Cognitive Behavioural Therapy (CBT) is a talking therapy that can help you understand the connection between your thoughts, feelings and behaviours.
It is one of the most widely used forms of talking therapy and can be helpful for a range of difficulties, including anxiety, depression, stress, low self-esteem and phobias.
But what actually happens during CBT, and how can it help? In this guide, we explain what CBT is, how it works, what you can expect from a session and whether it could be right for you.
What does CBT stand for?
CBT stands for Cognitive Behavioural Therapy. The basic idea behind CBT is that our thoughts, feelings and behaviours are connected.
For example, imagine you’re asked to give a presentation at work. You might think, “I’m going to make a fool of myself”. That thought could make you feel anxious. In response, you might avoid preparing for the presentation, consider calling in sick or spend hours worrying about everything that could go wrong.
CBT helps you explore this cycle and consider whether there are different ways of thinking and responding that could be more helpful. It’s not about simply ‘thinking positively’. Instead, CBT involves developing a more balanced and realistic way of looking at difficult situations.
How does CBT work?
CBT focuses on the relationship between three key areas – thoughts, feelings, and behaviours. These can influence one another. For example:
Situation: Your friend hasn’t replied to your message.
Thought: They must be annoyed with me.
Feeling: You feel anxious and rejected.
Behaviour: You send several more messages or withdraw from the friendship.
The problem is that the original thought may not necessarily be accurate. Your friend could simply be busy.
CBT can help you recognise these patterns and examine the thoughts behind them. You might learn to ask:
– What evidence do I have for this thought?
– Is there another possible explanation?
– Am I assuming I know what someone else is thinking?
– Am I focusing only on the negative?
– What would I say to a friend in the same situation?
Over time, this can help you respond to difficult situations differently.
What can CBT help with?
CBT can be used to help with a range of emotional and psychological difficulties. It is commonly used for:
- Anxiety
- Depression
- Panic attacks
- Phobias
- Stress
- Low self-esteem
- Social anxiety
- Health anxiety
- Obsessive thoughts and behaviours
- Sleep difficulties
- Relationship difficulties
CBT isn’t necessarily suitable for everyone or every situation, however. A therapist can help you explore whether it is an appropriate approach for your particular circumstances.
What happens in CBT?
CBT sessions are usually structured and focused on the difficulties you’re experiencing. Your therapist may start by helping you understand what is currently troubling you and how it is affecting your thoughts, feelings and behaviour. Together, you might identify particular patterns that you’d like to change.
For example, you might discover that you regularly expect the worst to happen, avoid situations that make you anxious, criticise yourself when something goes wrong, assume you know what other people think, overthink conversations, or put things off because you’re worried about getting them wrong.
Your therapist can then help you explore these patterns and develop different ways of responding.
Will I have homework in CBT?
CBT often involves practising things between sessions. Your therapist might suggest keeping a thought diary, trying a particular exercise or gradually approaching something you’ve been avoiding.
This doesn’t mean you’ll be given traditional ‘homework’ in the way you might have had at school. The idea is to give you opportunities to practise the skills you’re developing in therapy and see how they work in your everyday life.
How long does CBT take?
There’s no single answer because everyone’s circumstances are different. The number of sessions you need can depend on several factors, including what you’re experiencing, how long you’ve been experiencing it and what you’d like to achieve through therapy.
Some people may benefit from a relatively short course of CBT, while others may need longer-term support. Your therapist can discuss this with you and review your progress as your sessions continue.
What are cognitive distortions?
An important part of CBT involves recognising unhelpful patterns of thinking, sometimes referred to as cognitive distortions. These can include:
- Catastrophising – Assuming the worst possible outcome will happen. For example, “I’ve made one mistake at work, so I’m probably going to lose my job”.
- All-or-nothing thinking – Seeing situations in extremes, with little room for anything in between. For example, “If I don’t do this perfectly, I’ve failed”.
- Mind reading – Assuming you know what another person is thinking. For example, “they didn’t say hello, so they must be annoyed with me”.
- Overgeneralising – Taking one experience and applying it to everything. For example, “that relationship didn’t work, so I’ll never have a successful relationship”.
- Should statements – Putting pressure on yourself with rigid expectations. For example, “I should be able to cope with this”.
CBT doesn’t aim to tell you that your thoughts are wrong. Instead, it can help you examine them and consider whether they’re giving you a complete and balanced picture of what’s happening.
Is CBT about positive thinking?
Not exactly. CBT isn’t about pretending everything is fine or replacing every negative thought with an unrealistically positive one. For example, if you’re worried about an upcoming interview, CBT isn’t necessarily about telling yourself that you’re definitely going to get the job.
Instead, you might work towards something more balanced, like, “I’m nervous because this interview matters to me. I can’t know what will happen, but I can prepare and do my best”. The aim is to develop thoughts that are realistic, balanced and useful, rather than simply positive.
Can CBT change the way you think?
CBT can help you become more aware of patterns in your thinking and develop alternative ways of responding to them. With practice, you may start to recognise certain patterns more quickly.
For example, instead of immediately thinking, “I’ve messed everything up”, you might recognise the thought as an example of all-or-nothing thinking and ask, “have I really messed everything up, or have I made one mistake that I can deal with?”
This doesn’t mean difficult thoughts will disappear completely. Rather, you can become better at not automatically believing every thought that enters your mind.
Is CBT right for me?
CBT can be helpful if you’re experiencing patterns of thinking or behaviour that are affecting your everyday life. You might consider exploring CBT if you:
- Feel stuck in cycles of negative thinking
- Regularly worry about things that haven’t happened
- Avoid situations because they make you anxious
- Are very self-critical
- Struggle with low self-esteem
- Find yourself repeatedly seeking reassurance
- Want to understand why you respond to certain situations in particular ways
- Would like to develop practical tools for managing difficult thoughts and feelings
You don’t necessarily need to have a formal diagnosis to explore whether CBT could be useful. A therapist can talk through what you’re experiencing and help you understand what type of support may be appropriate.
What should I expect from my first CBT session?
Your first session is an opportunity for you and your therapist to get to know each other and discuss what has brought you to therapy.
You may talk about what you’re struggling with, how it affects your day-to-day life, when the difficulties started, what you’d like to change, what you’d like to get from therapy, and
whether CBT is an appropriate approach for you.
You should also have the opportunity to ask questions about the therapy itself. It’s important that you feel comfortable with your therapist. Finding the right therapeutic relationship can be an important part of the process.
CBT at Re…root
At Re…root, our therapists provide a supportive and confidential space where you can explore what’s going on for you and consider what might help.
If you’re interested in CBT, you can talk to a therapist about your circumstances, what you’d like to work on and whether CBT could be a suitable approach.
You don’t have to figure everything out before you start therapy. Sometimes the first step is simply talking to someone about what you’re experiencing.