Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) is an effective treatment approach for a
range of mental and emotional health issues, including anxiety and
depression. CBT aims to help you identify and challenge unhelpful thoughts
and to learn practical self-help strategies. These strategies are designed
to bring about immediate positive changes in your quality of life.

CBT can be good for anyone who needs support to challenge unhelpful
thoughts that are preventing them from reaching their goals or living the
life they want to live.

CBT aims to show you how your thinking affects your mood. It teaches you to
think in a less negative way about yourself and your life. It is based on
the understanding that thinking negatively is a habit that, like any other
habit, can be broken.

The main focus of CBT is that thoughts, feelings and behaviours combine to
influence a person’s quality of life. For example, severe shyness in social
situations (social phobia) may come from the person thinking that
other people will always find them boring or stupid. This belief could
cause the person to feel extremely anxious in social situations.

This could lead to certain behaviour in social situations, such as
trembling, sweating, accelerated heart rate or other uncomfortable
symptoms. The person could then feel overwhelmed with negative emotions
(such as shame) and negative self-talk (‘I’m such an idiot’). Their fear of
social situations could become worse with every bad experience.


CBT aims to teach people that it is possible to have control over their
thoughts, feelings and behaviours. CBT helps the person to challenge and
overcome automatic beliefs, and use practical strategies to change or
modify their behaviour. The result is more positive feelings, which in turn
lead to more positive thoughts and behaviours.

CBT focuses on changing unhelpful or unhealthy thoughts and behaviours. It
is a combination of two therapies: ‘cognitive therapy’ and ‘behaviour
therapy’. The basis of both these techniques is that healthy thoughts lead
to healthy feelings and behaviours.

Cognitive therapy

The aim of cognitive therapy is to change the way a person thinks about an
issue that’s causing concern. Negative thoughts cause self-destructive
feelings and behaviours. For example, someone who thinks they are unworthy
of love or respect may feel withdrawn in social situations and behave
shyly. Cognitive therapy challenges those thoughts and provides the person
with healthier strategies.


Many techniques are available. One technique involves asking the person to
come up with evidence to ‘prove’ that they are unlovable. This may include
prompting the person to acknowledge the family and friends who love and
respect them. This evidence helps the person to realise that their belief
is false. This is called ‘cognitive restructuring’. The person learns to
identify and challenge negative thoughts and replace them with more
realistic and positive thoughts.

Behaviour therapy

The aim of behaviour therapy is to teach the person techniques or skills to
alter their behaviour. For example, a person who behaves shyly at a party
may have negative thoughts and feelings about themselves. They may also
lack social skills.


Behaviour therapy teaches the person more helpful behaviours. For example,
they may be taught conversational skills that they practise in therapy and
in social situations. Negative thoughts and feelings reduce as the person
discovers they can enjoy themselves in social situations.

The details of treatment will vary according to the person’s problem.
However, CBT typically includes the following:

• assessment – this may include filling out questionnaires to help you
  describe your particular problem and pinpoint distressing symptoms. You
  will be asked to complete forms from time to time so that you and your
  therapist can plot your progress and identify problems or symptoms that
  need extra attention
• personal education – your therapist provides written materials (such as
  brochures or books) to help you learn more about your particular
  problem. The saying ‘knowledge is power’ is a cornerstone of CBT. A
  good understanding of your particular psychological problem will help
  you to dismiss unfounded fears, which will help to ease your anxiety
  and other negative feelings
• goal setting – your therapist helps you to draw up a list of goals you
  wish to achieve from therapy (for example, you may want to overcome
  your shyness in social settings). You and your therapist work out
  practical strategies to help fulfil these goals
• practise of strategies – you practise your new strategies with the
  therapist. For example, you may role-play difficult social situations
  or realistic self-talk (how you talk to yourself in your head) to
  replace unhealthy or negative self-talk
• homework – you will be expected to actively participate in your own
  therapy. You are encouraged to use the practical strategies you have
  practised during the course of your daily life and report the results
  to the therapist. For example, the therapist may ask you to keep a
  diary.

Medication is not always needed. CBT can be as effective as medication in the treatment of depression and anxiety. In other cases, you and your therapist may decide that medication, together with CBT, would produce the best results. For example, people with bipolar disorder usually benefit from medication that helps control their mood swings.

Before choosing CBT, issues you may like to consider include:

• CBT may not be the best form of therapy for people with any type of brain disease or injury that impairs their rational thinking.
• CBT requires you to actively participate in treatment. For example, you may be asked to keep detailed diaries on thoughts, feelings and behaviours. If you are not prepared to put in the work, you may be disappointed with the results of CBT.
• CBT involves a close working relationship between you and your therapist. Professional trust and respect is important. If you don’t like the therapist at the first interview, look for another one.
• While CBT is considered a short-term form of psychotherapy, it may still take months or longer for you to successfully challenge and overcome unhealthy patterns of thinking and behaviour. CBT may disappoint you if you are looking for a ‘quick fix’.