Understanding Cognitive Behavioural Therapy (CBT)
What may appear to be self-defeating behaviour patterns in adult life, may have served a useful purpose in childhood, and because of this, the client may be resistant to changing their behaviour and seek to maintain it.
Cognitive Behavioural Therapy (CBT) is a therapeutic approach that invites clients to take accountability for actions that might contribute to their experience of distress and, therefore, to be active in remedying it. This is not to shame or attribute fault to the client but to help change how the individual thinks about a situation and subsequently how they react to it, empowering them to choose and experience “other”, alleviating symptoms.
Below is a list which provides an overview of what CBT focuses on in an ordered way:
The client’s core beliefs;
Logical errors;
Triggers/event;
Automatic thought [leading to and interacting between]:
- Emotional Response;
- Physical Response;
Resulting behaviour;
Consequence.
When someone is in a state of distress, such as experiencing depression and anxiety (where CBT is commonly applied), the negative and untreated consequence without the therapy will reinforce the initially held core beliefs; creating a cycle and worsening one's mental state. CBT works to identify the initial components in the above list, challenge, and replace them so as to redefine and re-orient the clients’ experience of self and their reality.
The theory behind CBT believes that thoughts, beliefs, and attitudes determine emotion and behaviour. Therefore, through intervention, behavioural issues such as bullying, social anxiety, obsessive-compulsive disorders etc. can be treated.
The theory of CBT, and the approaches’ development, can be applied in many different ways therapeutically, which has led to modality variants for specific needs with the goal of creating behavioural and/or attitudinal change:
Cognitive Therapy (Beck, 1991);
Dialectic Behaviour Therapy (Dimeff and Koerner 2007);
Rational Behaviour Therapy (Maultsby 1984);
Rational Emotive Behaviour Therapy (Ellis, 2001);
Rational Living Therapy (Pucci, 2006);
Schema Therapy (Young, Klosko and Weishaar, 2003).
‘Schema Therapy’, for a more detailed example, suggests one's current problem(s) may be rooted in early life experiences. Those who may be experiencing dysfunctional core beliefs about themselves or others - differing from traditional methods of CBT – should focus on them and discuss them so to actively challenge patterns of thinking and behaviour. The underpinning theory is that individuals with more complex problems likely have one or more early maladaptive schemas, which can lead to long-term anxiety, depression, dysfunctional relationships, or addictions in later life and so must be tackled for true alleviation.
Schemas are triggered by events of a similar nature to the root of that schema (its initial structure and reasoning for being developed), therefore producing a significant emotional response when triggered. What may appear to be self-defeating behaviour patterns in adult life may have served a useful purpose in childhood and, because of this, the client may be resistant to changing their behaviour and seek to maintain it. Clients claiming they have few memories of their childhood are probably demonstrating cognitive avoidance in order not to trigger schemas. Clients who appear not to show emotion at times when it would be expected are probably demonstrating effective avoidance. In behavioural avoidance, the client will actively and physically avoid contact with triggers: Emotive, Interpersonal, Cognitive and Behavioural.
‘Cognitive Behavioural Therapy’ (CBT) has been shown to be an effective intervention for both depression (Harrington, Whittaker, and Shorebridge, 1998) and anxiety (e.g., Barrett, 1998; Flennery-Schroeder and Kendall, 2000). Its versatility in treating a wide range of mental health conditions, especially in children and young people, is a key strength of this therapeutic approach. One of the most notable examples of CBT having been applied to younger populations, is the ‘Coping Cat Program’, a structured 16-week intervention designed to address anxiety in children and adolescents.
The ‘Coping Cat Program’ was specifically designed for children aged 8 to 14 (Coping Cat) and adolescents aged 14 to 17 (C.A.T). It helps young people identify and analyse their anxiety, providing them with the tools to develop effective coping strategies when confronted with anxiety-provoking situations. The program combines cognitive and behavioural techniques to help children not only understand the nature of their anxiety but also to face their fears in manageable ways. Therapists and facilitators use a variety of supporting resources, including workbooks, videos, and other materials, to guide participants through the learning process.
