Chapter 1
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) is a structured, short-term, and present-focused form of psychotherapy
commonly used to treat depression and anxiety. It targets dysfunctional thinking patterns (negative cognitions)
and maladaptive behaviours to improve coping and emotional well-being. The therapy is grounded in an
individualised understanding of each patient, aiming to bring about enduring emotional and behavioural
change through cognitive restructuring.
Goals and Applications
CBT helps individuals:
- Identify and solve personal problems
- Become more behaviourally active
- Challenge and change depressed thoughts and beliefs
- In anxiety, CBT focuses on reducing avoidance behaviours and gradually confronting feared
situations to build resilience.
Variations of CBT
CBT encompasses multiple approaches, including:
- Rational Emotive Behaviour Therapy - Exposure Therapy
(REBT) - Cognitive Processing Therapy
- Dialectical Behaviour Therapy (DBT) - Cognitive Behavioural Analysis System of
- Problem-Solving Therapy Psychotherapy
- Acceptance and Commitment Therapy - Behavioural Activation
(ACT) - Cognitive Behaviour Modification
These variations illustrate CBT’s interconnected and integrative nature, drawing techniques from diverse
therapeutic models.
The Cognitive Model
The cognitive model proposes that dysfunctional thinking disrupts mood and behaviour, leading to
psychological distress. Recovery involves developing realistic, adaptive ways of interpreting experiences and
questioning the validity of automatic thoughts. By examining specific situations where negative beliefs prove
inaccurate, clients learn that struggles in one area do not define their overall competence. Research supports
CBT’s effectiveness, showing neurological changes associated with therapeutic improvement.
Two key types of thought:
1. Automatic negative thoughts: spontaneous, self-defeating ideas
2. Evaluative thoughts: judgments closely tied to emotional responses
Role of the CBT Therapist
A CBT therapist must:
- Conceptualise the client’s case in cognitive terms
- Build a collaborative and trusting relationship
- Engage the client actively in therapy
- Identify problems and set clear goals
- Collect and analyse data
- Test therapeutic hypotheses
- Summarise and review progress regularly
Developing Expertise in CBT
The process of becoming an expert CBT therapist involves four progressive stages:
1. Learning the basics: acquiring foundational skills in cognitive conceptualisation and structured case
formulation.
2. Integration: applying conceptual understanding alongside CBT tools and techniques to target
dysfunctional thoughts and behaviours.
3. Automaticity: integrating new information seamlessly into the case conceptualisation and formulating
hypotheses efficiently.
4. Lifelong learning: continually refining skills and knowledge throughout one’s professional career.
,Chapter 2:
Principles of CBT
CBT is tailored to each client, yet it follows several core principles that apply across most therapeutic contexts.
These principles ensure that treatment remains structured, evidence-based, and responsive to clients’ evolving
needs.
Principles
1. Evolving Cognitive Conceptualisation
The foundation of CBT lies in an ever-evolving cognitive conceptualisation. This is based on the information
gathered during the initial evaluation and continuously refined throughout therapy as new data emerge.
A thorough conceptualisation identifies:
- Cognitive and behavioural obstacles
- Precipitating factors
- Key developmental experiences
- Enduring patterns of interpreting life events
- The client’s strengths, resources, and positive qualities
2. A Sound Therapeutic Relationship
A strong therapeutic alliance is essential for success in CBT. The quality of this relationship varies between clients,
and therapists must invest the necessary time, empathy, and effort to develop sufficient trust and collaboration.
3. Continuous Monitoring of Progress
Client progress is regularly tracked throughout therapy. When both therapist and client receive consistent
feedback, treatment outcomes significantly improve, allowing for timely adjustments to the treatment plan.
4. Cultural and Individual Adaptation
CBT must be culturally and individually adapted. Therapists should enhance their cultural competence,
understand differences between themselves and clients, and recognise how these may influence treatment.
However, it remains vital to conceptualise each client individually rather than make assumptions based on
group identity.
5. Emphasis on the Positive
CBT highlights positive emotions, strengths, and hope. Focusing on what is going well helps counter depressive
thinking and fosters motivation for change.
