This document explains how cognitive behavioural therapy works in practice including session structure, techniques used, advantages and disadvantages and effectiveness in treating various conditions.
Cognitive behavioural therapy works by helping individuals manage problems through changing thought patterns and behaviours. This practical approach uses structured sessions, homework assignments, and skill-building techniques to address current difficulties and develop lasting coping strategies.
Cognitive behavioural therapy is a talking therapy that helps individuals manage specific problems by changing the way they think and act. Unlike other talking therapies that can continue for months or years, CBT helps individuals reach a point where they can tackle problems without a therapist within a specific number of sessions. The approach deals with current problems rather than issues from the past, looking for practical ways to improve daily life.
CBT has been shown to be particularly helpful at tackling mental health problems including anxiety, depression, post-traumatic stress disorder (PTSD), eating disorders, and phobias. Research also shows that CBT can be used to treat people with physical health conditions such as lower back pain and insomnia.
Note
CBT cannot cure physical symptoms like pain, but it can help individuals cope with them better. The therapy focuses on managing responses to symptoms rather than eliminating the underlying physical condition.
CBT helps individuals make sense of problems that feel too big to handle by breaking them down into manageable parts. The therapy uses a mix of techniques to address negative cycles and promote positive change.
CBT employs several key techniques to support therapeutic progress:
Relaxation Exercises: Techniques to reduce physical tension and manage stress responses.
Coping Skills Training: Developing practical strategies to handle difficult situations and emotions.
Education: Learning about how thoughts affect actions and emotional responses.
Stress Management: Building skills to manage and reduce stress levels effectively.
Confidence Building: Training to develop self-assurance and assertiveness.
Certain thoughts, feelings, and actions can trap individuals in negative cycles or create new situations that make them feel worse about themselves. CBT helps stop negative cycles by breaking down the things that make people feel bad, anxious, or scared into separate components.
By making problems more manageable, CBT helps individuals change negative thought patterns and improve the way they feel. The therapy empowers people to identify unrealistic or unhelpful thoughts and behaviours, then work systematically to change them.
CBT follows a structured format that typically consists of regular sessions over a defined period. Understanding what happens in these sessions helps individuals prepare and engage effectively with the therapy.
| Aspect | Details |
|---|---|
| Frequency | Sessions typically occur every week or every other week |
| Duration | Each session lasts 30 to 60 minutes |
| Total sessions | Up to 20 sessions may be provided |
| Delivery format | Can be done in person or through online/computer programmes |
During the first session, the therapist asks questions about the individual and the problem they would like help with. This assessment ensures CBT is appropriate and that the person is comfortable with the process. The therapist explains how CBT works and sets expectations for the therapeutic journey.
With the therapist’s help, individuals break down their problems into separate parts including the situation, thoughts, emotions, physical feelings, and actions. To facilitate this process, the therapist may ask individuals to keep a diary or write down their thoughts and responses.
The therapist and client examine thoughts, feelings, and behaviours together to work out if they are unrealistic or unhelpful, and to identify the effect they have on each other and on the individual. The therapist helps work out how to change unhelpful thoughts and behaviours.
After identifying what can be changed, the therapist asks individuals to practise new approaches in daily life. This involves recognising unhelpful thoughts and actions, then replacing them with more helpful alternatives.
Important
CBT therapists usually assign homework between sessions. This allows individuals to practise techniques learned in sessions within their daily lives, reinforcing new patterns and accelerating progress.
Facing worrying situations can be difficult, so therapists do not ask individuals to do things they do not want to do or move at a pace that feels uncomfortable. Therapists regularly check in to assess how individuals feel about the progress being made, adjusting the approach as needed.
CBT is not suitable for everyone. Weighing up the advantages and disadvantages can help determine if it is the right therapy for a particular individual.
Evidence-Based Effectiveness: Research has shown CBT can be as effective as medicine in treating physical conditions like low back pain, as well as mental health conditions like depression.
