CBT is an evidence based, structured, short term, time-sensitive and present oriented psychotherapy approach. It can be used with individuals or groups. The cognitive model proposes that unhelpful thinking patterns influence a person’s mood and behaviour, if changed or modified this can result in improvement to the person’s mood and bring changes to their behaviour. The way individuals perceive a situation is more closely connected to their reaction than the situation itself. Individuals’ perceptions are often biased and unhelpful, particularly when they are distressed. Cognitive Behaviour Therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. When they learn to change the distortions in their thinking and think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioural changes.
CBT is the most extensively scientifically tested, evidence-based psychological approach.
CBT became the first talking therapy demonstrated to be more effective than medication for the treatment of depression in 1977. In 1981, a UK-based research group published the results of a second study with the same findings.
Since then, more than 2000 studies have demonstrated the efficacy of CBT for psychiatric disorders, neurodiverse conditions like ADHD and the autism spectrum conditions, psychological problems and as an effective intervention for medical problems with a psychiatric component. CBT, implemented correctly, helps individuals get better and stay better.
CBT treatment is tailored to each individual and is adapted to meet the needs of the client. A good CBT treatment plan carefully considers the client’s goals, values, presenting problems, symptoms, and demographics including culture, religion, language, sexual and gender identity and more.
First session involves gathering information such as:
- Identifying the main psychological and physical symptoms
- Identifying healthy and unhealthy coping methods
- Identifying possible triggers
- Identifying supports in the community
- Identifying shared goals for therapy and treatment plan
- Completing assessment measures for example Becks Anxiety & or Depression inventory
The CBT psychotherapist will select a suitable CBT model to use and will write a draft formulation to share with you. A formulation is a method of understanding how the symptoms developed over time. An individual formulation helps determine an individualized treatment plan for every client. Therapists should then explain the treatment plan, and any related skills and techniques, sometimes called interventions. If clients agree to the suggested interventions, then they work together with their therapists to learn these techniques and skills. Each session of CBT will have an agenda so the person will always be aware of the content of upcoming sessions. The psychotherapist will agree weekly tasks to do and this may involve giving the person helpful reading information in the form of handouts as relevant.
It can be challenging: the way people get better is by making small changes in their lives every day. The collaborative ‘Action Plan’ designed with the therapist will allow a client to practice the new skills learned between sessions. Regular Action Plan completion is associated with better results in CBT.
Therapists and clients work together to make the treatment effective: Therapists and client work together to decide to set the agenda for each session, how much time to devote to each issue being discussed and what interventions would be most helpful.
It takes time: Although CBT is time-sensitive, clients often see improvement more quickly than with other types of therapy. Instantaneous results shouldn’t be expected. Continuing to attend scheduled therapy sessions and completing your Action Plan between sessions helps clients to feel better faster.
Honesty is critical: CBT therapists often seek feedback from clients on what you are finding beneficial or unhelpful about treatment and whether there’s anything they may have gotten wrong. Be honest with your therapist. This is critical information that can help them improve their treatment plan and benefit you in the long run.
CBT sessions are highly structured: If as a client you have tried other types of therapy, you may be used to a loose session structure, where you relate whatever is on your mind with minimal intervention by the therapist. CBT therapists maximize and direct appointment session time by structuring the time spent to make sure that the client’s most pressing problems get solved and most important goals are met. If you are having difficulty adjusting to the structured nature of a CBT session, you should discuss this with the therapist.
Sometimes CBT clients need medication, and that is okay: CBT is often used concurrently with medication, especially for more serious mental health conditions like bipolar mood disorder and schizophrenia. CBT could help you manage your medication and can facilitate honest conversations about medication preferences with your prescribing doctor.
Consequent upon CBT’s demonstrated success, clinicians and researchers have developed and tested a range of specialised treatment approaches that build and expand on the theory behind CBT.
Some of these include:
- CBT for Insomnia (CBTi)
- Trauma-Focused CBT (TF-CBT)
- CBT for Psychosis (CBTp)
- Recovery-Orientated Cognitive Therapy (CT-R)
In addition CBT has also inspired a range of other cognitive and behavioural-based therapies such as Dialectical Behaviour Therapy (DBT), Acceptance & Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT).
CBT protocols can be used in a variety of settings such as in groups, school settings, primary care and hospital settings.
- CBT treatment plans are based on an ever-evolving cognitive conceptualization.
- CBT requires a sound therapeutic relationship.
- CBT continually monitors client progress.
- CBT is culturally adapted and tailors treatment to the individual.
- CBT emphasizes the positive.
- CBT stresses collaboration and active participation.
- CBT is aspirational, values based, and goal oriented.
- CBT initially emphasizes the present.
- CBT is educative.
- CBT is time sensitive.
- CBT sessions are structured.
- CBT uses guided discovery and teaches clients to respond to their dysfunctional cognitions.
- CBT includes action plans (therapy homework).
- CBT uses a variety of techniques to change thinking, mood, and behaviour.
Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition
- CBT is not a set of techniques or tools.
- CBT is not a quick fix that does not take into account the origin of the symptoms.
- CBT does not down play the relevance of the therapeutic relationship.
- That CBT is not for complex conditions.
CORU is Ireland’s multi-profession health regulator. The role of CORU is to protect the public by promoting high standards of professional conduct, education, training and competence through statutory registration of health and social care professionals. Upon opening of the ‘Psychotherapist’ Register in the Republic of Ireland all CBPI accredited practitioners on the CBPI register must register with CORU. This is a condition of using the title ‘psychotherapist’ whether working in the public or in the private sector.