6. Collaboration and Active Participation
Therapy is viewed as a collaborative partnership. Clients are encouraged to take an active role in their treatment,
with the therapist and client working together as a team.
7. Values-Based, Aspirational, and Goal-Oriented
CBT emphasises values and goals. Early in therapy, clients identify their core values, aspirations, and specific
objectives for treatment, which guide the therapeutic process.
8. Focus on the Here and Now
CBT primarily focuses on current issues and practical skill-building to improve mood and functioning. However,
exploration of the past may be appropriate when:
- The client expresses a strong desire to do so
- Progress has stalled despite working on the present concerns
- Understanding the origins of dysfunctional beliefs or coping patterns is necessary
After reflecting on the past, clients apply their new insights to present and future situations.
9. CBT is Educative
Education is central to CBT. Clients are taught to understand the therapeutic process, learn key psychological
concepts, and apply practical techniques to manage their thoughts, emotions, and behaviours independently.
10. Time-Sensitive and Efficient
CBT aims to be time-limited and goal-focused, helping clients achieve meaningful results as efficiently as
possible without compromising quality.
11. Structured Sessions
Sessions follow a consistent structure to maximise efficiency and therapeutic benefit. A clear format helps clients
stay focused, track progress, and achieve results more quickly.
12. Guided Discovery
Therapists use guided discovery to help clients recognise, evaluate, and modify dysfunctional cognitions through
questioning and reflection rather than direct instruction.
, 13. Homework and Action Plans
Between-session assignments are an integral part of CBT.
Homework may include:
- Identifying and evaluating automatic thoughts
- Implementing solutions to anticipated obstacles
- Practising behavioural skills introduced in therapy
- Recording key insights to enhance recall and progress
Homework increases engagement and promotes long-term change.
14. Use of Diverse Techniques
CBT integrates a wide range of techniques to modify mood, cognition, and behaviour. Therapists select and
combine methods to best suit each client’s needs and therapeutic goals.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) is a structured, short-term, and present-focused form of psychotherapy
commonly used to treat depression and anxiety. It targets dysfunctional thinking patterns (negative cognitions)
and maladaptive behaviours to improve coping and emotional well-being. The therapy is grounded in an
individualised understanding of each patient, aiming to bring about enduring emotional and behavioural
change through cognitive restructuring.
Goals and Applications
CBT helps individuals:
- Identify and solve personal problems
- Become more behaviourally active
- Challenge and change depressed thoughts and beliefs
- In anxiety, CBT focuses on reducing avoidance behaviours and gradually confronting feared
situations to build resilience.
Variations of CBT
CBT encompasses multiple approaches, including:
- Rational Emotive Behaviour Therapy - Exposure Therapy
(REBT) - Cognitive Processing Therapy
- Dialectical Behaviour Therapy (DBT) - Cognitive Behavioural Analysis System of
- Problem-Solving Therapy Psychotherapy
- Acceptance and Commitment Therapy - Behavioural Activation
(ACT) - Cognitive Behaviour Modification
These variations illustrate CBT’s interconnected and integrative nature, drawing techniques from diverse
therapeutic models.
The Cognitive Model
The cognitive model proposes that dysfunctional thinking disrupts mood and behaviour, leading to
psychological distress. Recovery involves developing realistic, adaptive ways of interpreting experiences and
questioning the validity of automatic thoughts. By examining specific situations where negative beliefs prove
inaccurate, clients learn that struggles in one area do not define their overall competence. Research supports
CBT’s effectiveness, showing neurological changes associated with therapeutic improvement.
Two key types of thought:
1. Automatic negative thoughts: spontaneous, self-defeating ideas
2. Evaluative thoughts: judgments closely tied to emotional responses
Role of the CBT Therapist
A CBT therapist must:
- Conceptualise the client’s case in cognitive terms
- Build a collaborative and trusting relationship
- Engage the client actively in therapy
- Identify problems and set clear goals
- Collect and analyse data
- Test therapeutic hypotheses
- Summarise and review progress regularly
Developing Expertise in CBT
The process of becoming an expert CBT therapist involves four progressive stages:
1. Learning the basics: acquiring foundational skills in cognitive conceptualisation and structured case
formulation.
