Cognitive behavioural therapy (CBT) explained

Life has its ups and downs, but sometimes the weight of stress, anxiety, or negative thinking feels like it’s taking over everything. You might be trying to cope the best way you can, or supporting someone close to you who’s struggling. Along the way, you may have come across the term cognitive behavioural therapy and wondered how this therapy can help.

In this resource, we’ll discuss what CBT is, how cognitive behavioural therapy works, what it can help with, and the potential risks to be aware of. 

What is cognitive behavioural therapy?

Cognitive behavioural therapy or CBT is a structured psychotherapy that focuses on identifying and changing unhelpful patterns in thinking and behaviour. First developed by psychiatrist Aaron Beck in the 1960s, CBT is based on the idea that our thoughts, feelings, and actions are all connected. And by adjusting the way we think or act, we can positively respond to life’s challenges.

Unlike general talk therapy, which explores your past more openly, CBT is goal-focused and teaches you specific skills to manage challenges in the present. CBT is also different from DBT (dialectical behaviour therapy), which is a type of CBT that places more emphasis on managing intense emotions and relationship difficulties.

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By adjusting the way we think or act, we can positively respond to life’s challenges.

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In Australia, CBT is offered by behavioural therapists or psychologists, psychiatrists, trauma counsellors, mental health nurses, and some GPs who are specifically trained in CBT. For those who aren’t quite ready for in-person sessions, some therapists can provide CBT online.

Online CBT therapy allows you to access low-cost therapy support in a way that feels comfortable, with the option to connect through video, phone call, or chat with your therapist. 

How does CBT work?

CBT works by teaching practical strategies you can use to manage daily challenges more effectively. CBT techniques vary depending on your goals and what you’re working through, but the most common ones are:

You can also practice CBT at home by using guided worksheets and structured self-help books. Expressive writing and journaling, whether through handwriting or digital journaling through tools like Talked’s in-app journal, can also be a helpful way to process stress and anxiety.

Consistently using these CBT tools can deepen your progress even outside of your therapy sessions.

What to expect in a CBT session?

In your first session, your therapist will ask about what’s been going on for you, your mental and physical health history, and what you’d like to work on. Following that, the therapy will usually follow a structured and goal-oriented format.

The structure of a CBT session typically looks like this:

• You’ll explore the thoughts, feelings, and beliefs connected to the most troubling issues you’re facing right now.

• You’ll explore recurring negative thoughts with your therapist and learn how to shift them.

• Together, you’ll look at how those patterns affect your behaviour and work toward more helpful responses.

• You may be given between-session tasks, like journaling or trying out a new coping strategy, to support what you are learning.

Sessions are usually once a week and last around an hour. Depending on your progress, your sessions can later change to once a month or once every few months. A typical course runs for 5-20 weeks, but this depends on your progress and personal needs. 

What conditions can CBT help with?

Over the years, a sufficient amount of research has proven the benefits of CBT, showing it to be effective in treating conditions like anxiety, depression, and stress-related issues. But it can also be adapted to help manage insomnia, substance use, eating disorders, and even major life changes like divorce or relationship breakdowns.

It’s worth noting that CBT can be helpful for children, teens, and adults alike. If you find yourself stuck in unhelpful thought patterns, CBT can offer practical tools to help you think more clearly and respond more constructively, no matter the stage of your life.

CBT for anxiety

There’s strong evidence supporting CBT’s effectiveness for a range of anxiety disorders, including social anxiety, panic disorder, post-traumatic stress disorder or PTSD, phobias, and obsessive-compulsive disorder or OCD.

In CBT for anxiety, you’ll learn a couple of techniques to break that cycle of constant stress, worry, and fear. You’ll get to identify thinking traps like catastrophising or assuming the worst, and replace them with more realistic and calming thoughts. 

Techniques like gradual exposure and cognitive restructuring are mostly used to reduce sensitivity to anxiety triggers over time. In time, it can boost your emotional intelligence through increased self-understanding and emotional balance. These skills may also help reduce the impact of your anxiety in the future.

CBT for depression

Depression often involves ongoing negative thoughts about yourself or your life in general. If these thoughts keep going on, they can become automatic and hard to spot.

You might start to believe thoughts like you aren’t good enough, you’re lost, or that nothing will ever get better, without realising these are cognitive distortions, or thoughts that feel true but aren’t necessarily based on facts.

CBT helps you recognise these distortions, challenge them, and gradually replace them with more balanced and realistic thinking. Over time, the skills you build through CBT can help reduce the risk of future episodes and make it easier to manage setbacks when they arise.

Risks and dangers of CBT

Though CBT is widely regarded as safe, some people may experience emotional challenges. Research involving 100 CBT therapists showed that around 43% of their clients reported at least one side effect during treatment. Most felt more emotionally distressed, while some experienced a temporary spike in their symptoms.

Most of these side effects were reported to be mild and temporary. But, it’s a reminder that CBT is not a one-size-fits-all type of therapy. After all, it’s a well-known fact that CBT alone isn’t enough for people with severe mental health conditions, cognitive difficulties, substance use issues, or significant social barriers that make consistent participation harder. 

But despite its challenges, CBT remains one of the most trusted and evidence-based therapies. It takes effort, being the most effective when you’re ready to actively engage and practise between sessions. 

If you find talking through trauma distressing or unhelpful, there are other approaches to consider, like EMDR therapy. It doesn’t require detailed verbal recounting, so it’s a supportive option for clients who are not ready or advised to revisit their experiences directly.

Helping you get your life back with CBT

CBT isn’t a quick fix, but for many people, it offers practical tools and strategies to better understand themselves, manage tough emotions, and respond more constructively to life’s challenges. 

At Talked, you can find therapists who use CBT as part of their approach and can tailor sessions to your needs. If the cost of therapy is a concern, Medicare rebates can make CBT more affordable, with up to 10 subsidised sessions per year through a Mental Health Care Plan from your GP. Talked can help you get a referral, choose a psychologist, and receive your rebate directly into your bank account.

Taking that first step into counselling or therapy might feel daunting, but it could be the start of a more grounded, supported path forward.

References:

• American Psychological Association. (n.d.). Steps of Cognitive Restructuring Instructions. https://www.apa.org/pubs/books/supplemental/Treatment-for-Postdisaster-Distress/Handout-27.pdf

• Chand, S.P., Kuckel, D..P, & Huecker, M.R. (2023). Cognitive Behavior Therapy. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/

• Cully, J.A. & Teten, A.L. (2008). A Therapist’s Guide to Brief Cognitive Behavioral Therapy. Department of Veterans Affairs South Central MIRECC, Houston. https://depts.washington.edu/dbpeds/therapists_guide_to_brief_cbtmanual.pdf

• Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry, 62(Suppl 2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19

• Kaczkurkin, A.N., & Foa, E.B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

• Schermuly-Haupt, ML., Linden, M. & Rush, A.J. (2018). Unwanted Events and Side Effects in Cognitive Behavior Therapy. Cognitive therapy and research, 42, 219–229. https://doi.org/10.1007/s10608-018-9904-y

• The Open University. (n.d.). Exploring Anxiety. https://www.open.edu/openlearn/science-maths-technology/exploring-anxiety/content-section-5.5.1

• University of Michigan. (n.d.). Behavioral Activation for Depression. https://medicine.umich.edu/sites/default/files/content/downloads/Behavioral-Activation-for-Depression.pdf