Cognitive Behavioural Therapy (CBT)

CBT is a form of talking therapy that focuses on both cognitions (what we think) and behaviours (what we do).

Developed in the 1960s by Dr Aaron Beck, it revolutionised the way we treat common mental health conditions, such as depression and anxiety. While researching depression, Dr Beck discovered his patients experienced negative automatic thoughts (NATs) that he could group into three categories:

Following this discovery, he created a new form of therapy that helped people develop skills to challenge these negative beliefs and change their behaviour. This therapy is what we now know as CBT.

CBT is structured around the cognitive triangle, which proposes that our thoughts, feelings and actions are all connected. According to this triangle, we can change how we feel by modifying our thoughts and our behaviour.

In line with this theory, CBT consists of two components:

Most of our thoughts happen involuntarily. We don’t consciously decide what we’re going to think — the thoughts just happen. They occur from the moment we wake up in the morning until we fall asleep at night.

These automatic thoughts may be positive, negative, or neutral. However, if you’re living with a mental health condition, many of these thoughts will likely be negative.

One of the goals of CBT is to help you identify these negative automatic thoughts and challenge them. Your therapist may encourage you to think about evidence that either proves or disproves the beliefs, or to provide alternative explanations.

For example, people living with contamination OCD may perceive an everyday event — like eating in a restaurant — as life-threatening. CBT would help this person evaluate and challenge this thought, replacing it with a more realistic alternative.

Although this sounds simple, challenging automatic thoughts is far from easy if you tackle it alone. Our CBT therapists can guide you through the process, ensuring progress while moving at a pace that works for you.

As well as working on your thoughts, CBT aims to modify behaviour. How this works depends on your condition and your circumstances, but can include:

CBT has been tested with a wide variety of mental health conditions and psychological challenges.

Here are some of the most common applications:

Dr Beck originally developed CBT to treat depression. Sixty years later, it’s still the most widely used form of therapy for the condition.

As well as helping people with depression challenge their negative thoughts, CBT can help them to make manageable behavioural changes to improve their functioning. For example, people living with depression often find it hard to take care of themselves, so CBT may focus on building health behaviours.

Science supports the use of CBT for many anxiety disorders, including generalised anxiety disorder, phobias and panic disorder. People with anxiety often experience specific automatic thoughts, such as catastrophising — putting all their focus on the worst-case scenario.

CBT helps people with anxiety challenge these thoughts, as well as encouraging them to expose themselves to their triggers so they can learn to face their fears and thrive, despite their feelings of anxiety.

CBT is often used as a first-line treatment for bulimia nervosa and binge eating disorder, with strong evidence to support its use for these conditions.

Therapists help people living with these conditions understand the links between thoughts about their body, their behaviours (i.e. binging and/or purging), as well as their emotions.

The cognitive component helps individuals address the concerns they have about their body. In contrast, the behavioural component helps them to modify their eating and compensatory behaviours.

CBT helps people with low self-esteem by challenging the critical thoughts they have about themselves. Using a variety of techniques, the therapist can teach individuals to replace these thoughts with more realistic ideas to change the distorted beliefs they hold about themselves and the world around them.

Also, many people with low self-esteem struggle to live a fulfilling life, allowing their self-doubt to prevent them from pursuing their goals. CBT can help people with this, encouraging them to take action despite their low self-esteem levels.