Cognitive Behavioural Therapy

What is Cognitive Behavioural Therapy? | How does it work? | Effectiveness of Cognitive Behavioural Therapy | What to Expect during Sessions? | FAQ

Cognitive Behavioural Therapy (CBT) is a form of psychotherapy that is based on the theory that how we make sense of a situation determines how we feel and behave. It operates on the principle that:  

1. How we feel (emotions) influences what we do and how we think.
2. What we do (behaviours) influence how we feel and think.
3. How we think (thoughts) influences what we do and how we feel. 

According to this theory, behind our longstanding problems or mental distress often lies vicious cycles of automatic unhelpful thoughts, coping behaviours, emotions, and bodily sensations that reinforce each other, causing further distress.

This sense of safety reinforces the escape behaviour. Over time, this person learns that avoidance will make them feel safe and thus the cycle is reinforced.  

Given that the thought-feeling-behaviour components are interdependent, the CBT modality focuses on intervening at either the thought or behavioural component to influence the trajectory of a person’s reaction to situations.

Psychological problems arise from unhelpful thoughts and behaviour learned over time that mutually influence how we act and feel. By learning helpful ways to reframe unhelpful thoughts, individuals learn to cope better with problems, which reduces distress and improves functioning [1]. CBT works to target presenting thoughts and behaviours through various strategies: 

Some techniques to change our thinking patterns include unpacking thoughts that may contribute to unproductive behaviours that cause distress.

CBT helps individuals identify triggers (e.g., meeting new people) that evoke a certain reaction (e.g., intense anxiety), which in turn results in certain behaviours (e.g., avoidance of tasks that require socialising). Recognising the thoughts behind this reaction (e.g., a fear of meeting new people due to previous negative bad experiences) helps individuals become aware of how unhelpful thought patterns influence their reactions.

CBT then introduces techniques to reframe these negative thought patterns into more positive and productive thoughts. For example, the therapist might facilitate the process of helping the client realise that their thought of “I will surely say something wrong and cause people to judge me” to “I will take time to build my social skills one step at a time”. 

This reduction of emotional intensity and reframing of thoughts positions the client to feel more empowered to behave differently and in turn, see different outcomes. In other words, CBT helps individuals learn to recognise dysfunctional thought patterns and develop more rational, grounded ways of understanding challenging situations [2].

There are techniques to change unproductive behaviour as well including:

• gradually exposing the client to their fear, which helps people systematically approach what they fear.  
• using role-play to prepare for difficult situations (e.g. having social anxiety when meeting someone new) so that the client will have techniques that they can rely on (things they can say, what should they do when they meet someone).
• learning skills to cope more healthily  (e.g. instead of giving up when stressed, break down tasks into smaller segments or try journalling). 

CBT is one of the most widely used modalities [3] given its demonstrated effectiveness  for a wide range of problems including, but not limited to [1]:

• Depression [4]
• Anxiety disorders [5] 
• Alcohol and drug use problems [6] 
• Eating disorders [7] 
• Obsessive-Compulsive Disorder (OCD) [5]
• Post Traumatic Stress Disorder (PTSD)
• Phobias 
• Insomnia [8]

In general, CBT can be tailored to the needs of the individual and used for all ages [9]. This makes it applicable to various conditions and can even be used with children. Additionally, CBT sessions are not limited to the therapy room. Since it has been found to be effective online or face-to-face, CBT can be conducted where the individual feels more comfortable [10]. CBT aims to equip clients with skills that they can use when they face difficult situations in the future. The skills learned can be incorporated into aspects of daily life even outside of therapy sessions [11].

To maximise effectiveness, therapists commonly assign clients some homework centred around skills application between sessions. Active participation from clients to be intentional in implementing the skills to their everyday routines is crucial before they are likely to see positive outcomes in having healthier automatic thought and behaviour patterns. 

It is also important to acknowledge that change takes time, thus progress might not be immediately apparent. Automatic negative thought patterns and behaviours are usually a result of deep-seated beliefs developed over a long period of time. One can expect to go through a process for them to unpack and unlearn existing habits. 

There is no one-size-fits-all approach as therapists tailor the CBT sessions to the individual’s needs. Since CBT aims to equip individuals with the necessary skills to navigate challenges in their life, CBT is applicable both for short- and long-term session commitments. After the initial assessment, your therapist would have a better idea of what you need in your CBT journey.

Usually, the first session will involve setting goals for therapy as well as finding out the reason for coming to therapy. This is to help the therapist gain a better understanding of your situation in order to better tailor the intervention to suit your needs. The therapist may ask about your background, like your relationships with family, friends or romantic ones, career or education.

Subsequently, the therapist will explore the issues that brought you to therapy. This process might involve identifying your thought processes and feelings towards the issue, and how you acted in that situation.

A typical session will involve agenda-setting for what you want to achieve through that session. Subsequently, the therapist will use different techniques to address any concerns you may have. Lastly, the therapist will review the session and assign any homework that might be helpful.