Cognitive Behavioral Therapy

Posted by Frank Gillespie MA

Cognitive Behavioral therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. CBT is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems as well. Research has shown that CBT can be as effective as medication in treating some mental health problems.

What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. It is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. Unlike some other talking treatments, CBT isn’t a therapy that delves into your past trying to find causes for your emotional distress and symptoms. It concentrates on how you feel now, and the difficulties and problems you face now, and the changes you can make that will help you to feel better now. The past is only important to understand how it influenced the current picture. CBT is a therapy that concentrates on the here and now.

What conditions does CBT help?

CBT is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems including eating disorders (such as anorexia and bulimia), obsessive compulsive disorder, panic disorder, some phobias, post-traumatic stress disorder, sleep problems (such as insomnia) and substance abuse problems (such as alcohol misuse).

Is CBT effective?

Research has shown that CBT can be as effective as medication in treating some mental health problems. It is one of the most effective treatments for anxiety or mild to moderate depression, but it usually needs to be given in combination with antidepressants if your mood is very low. In mild to moderate depression it is as effective as antidepressants. CBT can help you to take control of the depression however, CBT isn’t suitable for everyone, and it doesn’t work for everyone.

What are the advantages of CBT?

    • CBT may be helpful in cases where medication alone has not worked.


    • Compared to other talking therapies, CBT can be completed over a relatively short period of time, though longer periods are sometimes needed and maybe in conjunction with other psychotherapy methods.


  • CBT can be provided in different formats, including groups, self-help books and computer programs and is flexible in its approach.
  • CBT skills and strategies can be incorporated into your everyday life and can help you cope better with future stresses and difficulties.
  • You can continue to practice and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.

How does CBT work?

CBT involves a series of sessions that last for between 30 minutes to an hour where you talk to a trained therapist. It is a way of learning about how you think about yourself, the world and the people around you and how your thoughts and feelings are affected by what you do. Once you understand this, you can learn to make changes in the ways you think about situations and how you respond to them. The ‘Cognitive’ part of the therapy is about how you think about things, and the ‘Behavioral’ part is about what you do. So CBT is about changing the ways you think and how you act. After a while, these changes add up to make you feel better.

An example: depression and CBT

In depression, there is a vicious circle that connects your thoughts, emotions, physical feelings and actions. If a situation arises that you think about in a negative way, this is likely to make you feel even more depressed, perhaps give you a physical symptom like headache, which makes you feel worse still, and your response is to do nothing about it because your negative thoughts tell you there is nothing you can do about it. Interpreting the situation in such a negative way almost always leads you to jump to unrealistic and unhelpful conclusions.

This can lead to a downward spiral that creates new situations out of nothing that have the effect of making you feel even worse. You start to have unpleasant (and false) thoughts about yourself. The world seems over-demanding and even minor problems can seem overwhelming. CBT helps by teaching you how to break down these seemingly insurmountable problems into smaller parts. You can then see how these smaller parts are connected and how they affect you.

The smaller parts are:

    • A Situation – a problem, or something that happens that you find difficult or distressing. The situation causes you to have:


    • Thoughts – what you think about the situation. Is it overwhelmingly difficult or are you able to deal with it?


    • Emotions – how you feel about the situation. Does it make you feel good or does it make you feel bad?


    • Physical feelings – sometimes a difficult situation or emotional turmoil can cause physical feelings like dizziness, nausea, headache, shortness of breath, sweating, palpitations and so on. Does this situation make you have feelings like this?


    • Actions – what you do in response to the situation. Do you do something positive about it or do you just ignore it?


Each part can affect the others. How you think about a problem can affect how you feel physically and emotionally and what you do about it. Changing one or more of the parts can also change the others. So, if you change the way you think about a situation, or what you do about it, this can change your emotional and response as well. CBT helps you to break the vicious circle of negative thinking, feelings and behavior. When you see these parts separately, you can learn to change them – and so change the way you feel.

What does CBT involve?

The series of CBT sessions is intended to help you to learn how to change your thinking and behavior so that you can do it on your own, and work out your own ways of tackling your problems.

CBT can be done on a one-to-one basis, or with a group of people. It can also be done effectively over the internet through video sessions.

One-to-one therapy usually involves between 5 and 20 sessions, weekly, or fortnightly, with a therapist. A course of treatment could last anywhere from 5 to 40 weeks, depending on the circumstances. For the first few sessions, the therapist will check that CBT is suitable for you, and you will decide what problems you want to address in the short, medium and long-term. Sessions usually start by agreeing on what to discuss that day. Although CBT concentrates on how you feel now, at times you may need to talk about the past to understand how it has affected you, so the therapist may also ask you questions about things that have happened previously in your life.

Once you’ve identified the problems you want to work on, with help from the therapist, each problem is broken down into its separate parts, as in the example above. It helps if you keep a diary so you can learn to recognize your own ways of thinking and how this affects your emotions, how you feel physically and how you respond.

The therapist will help you to work through your thoughts, feelings and behavior to see whether they’re negative, and how they affect each other, and you. They will then help you find ways to change unhelpful thoughts and behaviors. For example, you will probably learn how to challenge a negative or upsetting thought and replace it with a positive one. Your therapist will help you to develop a range of positive thoughts that you can use.

This is much more difficult than it sounds, so to help you get into the swing of it, your therapist will suggest ‘homework’ which involves exercises where you practice these changes in your everyday life.

Finding a CBT therapist

If you are considering engaging in CBT you are in the right place. Our trained, professional therapists have plenty of experience in the area of CBT and they can help you to put you back in charge of your own life. We can help you with several mental health problems.

Also, there is always a risk that bad feelings you associate with your problem will return, but with your CBT skills it should be easier for you to control them. This is why it is important to continue practicing your CBT skills even after you are feeling better and your sessions have finished. ‘Refresher’ CBT sessions are also available if you feel you need to go through skills you have learnt again.

Frank Gillespie MA

Frank Gillespie has a Master's Degree in Counseling from LaSalle University in Philadelphia. He is a nationally Certified Counselor (NCC). He has provided therapy for over 23 years. During his career, he has helped more than 10,000 people move past their obstacles towards reaching their potential and fulfillment in their lives. He practices Cognitive Behavioral Therapy with a warm and nurturing approach. In addition to being a therapist, Frank has been an adjunct college professor teaching social work, a clinical consultant, a clinical director, and a seminar speaker. Frank has recently retired from his full time practice to focus on a part time online practice. He is married. He enjoys listening to music, watching sports, power walking, swimming, reading and writing.


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