2. Integration: applying conceptual understanding alongside CBT tools and techniques to target
dysfunctional thoughts and behaviours.
3. Automaticity: integrating new information seamlessly into the case conceptualisation and formulating
hypotheses efficiently.
4. Lifelong learning: continually refining skills and knowledge throughout one’s professional career.
,Chapter 2:
Principles of CBT
CBT is tailored to each client, yet it follows several core principles that apply across most therapeutic contexts.
These principles ensure that treatment remains structured, evidence-based, and responsive to clients’ evolving
needs.
Principles
1. Evolving Cognitive Conceptualisation
The foundation of CBT lies in an ever-evolving cognitive conceptualisation. This is based on the information
gathered during the initial evaluation and continuously refined throughout therapy as new data emerge.
A thorough conceptualisation identifies:
- Cognitive and behavioural obstacles
- Precipitating factors
- Key developmental experiences
- Enduring patterns of interpreting life events
- The client’s strengths, resources, and positive qualities
2. A Sound Therapeutic Relationship
A strong therapeutic alliance is essential for success in CBT. The quality of this relationship varies between clients,
and therapists must invest the necessary time, empathy, and effort to develop sufficient trust and collaboration.
3. Continuous Monitoring of Progress
Client progress is regularly tracked throughout therapy. When both therapist and client receive consistent
feedback, treatment outcomes significantly improve, allowing for timely adjustments to the treatment plan.
4. Cultural and Individual Adaptation
CBT must be culturally and individually adapted. Therapists should enhance their cultural competence,
understand differences between themselves and clients, and recognise how these may influence treatment.
However, it remains vital to conceptualise each client individually rather than make assumptions based on
group identity.
5. Emphasis on the Positive
CBT highlights positive emotions, strengths, and hope. Focusing on what is going well helps counter depressive
thinking and fosters motivation for change.
6. Collaboration and Active Participation
Therapy is viewed as a collaborative partnership. Clients are encouraged to take an active role in their treatment,
with the therapist and client working together as a team.
7. Values-Based, Aspirational, and Goal-Oriented
CBT emphasises values and goals. Early in therapy, clients identify their core values, aspirations, and specific
objectives for treatment, which guide the therapeutic process.
8. Focus on the Here and Now
CBT primarily focuses on current issues and practical skill-building to improve mood and functioning. However,
exploration of the past may be appropriate when:
- The client expresses a strong desire to do so
- Progress has stalled despite working on the present concerns
- Understanding the origins of dysfunctional beliefs or coping patterns is necessary
After reflecting on the past, clients apply their new insights to present and future situations.
9. CBT is Educative
Education is central to CBT. Clients are taught to understand the therapeutic process, learn key psychological
concepts, and apply practical techniques to manage their thoughts, emotions, and behaviours independently.
10. Time-Sensitive and Efficient
CBT aims to be time-limited and goal-focused, helping clients achieve meaningful results as efficiently as
possible without compromising quality.
11. Structured Sessions
Sessions follow a consistent structure to maximise efficiency and therapeutic benefit. A clear format helps clients
stay focused, track progress, and achieve results more quickly.
12. Guided Discovery
Therapists use guided discovery to help clients recognise, evaluate, and modify dysfunctional cognitions through
questioning and reflection rather than direct instruction.
, 13. Homework and Action Plans
Between-session assignments are an integral part of CBT.
Homework may include:
- Identifying and evaluating automatic thoughts
- Implementing solutions to anticipated obstacles
- Practising behavioural skills introduced in therapy
- Recording key insights to enhance recall and progress
Homework increases engagement and promotes long-term change.
14. Use of Diverse Techniques
CBT integrates a wide range of techniques to modify mood, cognition, and behaviour. Therapists select and
combine methods to best suit each client’s needs and therapeutic goals.
