What is Cognitive Behavioural Therapy?

If you’re feeling anxious, down or stressed out then Cognitive Behavioural Therapy (CBT) could be the answer. CBT offers a structured, effective and practical approach to overcoming mental health challenges. In fact, CBT has one of the best track records for improving anxiety, depression and other mood disorders.

CBT is a goal-oriented, short-term therapy that aims to change unhelpful thoughts and behaviours in order to improve feelings and behaviours that are causing distress. It is based on the idea that thoughts, feelings and behaviours are interconnected and impact each other. Unlike talking-based therapies, this approach offers practical skills to cope with your current problems and to learn how to cope better in the future.

The main idea behind CBT is that the way we think about a situation will create a feeling that then provokes a behavioural response from us. For example, Ari has a fear of dogs. When Ari sees a dog (situation) he thinks “That dog will bite me!” (thought). He then feels scared (feeling) and runs away (behavior). In this example, the assumption is that Ari’s fear of dogs and response of running away is due to the belief that the dog will bite him. So how to help Ari?

Using a CBT model a therapist would work with Ari on strategies that are designed to disrupt the cycle between thoughts, feelings and behaviours. These strategies usually involve two key elements: cognitive restructuring and behavioural change.

Cognitive Restructuring

The goal of cognitive restructuring is to transform unhelpful or distressing thoughts into more helpful ones. But this strategy is not about “positive thinking”. Rather, it’s about training your mind to notice when your thoughts are unhelpful and how this makes you feel and act. CBT skills then teach you how to use evidence and logic to find a better way of thinking about a situation.

In Ari’s fear-of-dogs case, a therapist would help him to develop a more helpful, rational thought when he sees a dog. This new thought might be “That dog is unlikely to bite me, I am safe.” Ari would then need to try to find evidence to support this. That evidence may be that the dog is on a leash and that no one else is running away from the dog. This new thought would cause Ari to feel less scared and to change his response (i.e., not run away from the dog). Ari would be encouraged in therapy sessions to pay attention to unhelpful thoughts and to replace these with logical, realistic thoughts that help him feel less anxious.

Behavioural change

At times, CBT will focus on changing behaviour as well as changing unhelpful thoughts. These behavioural changes may involve exposure to situations that you have been avoiding, breathing techniques and relaxation strategies. For example, a CBT therapist might encourage Ari to stand closer to a dog each time he sees one with the goal of petting it. Each time he is not bitten by a dog is proof against the initial unhelpful thought (“That dog WILL bite me!”). This will help Ari to prove to himself that dogs will not necessarily bite him and eventually lead him to overcome his fear of dogs.

Another behavioural strategy you might use in CBT is called ‘behavioural activation’. Simply put, this strategy aims to encourage you to engage in helpful behaviours in order to improve your mood and is often used in cases of depression. Behavioural activation involves setting and achieving specific goals that make you feel successful and happy. In this strategy it is the behavioural change that impacts upon the thoughts and feelings in order to disrupt the unhelpful cycle and improve your mood.

As a practical and evidence-based therapy, CBT teaches you skills to change unhelpful thoughts and behaviours and to reduce the intensity of difficult emotions. By addressing the connection between thoughts, emotions, and behaviors, CBT empowers you to take control of your mental health,  learn to cope better with current and new situations and help you to live a better, healthier life.