Cognitive Behavioural Therapy (CBT): What is it and how does it work?

Throughout decades different types of therapy have emerged. From art therapy to narrative exposure therapy to cognitive behavioural therapy. In this article, we will explore what is cognitive behavioural therapy, its history, what it is, how does it work, its phases, and who can benefit from this type of therapy. Keep reading to find out more. 

History of Cognitive Behavioural Therapy

We can’t start explaining what is cognitive behavioural therapy without going all the way to its roots. This therapy branches from behaviour therapy and cognitive therapy.

Cognitive Behavioural Therapy takes a lot from behaviour therapy in the early 20th century. With the development of experimental psychology and Pavlov’s conditioning theories, authors like Wolpe and John Watson began exploring its effects on humans. In turn, these authors inspired Hans Eysenck and Arnold Lazarus to start developing new therapy techniques based on behaviour. It was, in fact, one of Eysenck’s colleagues that managed to discover that fear conditioning in humans could be controlled by verbally induced cognitive expectations. This opened researchers to the idea that humans were not mere responses to stimuli but something more might interact. Later, around 1950s Albert Bandura introduced their work on social learning theory by demonstrating the effects of cognition on learning and behaviour modification.

Cognitive therapy started with Alfred Adler and his notion of how basic mistakes contributed to unhealthy behaviours. This inspired Albert Ellis to create his rational emotive behaviour therapy. This lead Aaron Beck to notice in his practice that some types of thinking might be responsible for emotional distress becoming later what is known as cognitive therapy.

The competition between the two therapies reached a halt when they decided to combine both and create Cognitive Behavioural Therapy. The first trials were done to treat the panic disorder with incredible success. Cognitive Behavioural Therapy became the main term for all cognitive-based psychotherapies.

What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy or CBT is a psychosocial intervention that has the most evidence in practice for improving mental health. Its focus is for the person to develop coping strategies that help them solve problems or harmful patterns of cognitions, behaviours, and emotion. This therapy focuses mainly on thoughts, beliefs, and attitudes as well as emotional regulation.

Cognitive Behavioural Therapy is based on problem-solving and it is action oriented. This means that the therapist’s role is to help the patient find and practice effective strategies to reach their therapy goals and help decrease the symptoms that led them there in the first place. It is based on the premise that psychological disorders are perpetuated through thought distortions and maladaptive behaviors. These psychological disorders generate a lot of discomforts which can be treated by teaching the person new cognitive processing skills and coping mechanisms.

CBT establishes that the event doesn’t affect us directly but rather the thoughts that we have about the event. If our thoughts are too negative, it can generate discomfort and make it difficult to see other solutions or aspects of the situation. So, we continue to hold on to the same old thoughts and fail to learn anything new.

Therefore, the main idea is that by changing thought process the behaviour and emotion will in turn also change. Nonetheless, other therapists establish that changing the aspect that is hurting the most will also help change the rest.

Kanfer and Saslow developed basic steps in Cognitive Behavioural Therapy assessment. They are are:

1-Identify critical behaviours

2-Determine whether critical behaviours are excesses or deficits

3-Evaluate critical behaviours in terms of frequency, duration and intensity (baseline).

4-If its excesses then decrease if deficits then increase.

They included that patients should challenge their patterns and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior”

The errors they refer to are called cognitive distortions similar to cognitive biases. Cognitive Behavioural Therapy is meant to help the patients have a more mindful and open posture toward these distortions that way it might be easier to diminish the impact on their lives. 

Modern forms of CBT include a variety of diverse but related techniques such as exposure therapy, stress inoculation, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy.

Phases of Cognitive Behavioural Therapy

• Phase 1: Assessment
• Phase 2: Reconceptualization
• Phase 3: Skills acquisition
• Phase 4: Skills consolidation and application training
• Phase 5: Generalization of the skills and maintenance
• Phase 6: Post-treatment and follow-up

Phase 2 is the most important phase for Cognitive Behavioural Therapy where techniques such as relaxation, biofeedback, coping strategies, goal setting, etc. are most used. All these phases are time limited and meant to be brief and direct unlike other therapies in psychology. Cognitive Behavioural Therapy can be used in both individual and group settings and all the techniques can be adapted to any setting.

What to expect in a Cognitive Behavioural Therapy?

Patients attend one session per week, each session lasting approximately 50 minutes. At the beginning of the therapy, the client meets the therapist to describe specific problems and to set goals they want to work towards. These goals will become the main focus when planning the content of each session and what will be discussed. At the beginning of the session, together with your therapy, you will decide what topics you want to discuss and work on that week, as well as conclusions from the week before. Homework is common when engaging in cognitive behavioural therapy. It might consist in a diary of things that might increase symptoms of sadness, low self-esteem, or a thought diary throughout the day, etc. These will be discussed in the therapy session so that new cognitive processing skills or emotional processing can be learned in order to tackle the problem.

The first sessions tend to be very structured and guided by the therapist. When the patient has a grasp on how it works things start to flow easier without the full structure. This, in turn, helps the patient feel empowered to continue working independently.

Who can benefit from Cognitive Behavioural Therapy?

Since Cognitive Behavioural Therapy works through focus and specific goals, it can work for anyone who wants to change a particular aspect of their life. For example:

• Anger management
• Anxiety and Panic attacks
• Child and Adolescent problems
• Chronic Fatigue Syndrome
• Chronic Pain
• Depression
• Drug or Alcohol problems
• Eating Problems
• General Health Problems
• Habits (Facial Tics)
• Mood Swings
• Obsessive Compulsive Disorder
• Phobias
• Post-Traumatic Stress Disorder
• Sexual and Relationship Problems
• Sleep Problems

It has been discovered that people who are medicated can also benefit from Cognitive Behavioural Therapy. Cognitive behavioural therapy (CBT) can reduce symptoms of depression in people who fail to respond to drug treatment, says a study in the Lancet.

Is it possible to learn some Cognitive Behavioural Techniques?

Since CBT has a highly educational component, there are several reading materials that might be useful. These have been seen as self-help literature but with a scientific background, even though scientists have yet to prove if they are really helpful.

For depression, it is known that the Feeling Good Handbook has been found effective. This might be useful for other problems as well, however, it might depend on the severity of the issue.

Hope you enjoyed this article and please feel free to leave a comment below!

Alejandra Salazar

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.