What Is Cognitive Behavioural Therapy (CBT)

If you have looked for information about psychotherapy, you have very likely come across the initials CBT. Cognitive behavioural therapy is one of the best known and most studied psychological approaches, and it is often recommended for issues such as anxiety, low mood or certain habits that cause distress. But what does it really involve and how can it help you?

In this article we explain in simple terms what cognitive behavioural therapy is, what it is based on, how it is worked on in session and what you can expect if you decide to begin a process of this kind.

What cognitive behavioural therapy is

Cognitive behavioural therapy is a psychological approach that starts from a central idea: what we think, what we feel and what we do are deeply connected. According to this model, it is not events in themselves that determine how we feel, but largely the interpretation we make of them.

Two people can go through the same situation, for example a friend not replying to a message, and feel very differently. One may think they must be busy and stay calm; another may think I have probably annoyed them and feel anguish. CBT works precisely on that layer of interpretations and on the behaviours that follow from them.

The triangle of thought, emotion and behaviour

One of the pillars of cognitive behavioural therapy is understanding how three elements are related:

• Thoughts: what we tell ourselves in a given situation.
• Emotions: what we feel as a result of that interpretation.
• Behaviours: what we do or do not do as a consequence of all this.

These three elements influence one another, forming a circle. A negative thought creates an unpleasant emotion, which in turn leads to a behaviour (for example, avoiding a situation), and that behaviour usually reinforces the original thought. CBT seeks to identify that circle and learn to intervene in it in order to break it.

How CBT works in practice

One of the features of cognitive behavioural therapy is that it tends to be structured, practical and focused on concrete goals. Instead of focusing only on the past, it pays close attention to what is happening in the present and to what can be changed now.

Although each process is different, some common elements are:

• Defining clear goals: at the start you agree on what you want to work on and what you hope to achieve.
• Identifying thought patterns: learning to spot those automatic thoughts that appear almost without our noticing.
• Questioning and loosening: examining whether those thoughts are realistic or useful and looking for alternative ways of seeing the situation.
• Changing behaviours: proposing small experiments and changes in behaviour to see their effects.
• Practising between sessions: it is common for exercises to be suggested for everyday life, because change is consolidated through practice.

This way of working turns the person into an active agent in their own process. It is not only about talking in session, but about taking what you learn into real life.

Some common CBT techniques

To make it clearer, these are some of the tools that tend to be used within this approach. They are not all applied, nor in every case; they are chosen according to what each person needs:

• The thought record. Noting down the situation, the automatic thought, the emotion and a more realistic alternative. It helps you see in writing what the mind does very quickly.
• Cognitive restructuring. Questioning a thought with questions such as: what evidence do I have that this is so? Is there another way of seeing it? What would I say to a friend in my place?
• Gradual exposure. Approaching little by little what you fear and avoid, in manageable steps, to see that anxiety comes down over time.
• Behavioural activation. Recovering rewarding activities in a planned way when your mood is low, without waiting to feel like it.
• Problem-solving training. Learning an orderly method for facing difficulties instead of going round and round over them.

These techniques are learned in session and practised outside it, so that the person gradually gains autonomy and resources of their own.

What a CBT session is like

Many people arrive with doubts about what they will find. Although each professional has their own style, a session of cognitive behavioural therapy usually has a certain structure: you review how the week has gone and the exercises suggested, you work on a specific topic agreed between you both and you close with some suggestion for the days ahead.

It is not an interrogation or a lecture. It is a space of collaboration where the psychologist brings knowledge and method, and the person brings their experience and their knowledge of themselves. The bond of trust between the two is as important as the techniques; without it, no tool works well.

What it can help with

Cognitive behavioural therapy has been applied to a wide variety of psychological difficulties. It is often used to support situations such as:

• States of anxiety and excessive worry.
• Low mood and lack of motivation.
• Specific fears and situations that are avoided.
• Difficulties managing stress.
• Patterns of self-demand and very rigid thinking.

