CBT is a psychological therapy that works on the links between what we think, how we feel and what we do (including how we try to cope).

By identifying how our thoughts, beliefs, emotions and responses can lead to patterns such as feedback loops (e.g. vicious cycles), CBT aims to facilitate our understanding of our distress, resolve unhelpful thoughts and ideas we might have, and lead to more effective coping.

CBT is an evidence-based therapy which is now widely-used in the NHS. It is recommended by NICE (the National Institute for Health & Care Excellence) for difficulties including depression, anxiety disorders including phobias and panic, PTSD (Post-Traumatic Stress Disorder) and OCD (Obsessive Compulsive Disorder) as well as having applications in physical health conditions including for chronic pain and IBS (Irritable Bowel Syndrome).

CBT is a collaborative form of therapy - therapist and client work together and may use structured approaches such as questionnaires and flow-charts to work out what patterns might be playing out in certain situations and how to change them.

CBT is an active approach to therapy which ultimately aims to help clients become their own self-therapist and feel confident coping in positive new ways. Often, “therapeutic homework” is agreed between sessions so that new ideas can be tried out and any arising problems can be solved together in sessions.

Usually in CBT, sessions will start with “checking in” – finding out how you have been since the last session and how any homework went - before setting an agenda for the session, working on agreed goals and agreeing next actions.

CBT usually starts with a focus on here-and-now experiences – making sense of current patterns and finding strategies to cope effectively with arising concerns and situations. However, CBT can be used to explore deeper-rooted beliefs and ideas that might have arisen from life events including both recent and early experience.

Specially-adapted versions of CBT can often be used with children, adolescents and families – frequently alongside other approaches. It is important that any approach to therapy with children and adolescents takes into account their stage of psychological development, individual needs and wider situations (including with family, school, peer-groups and wider community).

Adolescents are more likely to access individual CBT sessions as part of their treatment than young children, but everyone is different and the overall therapy plan is carefully tailored to the needs of the person, family and situation.

Family-based CBT

Sometimes CBT-based approaches are used in a family setting or with a parent or carer and their child working and learning together – which can be empowering for parents/carers as well as powerfully supportive for children and adolescents.

Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is a form of CBT specifically adapted to treat PTSD (Post-Traumatic Stress Disorder). It is one of the evidence-based therapies recommended by NICE (the National Institute of Health & Care Excellence) for PTSD.

Trauma-Focused CBT takes into account how our brains respond differently to traumatic memories compared with more routine memories. Commonly, the very strategies we have all evolved to survive dangerous situations can interact with the sides of the human mind that seek to make rational sense out of what has happened later on - and these processes can sometimes get us “stuck”. For example, feelings of overwhelm or self-blame can make it harder for our brains sort through traumatic memories and for us to feel like we have come to terms with events and are able to live our lives as we wish.

Carefully supported steps to recovery

Trauma-Focused CBT has a number of steps and stages that can be helpful in building a sense of safety and stability, understanding what can lead our minds to get “stuck” when dealing with traumatic experiences, having carefully supported opportunity to sort through memories in a manageable and healthy way, and finding ways put difficult memories “in their rightful place” so you can move on or even grow from past experiences

Since it was first developed in the 1960s, CBT has gone through a number of developments. In general, earlier models of CBT (referred to as the “first wave”) tended to focus more on trying to correct unhelpful behaviours and unbalanced patterns thinking (such as all-or-nothing thinking).

Later “second wave” CBT approaches tended to place more emphasis on understanding how negative cognitions (thoughts, interpretations and beliefs) could arise from and be activated by life events and situations - leading to distress and prompting behaviours (attempts to cope) which might inadvertently get into feedback loops.

Many CBT approaches to specific difficulties developed from the idea that re-evaluating and re-balancing unhelpful patterns of thought would alleviate distress, and many of these approaches remain widely-used and continue to show strong evidence of effectiveness. But as psychological research has progressed, it seems CBT might work slightly differently than first thought.

Caring for ourselves with our thoughts and emotions

Rather than simply replacing negative cognitions with more balanced or positive ones, it is now thought that CBT works – at least in part – by changing our relationship to our thoughts, ideas and beliefs (you can find recommended reading about John Teasdale’s work on this in Resources). More recent “Third Wave” approaches to CBT tend to view “negative”, disturbing and upsetting thoughts and emotions as normal, but refine our capacity to take care of ourselves when we have these very human experiences.

The Third Wave CBT therapies include Compassion-Focused Therapy (see below), Acceptance & Commitment Therapy (ACT) and Mindfulness-Based approaches.  

Compassion Focused Therapy (also known as the Compassionate Mind Approach) is relatively new approach to therapy first developed by Professor Paul Gilbert (see Resources for links to more information).

The model is based on the idea that, in modern life, our brains and nervous systems spend a lot of time being pushed to strive towards goals or react to threat of some sort. But often the side to human nature which is compassionate, connects with others and seeks to soothe and help in times of distress can be end up under-developed or under-utilised – especially when we need to be compassionate towards ourselves during periods of distress.

Compassion-Focused practices foster mindsets to help increase our sense of compassion for ourselves, for others and from others. These practices can be particularly helpful during periods of stress, hardship, and burnout (including caregiver burnout), or when dealing with trauma and feelings of shame, and can be used with individuals, families, professionals and groups, as well as integrating well alongside other approaches such as EMDR and ecotherapy.