What is Cognitive Behaviour Therapy?
Introduction
Counselling is more than talking about our problems. Counsellors use a 'theoretical orientation' or 'modality' to understand what you share in therapy and translate it into a problem with a solution. Depending on your counsellor’s theoretical orientation, they will have a different perspective on the causes of the problem and how therapy can help.
The main theoretical orientation that I use in therapy is Cognitive Behaviour Therapy. Cognitive Behaviour Therapy (CBT) has been around since the 1960’s and has been heavily researched and used to treat a wide variety of problems. In fact, many other theoretical orientations were founded from CBT!
What is the “problem” according to CBT?
The foundation of CBT is the idea that our thoughts, physical reactions, emotions, and behaviours all influence one another. For example, we see a snake, we feel the sensation of our “heart dropping into our stomach,” we label this as fear, we think “that snake is going to bite me.”
These thoughts are called 'automatic thoughts' in CBT.. They’re the kind of thoughts that come up instantly for us, sometimes so quickly and automatically that we don’t even notice them. Automatic thoughts can be helpful, unhelpful, or neutral. When these thoughts are kind and accurate, they help us stay grounded in difficult situations and contribute to emotional growth and resilience. However, when these thoughts are unkind and biased in negativity, they can really bring us down.
The main assumption of CBT is that the situations we face in life are not (so much) what cause us distress. Rather it is how we react and respond to these situations that is distressing for us. In other words, the automatic thoughts, physical reactions, and emotions we experience in response to the situation are the main source of our distress. Further, CBT believes that the things we do in response to these feelings of stress and distress can reinforce our thoughts about the original situation.
How does CBT help?
CBT helps people by interrupting these cycles.
CBT can help you to identify, label, and connect your physical reactions, thoughts, and emotions. Once we understand what we’re feeling and why, it can lift a huge weight off our shoulders. It opens the possibility of change and gives us a sense of control over our future.
One of the ways CBT does this is by identifying those unhelpful automatic thoughts and gently challenging them. Together, you and your therapist will explore the facts and evidence from your life to get a clearer picture of the accuracy (or inaccuracy) of these thoughts. From there, you will work on creating new, more accurate and neutral thoughts to replace the unhelpful ones. This process can be as simple as moving from I always mess up, a more negative and generalizing statement, to sometimes I make mistakes, a (likely) more accurate and neutral statement. The goal isn’t to make huge changes to these thoughts, it’s to shift them to something more accurate and kinder. If we’re not used to giving ourselves grace, this process can feel weird and uncomfortable, but it does get better as we get used to our new self-talk.
We need to plant the seed of kind self-talk and then nurture it as it grows.
CBT can also help by tackling those unhelpful, reinforcing behaviours. When we’re depressed, we tend to disengage from friends and activities we used to enjoy. When we’re anxious, we tend to avoid situations that trigger our anxiety. However, disengaging and avoiding often reinforce our depression or anxiety. CBT uses techniques such as behavioural activation and exposure therapy to help us override the urge to avoid, opening us up to new experiences and opportunities to learn and grow.
Click here for an overview of CBT for anxiety.
What are thinking traps?
Thinking traps are patterns of thinking that are biased, overly negative, or unrealistic. We all fall into these traps sometimes, especially when we’re stressed, anxious, or feeling down.
Here are a few common examples:
All-or-nothing thinking: Seeing things in black-and-white terms (e.g., “If I’m not perfect, I’ve failed.”)
Catastrophizing: Expecting the worst-case scenario (e.g., “If I make a mistake, I’ll lose my job.”)
Mind reading: Assuming you know what others are thinking (e.g., “They didn’t text back - they must be mad at me.”)
Overgeneralizing: Believing one bad thing means everything will go wrong (e.g., “I failed this one test, so I’ll never succeed.”)
In CBT, you’ll learn how to spot these thinking traps and practice challenging them. With time and support, you’ll get better at catching unhelpful thoughts and replacing them with more accurate, compassionate ones.
Where do these unhelpful thoughts and behaviours come from in the first place?
Hint: they didn’t start as unhelpful! CBT believes that our early life experiences shape the way we see ourselves, the people around us, and the world. Someone who was bullied throughout childhood will likely have a different view of themselves, others, and the world than someone who was never bullied.
Through these experiences, we may have learned that certain behaviours helped us to avoid unwanted consequences like feeling embarrassed or sad. In the future, when faced with similar situations, we’re more likely to turn towards those behaviours that helped us in the past. However, when the threat to our safety is no longer there, these behaviours are more likely to get in our way than protect us.
For example, someone who was bullied in school may have learned that it is not safe to share personal, vulnerable details about their life. However, they may find later in life that being emotionally guarded has made relationships challenging. What protected them from bullying is now preventing close relationships with people who are not a threat to our safety.
What are core beliefs?
Core beliefs are the deep, underlying ideas we hold about ourselves, others, and the world. These beliefs are often formed in childhood and shaped by our experiences. While automatic thoughts are like the surface-level thoughts that pop up in a situation, core beliefs are the long-standing messages that sit underneath them.
For example, someone who thinks “I always mess up” might have a deeper core belief like “I’m not good enough.” CBT can help bring these beliefs to the surface, especially if they’re getting in the way of your confidence, relationships, or mental health.
Once you and your therapist identify a core belief, you can gently start to explore where it came from, how it has impacted your life, and whether it still fits with who you are now. Over time, you can begin to replace rigid, unhelpful beliefs with ones that are more neutral, compassionate, and helpful.
