What is cognitive behavioural therapy?

A brief guide to cognitive behavioural therapy: Background, information, and resources.

A background on CBT

CBT was developed by Aaron Beck in the 1960s. It was originally called cognitive therapy and used to treat depression. The basic premise of CBT is that our thoughts determine our behaviours. For example, clients with symptoms of depression may have negative thoughts about themselves, others, their experiences, and/or their future. These thoughts may lead to feelings of guilt, blame, and hopelessness, which may lead to behavioural patterns, such as isolating from others. CBT posits that we can change our behaviours by changing how we think. In fact, our thoughts, emotions, and behaviours can each influence and affect the other in the CBT model.

CBT for symptoms of depression may involve helping clients create distance from negative or ruminative thinking to develop more balanced thinking and restore client activity levels, engagement, and problem-solving skills.

How does CBT work?

CBT helps clients change thoughts, feelings, and behaviours by developing healthier thinking and/or behavioural patterns. It is an evidence-based therapy that replaces irrational thoughts with balanced ones through a cognitive restructuring process that builds new neural pathways. CBT can help clients gain insight into how their thoughts and behaviours may be contributing to their distress and encourages strategies to help clients respond to unhelpful thinking that may otherwise sustain or worsen their mental health. CBT can help clients with problematic thinking that may be automatic, assumed, or part of the core beliefs they hold about themselves, the world, and/or the future. Since behaviour is learned in the CBT model, it can also be unlearned for clients to make changes in problematic behaviours that may be excessive, deficient, and/or inappropriate. Clients may prefer exploring either cognitive or behavioural strategies first with their psychotherapist.

What does CBT involve?

CBT is a structured psychotherapy that is collaborative between the psychotherapist and client. It is problem-focused, present-oriented, and time-limited, with regularly scheduled appointments. Psychotherapists provide psychoeducation in CBT, such as teaching clients about cognitive distortions. CBT skills may include self-monitoring (through daily thought records), guided discovery (to evaluate thoughts), activity scheduling (to boost mood), and behavioural experiments (to challenge avoidance behaviours). Relaxation skills may be helpful for clients with more generalized anxiety, while imaginal exposure (imagining a trigger to fear until anxiety is decreased) may be useful for clients with unhelpful emotional imagery. Clients take an active role in CBT and practice skills between sessions and psychotherapists use assessment tools to monitor changes in client mood and behaviour.

Is CBT right for me?

CBT can help clients with many different concerns, such as issues with mood, anxiety, rigid thinking, problematic behaviours, and coping with physical health issues. Sometimes other psychotherapies may be better suited for clients. Since CBT emphasizes change, it may not be as helpful or appropriate for clients who are not seeking changes in their thinking or behaviour. Some clients may feel CBT reinforces feelings of invalidation and may prefer dialectical behavioural therapy (DBT), which emphasizes the dialectics of acceptance and change to help clients develop strengths. It's important to talk to your health care provider to determine if CBT is the right fit for you.

It can be difficult to reach out for professional support. If you are struggling with anxiety and want suggestions on what to discuss with your health care provider, this guide may be helpful. In Ontario, adults with depression and anxiety-related concerns can receive free CBT through the Ontario Structured Psychotherapy Program. Adults and youth ages 15 years old+ can access BounceBack Ontario, a free self-led CBT-based program with supportive coaching. You are welcome to book an appointment with me if you would like to start utilizing CBT strategies in therapy.