What is CBT?

(Cognitive Behavioural Therapy)

Cognitive and behavioural psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behaviour. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self-help material.


Cognitive and/or behavioural psychotherapies (CBP) are psychological approaches based on scientific principles and which research has shown to be effective for a wide range of problems. Clients and therapists work together, once a therapeutic alliance has been formed, to identify and understand problems in terms of the relationship between thoughts, feelings and behaviour. The approach usually focuses on difficulties in the here and now, and relies on the therapist and client developing a shared view of the individual’s problem. This then leads to identification of personalised, usually time-limited therapy goals and strategies which are continually monitored and evaluated. The treatments are inherently empowering in nature, the outcome being to focus on specific psychological and practical skills (e.g. in reflecting on and exploring the meaning attributed to events and situations and re-evaluation of those meanings) aimed at enabling the client to tackle their problems by harnessing their own resources. The acquisition and utilisation of such skills is seen as the main goal, and the active component in promoting change with an emphasis on putting what has been learned into practice between sessions (“homework”). Thus the overall aim is for the individual to attribute improvement in their problems to their own efforts, in collaboration with the psychotherapist.

The Evidence Base for CBT

Treatment interventions are predicated on a robust evidence base derived from studies utilising randomised controlled and single-case methodologies that have demonstrated the efficacy and effectiveness of cognitive and behavioural psychotherapies in the treatment of common mental health problems, including the anxiety disorders, generalised anxiety, panic, phobias, obsessive-compulsive disorder, posttraumatic stress disorder, bulimia and depression as identified by a host of recent reviews by NICE, SIGN and other review bodies. CBT models have also been developed for use in an increasing range of mental health and health difficulties including severe and enduring mental health problems, such as psychosis, schizophrenia, bi-polar disorder, anger control, pain, adjustment to physical health problems, insomnia and organic syndromes, such as early stage dementia. There is an extensive research base around behavioural approaches in working with children and people with learning disabilities, severe and enduring mental health problems and “challenging behaviour” generally. More recently CT and CBT have become the treatments of choice for adolescent depression, and for use with children and in intellectual disability (learning disability). Research into the contribution of psychological factors to physical health problems (such as low back pain, chronic fatigue, recovery from surgery for example) is growing and has led to the development of CB approaches in these areas.

Key Concepts in Cognitive-Behavioural Therapy (CBT)

The cognitive component in the cognitive-behavioural psychotherapies refers to how people think about and create meaning about situations, symptoms and events in their lives and develop beliefs about themselves, others and the world. Cognitive therapy uses techniques to help people become more aware of how they reason, and the kinds of automatic thought that spring to mind and give meaning to things.

Cognitive interventions use a style of questioning to probe for peoples’ meanings and use this to stimulate alternative viewpoints or ideas. This is called ‘guided discovery’, and involves exploring and reflecting on the style of reasoning and thinking, and possibilities to think differently and more helpfully. On the basis of these alternatives people carry out behavioural experiments to test out the accuracy of these alternatives, and thus adopt new ways of perceiving and acting. Overall the intention is to move away from more extreme and unhelpful ways of seeing things to more helpful and balanced conclusions.

The behavioural component in the cognitive-behavioural psychotherapies refers to the way in which people respond when distressed. Responses such as avoidance, reduced activity and unhelpful behaviours can act to keep the problems going or worsen how the person feels. CBT practitioners aim to help the person feel safe enough to gradually test out their assumptions and fears and change their behaviours. For example this might include helping people to gradually face feared or avoided situations as a means to reducing anxiety and learning new behavioural skills to tackle problems.

Importantly the cognitive and behavioural psychotherapies aim to directly target distressing symptoms, reduce distress, re-evaluate thinking and promote helpful behavioural responses by offering problem-focussed skills-based treatment interventions.

Key Factors Influencing the Effective Delivery of CBT

• Therapeutic relationship – a trusting, safe, therapeutic alliance is essential but not sufficient for successful CBT.
• Collaboration–
• Is a way of being with clients based on an equal partnership, each party bringing something to the relationship. The therapist brings skills and knowledge of psychological processes, theories of emotion and techniques that have helped others and could help the current client. The client is an expert in their own experience, and brings their own resources.
• The therapist should not have pre-conceived ideas about where the therapy is going.
• The overall aim is for the individual to attribute improvement in their problems to their own efforts, in collaboration with the psychotherapist.
• Therapy is not experienced as something that has been “done to” the client.
• Formulation – a unique map or hypothesis of presenting problems or situations which integrate information from assessments within a coherent CBT framework drawing upon theory and evidence based practice.
• Socratic dialogue/ guided discovery – is a style of questioning to both gently probe for people’s meanings and to stimulate alternative ideas. It involves exploring and reflecting on styles of reasoning and thinking and possibilities to think differently. CBT is not about trying to prove a client wrong and the therapist right, or getting into unhelpful debates – rather by skilfully collaborating, clients come to see for themselves (discover) that there are alternatives
• Homework – the client tries things out in between therapy sessions, putting what has been learned into practice. This is referred to as homework and sometimes includes behavioural experiments.

CBT Compared to other Modalities and Myths about CBT:

The cognitive and behavioural psychotherapies target problems in the here and now with much less therapeutic time devoted to experiences in early life.

The therapeutic relationship is seen as an essential ingredient but unlike other psychotherapies is not viewed as the main vehicle of change. Instead the focus is in collaborative working on jointly agreed problems.

The effectiveness of CBT is supported by evidence from randomised controlled trials (RCTs), uncontrolled trials, case series and case studies.

It is both highly structured (although always based on a formulation of the relationship between the client’s presenting problems and underlying cognitive and/or behavioural processes) and flexible due to the constant evaluation of the outcome of the interventions.

Cognitive therapists do not usually interpret or seek for unconscious motivations but bring cognitions and beliefs into the current focus of attention (consciousness) and through guided discovery encourage clients to gently re-evaluate their thinking.

It is a form of therapy that addresses problems in a direct and targeted way.

It focuses on a shared model of understanding, using a psycho-educational approach, open sharing of the formulation and teaching of self-evaluation and management skills.

Its potency as a model is shown by its increasing use and accumulating recommendation by a range of evidence-based guidelines.