A key aspect of the ‘Coping Cat Program’ is behavioural training, which includes strategies such as:
Cognitive restructuring – Helping participants reframe negative or irrational thoughts.
Modelling – Demonstrating adaptive behaviours for children to imitate.
Guided imagery – Using visualisation to create calming mental images.
Simulation and real-life exposure – Gradually exposing children to situations that trigger anxiety.
Role-playing – Practicing scenarios to build confidence and coping skills.
Relaxation training – Teaching relaxation techniques to manage physiological symptoms of anxiety.
Contingent reinforcement – Rewarding positive coping behaviour to reinforce progress.
According to the ‘Promising Practices Network’ (2006), the program helps children "verbally reinforce their own successful coping" and encourages them to apply the coping skills they've learned in real-world situations. This approach not only aims to reduce anxiety in the short term but also to empower children with lasting strategies for managing anxiety throughout their lives.
A central tenet of CBT is that it encourages clients to examine their thought processes, which then leads to reflection on their emotions and behaviours. This self-examination is achieved through ‘Socratic Questioning’, a method where the therapist asks open-ended questions to prompt the client to explore their thoughts and beliefs. This approach fosters a deeper understanding of how automatic thoughts influence emotional and behavioural responses.
CBT creates a collaborative space where the client can explore a situation from multiple perspectives. The goal is to help the individual identify more rational and adaptive thoughts, behaviours, and reactions, ultimately allowing them to take control of their emotional and psychological responses.
For young people, this means recognising that many of their behaviours have been learned over time and may have been adaptive in specific circumstances. CBT provides them with the opportunity to unlearn maladaptive responses and develop new ways of relating to themselves, others, and the world around them.
CBT is not simply a space for clients to vent their emotions or offload their frustrations. Instead, it focuses on client responsibility. Clients are encouraged to actively identify new, more adaptive ways of behaving and reacting. Importantly, they are also asked to put these new learnings into practice between therapy sessions. This is crucial for reinforcing the skills learned in therapy and ensuring that the changes are integrated into everyday life.
Similarly, ‘Relational Behaviour Therapy’ and ‘Rational Behaviour Therapy’ emphasise the importance of client development in both behavioural and cognitive domains. ‘Relational Behaviour Therapy’ focuses on helping clients develop new ways of reacting in various situations, while ‘Rational Behaviour Therapy’ places particular emphasis on cultivating rational thought and self-counselling skills. Both approaches also emphasise the importance of therapeutic homework, where clients are encouraged to practice and apply the strategies learned during therapy (Maultsby, 1975).
At its core, CBT focuses on the interconnectedness of thoughts, emotions, and behaviours. The therapy works by helping individuals recognise how these elements influence each other and how negative thought patterns can lead to distress.
CBT focuses on the relationship between:
Cognitions (what we think)
Affect (how we feel)
Behaviour (what we do)
Vulnerable individuals may have negative beliefs about:
Themselves
The world
Their future
Cognitive (thought) processes include:
Schemas and core beliefs – e.g., "I must never fail."
Logical errors and assumptions – e.g., "I should be more productive."
Automatic thoughts – e.g., "I can't cope."
Helping vulnerable individuals change involves:
Working cooperatively as partners.
Exploring faulty cognitive patterns (e.g., expectations and beliefs).
Focusing on short-term, immediate actions or behaviours.
CBT and its related approaches are particularly effective in responding to mental health conditions such as depression, anxiety, phobias, and trauma. Additionally, it has been widely used in areas such as anger management and youth justice. The success of CBT is largely dependent on the individual's cognitive development and their ability to take responsibility—without judgment—for their thoughts, feelings, and actions.
Ultimately, CBT provides a structured, evidence-based approach that encourages individuals to take charge of their mental health by understanding and reshaping the thoughts, beliefs, and behaviours that contribute to their distress. Whether for children, adolescents, or adults, CBT offers a powerful toolkit for lasting change and improved emotional well-being.