It is worth remembering that no approach is a magic formula, nor does it work the same for everyone. A good therapeutic process adapts to each person and often combines tools from different models. If you are considering starting, you can see our services to learn how we work.

What cognitive behavioural therapy is NOT

Some mistaken ideas circulate around CBT that are worth clearing up:

• It is not about thinking positive. It is not about repeating optimistic phrases to yourself, but about learning to think in a more realistic and flexible way.
• It does not ignore emotions. On the contrary, it keeps them very much in mind and seeks to understand them, not to cover them up.
• It is not quick advice. It requires work, practice and a relationship of trust with the professional who accompanies you.
• It does not deny the importance of the past. Although it focuses on the present, it takes each person's history into account in order to understand where certain patterns come from.

Understanding what it is and what it is not helps you approach therapy with realistic expectations and make the most of it.

An example to make it clear

Imagine a person who is very afraid of speaking in public. Every time they have to present something at work, they think I am going to look terrible, they are going to notice how nervous I am. That interpretation triggers anxiety, and to calm it they start avoiding any situation in which they have to speak in front of others.

From cognitive behavioural therapy, you would work on several fronts at once:

• The thought: you examine that idea that they will look terrible. What real evidence is there? What has happened other times? Would it really be so bad to seem nervous?
• The emotion: you learn strategies to regulate the activation, such as breathing or managing attention.
• The behaviour: instead of continuing to avoid, gradual approaches are proposed, starting with more manageable situations, so that they see from their own experience that they can face it.

Over time, by facing things little by little and reviewing their interpretations, the anxiety tends to come down and the person recovers situations they had given up. This example illustrates how thought, emotion and behaviour are worked on together, not separately.

How it differs from other approaches

There are many valid psychological approaches, and none is the only correct one. Knowing the differences helps you understand what to expect from CBT compared with other options:

• Compared with approaches focused on the past, CBT places more emphasis on the present and on what can be changed now, even though it takes personal history into account.
• It is a structured, goal-oriented approach, which provides a clear road map, as opposed to more open and exploratory models.
• It gives a lot of importance to practice, with exercises between sessions, whereas other approaches work more through conversation within the session.

In practice, many professionals integrate tools from different models and adapt the work to each person. What matters is not the label of the approach, but that it fits what you need and that you feel supported. You can learn how we work in our services.

How to get more out of therapy

The outcome of a therapeutic process does not depend only on the professional, but also on the person's involvement. These attitudes tend to help you make the most of it:

• Being honest, even when it is hard. The more real what you share is, the better you can be helped.
• Doing the exercises suggested, because change is consolidated by practising outside the session.
• Being patient, understanding that progress is sometimes slow and not linear.
• Raising your doubts, even if something about the process does not convince you. Adjusting as you go is part of the work.

Therapy is a space of collaboration. Arriving with a willingness to take part, and not only to receive solutions, makes a big difference to the results.

Frequently asked questions about CBT

How long does a CBT process last?

Cognitive behavioural therapy is usually set up as a relatively structured process, but its length depends on each person and on the situation being worked on. Some processes are shorter and others need more time. It is something that is assessed and reviewed throughout the support.

Will I have to do homework?

Yes, usually. Exercises between sessions are an important part of this approach, because change is consolidated by practising in real life, not only by talking in session. They are always agreed realistically and adapted to you.

Does CBT work if I do not know exactly what is wrong?

Yes. You do not need to arrive with a diagnosis or to know everything. Part of the initial work is precisely to understand together what is happening and what is worth focusing on.

How to know if it is for you

The best way to know whether cognitive behavioural therapy fits what you need is to talk it over with a psychologist. In a first assessment, your specific situation can be looked at and the most suitable approach proposed, which may be CBT, another model or a combination of several.

If you feel that certain thoughts or behaviours are limiting you and you want concrete tools to change them, this kind of therapy can be a good starting point. You can download our free guides to start getting familiar with some of these ideas or, if you prefer, book a consultation and tell us what is worrying you. We will be glad to accompany you in the process.