What is psychoeducation in CBT?
CBT isn’t just about talking - it’s also about learning. Psychoeducation is a key part of CBT, where your therapist shares helpful information about how your brain and body respond to stress, anxiety, depression, or other issues.
You might learn about how anxiety affects your nervous system, how avoidance fuels fear, or how habits get reinforced over time. Understanding what’s happening behind the scenes helps you feel less confused and more in control. It also helps normalize your experiences - many of the things we struggle with are common and treatable.
Your therapist will tailor psychoeducation to your needs and pace. It’s not a lecture - it’s about giving you the tools and knowledge to better understand yourself and support your own healing.
What does a typical CBT session look like?
CBT is a more structured form of therapy. Sessions begin with a check-in, where you and your therapist review how things have been since the last session, go over your action plan (explained below), and decide what to focus on during the session (e.g., what you'd like to discuss).
During the middle of the session, you'll focus on a specific situation (or a few situations) that's currently on your mind. Together with your therapist, you'll explore the thoughts, emotions, and behaviors connected to it. After a few sessions, you’ll begin to identify patterns in thinking and behaving. You’ll also work on coping strategies and start taking small, manageable steps towards creating new, more neutral and accurate thoughts.
The session closes with a summary and small goal setting. With your therapist, you’ll come up with some small steps that you can take between sessions, also known as an action plan.
How is progress tracked?
CBT is a structured and goal-oriented therapy, which means tracking progress is an important part of the process. At the beginning of therapy, you and your therapist may work together to set specific, realistic goals. As therapy progresses, you’ll check in on these goals, celebrate improvements, and make adjustments as needed.
In addition to discussions during sessions, your therapist may use simple questionnaires or rating scales (like mood logs or symptom checklists) to help you both understand how things are shifting over time. These tools aren’t tests—they’re meant to help you notice patterns and measure real-life progress, even if the changes feel small day to day.
Why is a strong relationship between therapist and client important in CBT?
CBT is hard work, and it can be emotionally vulnerable. Our automatic thoughts, especially our more negative ones can be very personal and difficult to share with a therapist, especially if you know your therapist is going to encourage you to examine those thoughts and take steps towards replacing them with more helpful thoughts.
A strong, nonjudgmental, compassionate, supportive, and trusting relationship is essential. Without such a relationship, clients may feel invalidated, ashamed, or judged. Changing our thoughts and behaviours can feel awkward and vulnerable. This is why it is so important to work with a therapist who makes you feel heard, valued, and validated. Someone you feel comfortable being yourself with. And most important, someone you can be honest with and give feedback to when things aren’t working.
Who is a good fit for CBT?
If you’re still reading this, you’re probably a good fit for CBT! CBT is a good fit for people who want to take small, manageable steps to change those automatic thoughts and unhelpful behaviours. It is a goal-oriented, future-focused approach.
CBT is not an “easy” therapy, and it doesn’t go as emotionally deep as some other therapeutic approaches. It can feel uncomfortable and unnatural at times as we rewire our brains to think differently and encourage ourselves to re-engage with life. CBT is highly effective and efficient. A typical course of treatment can take anywhere from 8-20 sessions, while some people improve significantly in as little as 4-6 sessions.
CBT is a collaborative therapy. You’re the expert in your life and your therapist is the expert at therapy. This means that regular feedback to your therapist is a very important part of CBT. If something isn’t working, let them know.
CBT may not be for you if you’re more focused on unpacking and working on the past than creating a preferred future. CBT can be a great second step once you feel that you have the closure you need to move into the future.
What happens after CBT ends?
Towards the end of therapy, you and your therapist will spend some time preparing for life after CBT. This process is called relapse prevention, and it helps you feel confident in continuing the work on your own.
A relapse simply means that some of the thoughts, feelings, or behaviours you’ve worked hard to change start to come back. It doesn’t mean you’ve failed - it’s a normal part of the healing process and something that many people experience from time to time.
Together, you’ll review the skills and strategies that have helped the most, identify potential challenges in the future, and create a personalized plan for what to do if old patterns start to return. This might include writing down reminders, identifying warning signs, or keeping a list of your go-to coping tools. Some people even book occasional “booster” sessions to check in.
The goal of relapse prevention is not perfection—it’s about being prepared and feeling empowered to take care of yourself with the skills you’ve learned.
Does CBT work for culturally diverse populations?
While most research on CBT has focused on White Americans, there is an increasing body of studies involving other populations. Culturally responsive CBT acknowledges the role that culture plays in shaping our thoughts, determining which behaviors are helpful or unhelpful, influencing how we connect with our emotions and physical reactions, and how we perceive the issues we bring to therapy.
A culturally informed therapist will avoid making assumptions, seek clarification, be open to feedback and correction, and take some time to do their own learning about their client’s specific identity. Additionally, they will never use CBT to question experiences of discrimination or oppression.
This is another reason why collaboration is key in CBT. Your therapist should take their time and make sure that they understand before suggesting techniques, and they should involve you in the selection of techniques and the ways in which they will be used.
Summary
CBT can be a powerful tool for overcoming anxiety and depression. It works best for individuals focused on their future and seeking a structured, goal-oriented approach. It won’t work as well if the relationship between therapist and client isn’t strong. It is not a one size fits all and won’t work for everyone, even if they check off all the boxes above.
Reach out to see if CBT is the right fit for you; send me an email or book a free consultation.