Definition

CBT is a structured, collaborative psychotherapeutic approach that integrates cognitive and behavioural techniques to reduce psychological distress and improve functioning. It is typically goal‑oriented, problem‑focused and involves homework between sessions.

Historical development

• 1950s–1960s: Behavioural therapies (classical and operant conditioning) developed from learning theory (e.g., Wolpe, Skinner).
• 1960s–1970s: Aaron T. Beck developed cognitive therapy for depression after observing patients’ automatic negative thoughts.
• 1970s–1990s: Integration of cognitive and behavioural approaches led to the CBT label; emergence of manualised treatments and randomized controlled trials demonstrating efficacy.
• 1990s–present: Expansion into disorder‑specific protocols (e.g., CBT for anxiety, PTSD, OCD), third‑wave CBT (ACT, DBT, mindfulness‑based approaches) and digital/low‑intensity delivery formats.

Core principles

1. Collaborative empiricism: therapist and patient work together as a team to test beliefs and behaviours.
2. Time‑limited, structured approach: sessions follow an agenda, use clear goals and focus on measurable change.
3. Present‑focused and problem‑oriented: emphasis on current difficulties and practical strategies to change them.
4. Model of interaction: thoughts, emotions and behaviours interact — changing one can influence the others.
5. Skills and relapse prevention: emphasis on teaching coping skills, homework and strategies to maintain gains over time.

The CBT model – simplified

Situation → Thoughts (automatic) → Emotions → Physical sensations → Behaviours. CBT targets automatic thoughts, core beliefs and behavioural patterns with cognitive restructuring and behavioural experiments.

Common CBT techniques

• Behavioural activation: scheduling activities to increase positive reinforcement (useful in depression).
• Exposure therapy: graded exposure to feared stimuli with response prevention (effective for anxiety disorders, PTSD, OCD adaptations).
• Cognitive restructuring: identifying, testing and modifying unhelpful automatic thoughts and underlying beliefs.
• Problem‑solving training: structured steps to address practical problems contributing to distress.
• Skills training: relaxation, assertiveness, social skills and emotion regulation strategies.
• Behavioural experiments: real‑world tests to disconfirm maladaptive beliefs.
• Relapse prevention and homework: consolidation of skills via between‑session practice and planning for setbacks.

Delivery formats

• Individual CBT (typical format: 8–20 weekly sessions depending on problem and severity).
• Group CBT — efficient for common problems like social anxiety, depression or panic disorder.
• Brief/low‑intensity CBT — guided self‑help, bibliotherapy, digital CBT (internet‑delivered) with therapist support.
• Specialist protocols — exposure with response prevention for OCD, trauma‑focused CBT for PTSD, CBT‑E for eating disorders.

Evidence and effectiveness

• CBT is evidence‑based for a wide range of conditions: depression, generalized anxiety disorder, panic disorder, social anxiety, PTSD, OCD, insomnia and many others.
• Effect sizes vary by condition; CBT often performs as well as or better than pharmacotherapy for many disorders and combines effectively with medication when needed.
• Long‑term benefits depend on skill acquisition and relapse prevention; booster sessions and ongoing practice improve maintenance.

Adaptations & cultural considerations

• Adapt CBT language and metaphors to be culturally sensitive and relevant; involve family/community where appropriate.
• Consider literacy, access to technology and stigma — low‑intensity or community‑based models can improve reach.
• Third‑wave adaptations (ACT, DBT, mindfulness) integrate values and acceptance strategies useful across cultures.

Practical tips for clinicians

• Set a collaborative agenda each session and use measurable goals (behavioural targets, symptom scales).
• Assign brief, achievable homework and review it at the start of the next session — this predicts good outcomes.
• Use simple worksheets for thought records, activity scheduling and behavioural experiments; tailor language to the patient’s level.
• Monitor progress with brief scales (PHQ‑9, GAD‑7) and adjust intensity or consider referral if_no_improvement.

Key takeaways

• CBT is a structured, evidence‑based therapy that targets the interplay between thoughts, emotions and behaviours to reduce distress and improve functioning.
• It is collaborative, time‑limited and skills‑focused — effective across many mental health conditions and adaptable to different delivery formats.
• Successful CBT depends on clear goals, homework, and translating therapeutic gains into everyday behaviour change.