Time-Efficient: CBT can be completed in a relatively short period compared with other types of talking therapies, making it a practical option for many people.
Flexible Delivery: Because CBT follows a structured format, it can be delivered in many ways including in groups, through self-help books, or via computer programmes.
Long-Term Skills: The skills learned in CBT can be integrated into everyday life to help cope better with future problems. Even after the course finishes, individuals can continue using these skills, making it less likely that symptoms will return.
Requires Commitment: To benefit from CBT, individuals need to commit to the process. A therapist can provide advice, but cannot make problems disappear unless the individual does their part, including homework and practice.
Limited Suitability: CBT is not always suitable for people with more complex mental health needs or learning difficulties because of its structured nature.
Present-Focus Limitation: Because CBT only addresses current problems and focuses on specific issues, it does not address possible underlying causes of mental health conditions, such as an unhappy childhood.
Individual-Focused: CBT focuses on individuals changing themselves, but it does not examine the impact of other factors on health and wellbeing, such as environmental or social circumstances.
Caution
CBT may not be the best first choice for everyone. Individuals with complex trauma, severe learning difficulties, or who are not ready to examine their thought patterns may benefit from alternative therapeutic approaches initially.
CBT can help individuals manage certain problems and make them less likely to negatively affect daily life. The therapy has demonstrated effectiveness across various conditions when individuals engage fully with the process.
CBT does not cure physical problems like low back pain, but it helps individuals cope better with them. Even after starting to feel more in control of problems, individuals need to practise CBT skills to maintain the effects. The techniques learned become tools that can be used whenever challenging situations arise.
Individuals can complete a refresher CBT course if they feel they need to revisit skills learned previously. This flexibility allows people to strengthen their coping strategies when facing new challenges or when old patterns begin to re-emerge.
The structured nature of CBT means that skills learned can be applied independently after therapy ends. This self-sufficiency is one of the key advantages of CBT, as it empowers individuals to become their own therapists in managing ongoing challenges.
Look at the following case study example to see how CBT works in practice1
Carol had CBT after the death of her husband. She found it to be a painful experience at times, but it gave her the confidence to continue helping herself. She said:
“I had CBT in the millennium year, a couple of years after my husband died. My husband’s death hit me really badly, because we had been together for so long. I had experienced depression as a teenager and was feeling extremely down again.
One of the things about CBT is a very emotional experience, because as you work through it, you relive painful experiences. It can be agonising in many ways.
I had eight or so treatments by the time I finished the course, and I had definitely shaken a lot of things out of myself. It’s given me the confidence to be able to help myself.
The CBT worked for me because I understood what was happening. It was a clearly-defined exercise that was obviously leading somewhere, and the truth is that deliberately raking everything up achieved something.
The psychiatrist gave me a book called ‘Mind over Mood’ with exercises that you can do on your own. It’s a very good book for depression.”
Cognitive behavioural therapy works by providing a structured, practical approach to managing mental health and physical conditions through changing thought patterns and behaviours. The therapy uses a range of techniques including relaxation exercises, coping skills training, and homework assignments to break negative cycles and build lasting change. While CBT offers numerous advantages such as evidence-based effectiveness and time efficiency, it requires commitment and may not suit everyone, particularly those with complex needs. Understanding how CBT works in practice helps individuals make informed decisions about whether this therapeutic approach is right for their circumstances.
Healthily. (2020). What is cognitive behavioural therapy (CBT) and how does it work?
National Health Service (NHS). Cognitive behavioural therapy (CBT)
British Association for Behavioural and Cognitive Psychotherapies (BABCP). What is CBT?
Mental Health Foundation. Carol’s story: There should be no shame in how we feel. https://www.mentalhealth.org.uk/explore-mental-health/stories/carols-story-there-should-be-no-shame-how-we-feel
Mind. Bereavement - Support and self-care. https://www.mind.org.uk/information-support/guides-to-support-and-services/bereavement/support-and-self-care/
West Sussex College ↩︎