behavior therapy and acceptance and commitment therapy


How is CBT Useful?

Cognitive behavioural therapy (CBT) has been shown to be as effective as medication in treating some mental health problems and it can certainly be useful for a wide range of people with a wide range of different issues.

CBT can be particularly useful when time or funds mean you would rather complete therapy in a relatively short period of time. CBT can be accessed in individual counselling, through group work, and even alone through, self-help books and online programmes.

CBT is a popular therapy and The National Institute for Clinical Excellence (NICE), has advised that CBT should be the first line treatment for mild to moderate depression, followed by medication only if CBT proves unsuccessful.

Some critics argue that CBT has only limited usefulness because its focus on current problems specific issues, means that it doesn’t address the possible underlying causes of persistent patterns, such as trauma in childhood.

Cognitive behavioural therapy will help you to make sense of overwhelming problems by breaking them down into smaller parts.

CBT is:

  • pragmatic – focused on specific issues and solutions for them
  • highly structured – structured via goal setting in the present

CBT addresses five main, interconnected areas of your life, these are:

  • situations
  • thoughts
  • emotions
  • physical feelings
  • actions

CBT aims to get you to a point where you can tackle problems without the help of a therapist relatively quickly.If you have CBT on an individual basis, you’ll usually meet with a CBT counsellor for between five and 20 weekly or fortnightly sessions, with each session lasting around an hour. Every person is different and will therefor require a different length of treatment. While CBT does aim to be a fast working type of talking therapy it does require a high level of commitment from the client to work.


Categories: Counselling