Cognitive Behavioural Therapy (CBT) – what it is and how it works

Cognitive behavioural therapy, commonly referred to as CBT, is one type of psychotherapy which can be utilised to address a wide range of mental health challenges including depression, anxiety, panic, OCD, PTSD, eating disorders and specific phobias (APS, 2018). It is also one of the most commonly studied forms of psychological treatment, and is influenced by both behavioural therapy and cognitive therapy. A CBT approach may be adjusted depending on the problem being treated, however, the basic principle of the treatment remains the same – our behaviours, feelings and thoughts are all linked in an interacting system which influences and impacts on wellbeing (IQWiG, 2006).

What is behavioural therapy (BT)?

BT has its’ roots in behaviourism, which is a theory which states that behaviour is learned, and therefore can be changed. Behaviour therapy helps people to identify whether particular patterns of behaviour are having a negative impact on their life or if these patterns are causing them problems. From here, the therapist will work with the person to learn different behaviours and change the current behavioural patterns.

What is cognitive therapy (CT)?

CT encourages a person to become the observer of their thoughts and get a clear understanding of their attitudes and expectations, with the goal being to identify any beliefs that may be resulting in distress or that are false. An example of a thought pattern which is false may be the tendency of someone to immediately jump to worst case scenario when something doesn’t quite go to plan, not being able to rationally consider other possible options. Another example may be when someone only recognises the negative aspects of a situation without giving any consideration to the positives of the situation. CT aims to help people recognise these thought patterns and replace them with more realistic and helpful thoughts.

Cognitive Behavioural Therapy (CBT)

So based on the above, when we talk about CBT, we are referring to the combination of both behavioural and cognitive therapy. As mentioned above, the central premise of this type of therapy is that behaviour, thoughts and feelings interact and influence wellbeing. CBT focuses on the problem/s the person is currently facing and looks for solutions to these problems. CBT does not address the past. While it acknowledges that the past influences the present, the focus is on solving current problems rather than unpacking the past. And for this reason, CBT is not for everyone – but that is true for all types of therapy, and why it is important to speak with a mental health professional to decide what will be the most helpful for you.

If we look at anxiety through a CBT lens, we can see how it works. Say someone goes to see a therapist as they are finding it difficult to go out and socialise and they want to change this. First, the client will identify a situation, such as being invited to a friends’ party. Next, they recognise that a thought pops up about the situation, such as “party, that means there will be lots of people there and I will have to socialise, I really don’t like socialising”. Next, they notice is a feeling or two that comes with the thought, such as worry, fear, and they may also experience physical sensations such as nausea, or racing heart. And finally, they have a behavioural response to the thoughts and feelings, such as avoidance, declining the invitation, or accepting with no intention of actually showing up. As can be seen, when it’s broken down into these steps, it can be helpful in identifying the patterns of thoughts and behaviours, providing the basis for the therapy work. From here, a person will work with their therapist to identify the types of thoughts that are occurring such as automatic thoughts, negative automatic thoughts, core beliefs and underlying assumptions. A CBT therapist may refer to these as levels of cognition and will work through a number of different strategies to help identify these (Kennerley et al., 2017).

What types of strategies are there?

There are many different strategies a therapist might use in CBT. Here’s a short list of a few:

Challenging thoughts – in order to challenge thoughts, first you need to know what the thoughts are, so to capture these, you may be asked to complete a thought log or a thought diary. When thoughts are challenged, there are a few questions that are asked when the thought arises to test how true the thought is, and determine whether there is any evidence to support the thought. Recording thoughts will identify any negative automatic thoughts and/or unhelpful thinking styles.

Distraction – this can be useful to help break out of the cycle of getting caught up in negative thoughts and/or urges. The mind can only concentrate on one thing at a time. Different distraction techniques can include exercise, refocusing, doing mental exercises and counting thoughts.

Grounding strategies – these are like distraction techniques however the intention with these strategies is to ground someone back to the present, or to a pleasant or comfortable place during times of distress.

Behavioural activation – this strategy can be helpful to spark reengagement with activities that someone once felt a sense of achievement from or that was pleasurable to them in the past.

CBT focuses on strategies that are active and problem-focused. The therapist works collaboratively with each person to guide them to become problem-solvers in their own lives. CBT is a time-limited therapy where the goal is to help someone learn the skills to apply not only during session but also in the future if they experience emotional distress again.

Where to from here?

If you are finding that your emotions seem to be in control of you, speaking with a registered health professional can be a helpful first step. They can provide an assessment and discuss evidence-based treatment options tailored to your needs.

Disclaimer: This article is for general educational purposes only and is not a substitute for personalised psychological or medical advice. If you are concerned about your mental health, please seek support from a qualified health professional.

REFERENCES

Australian Psychological Society. (2018). Evidence-based psychological interventions in the treatment of mental disorders: a literature review (4th ed.). Australian Psychological Society.

Institute for Quality and Efficiency in Health Care (IQWiG).( 2006). In brief: Cognitive behavioral therapy (CBT) [Updated 2025 Aug 21]. InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK279297/

Kennerley, H., Kirk, J., & Westbrook, D. (2017). An introduction to cognitive behavioural therapy (3rd ed.). Sage Publications Ltd.

Wenzel A. (2017). Basic Strategies of Cognitive Behavioral Therapy. The Psychiatric clinics of North America, 40(4), 597–609. https://doi.org/10.1016/j.psc.2017.07.001