PTSD Recovery Blog

Kevin William Grant- Counsellor / Life Coach

What is Cognitive-Behavioural Therapy? and How Does it Work?

The Cognitive-Behavioural Therapy approach works by positively impacting the two-way relationship between thoughts (“cognitions”) and behaviours.

The Cognitive-Behavioural Therapy Approach

There are three levels of thought:

  1. Conscious thoughts: Rational thoughts and choices that are made with full awareness.
  2. Automatic thoughts: Thoughts that flow rapidly, so that you may not be fully aware of them. This may mean you can’t check them for accuracy or relevance. In a person with a mental health problem, these thoughts may not be logical.
  3. Core Beliefs: Personal rules for processing information. These core beliefs are shaped by influences in childhood and other life experiences.

Thoughts and behaviours influence each other. Behaviour can be changed using techniques such as:

  • Self-monitoring
  • Activity scheduling (for depression)
  • Exposure and response prevention (for anxiety)

What is Cognitive-Behavioural Therapy?

Cognitive-Behavioural Therapy (CBT) is practical and short-term. It helps my clients develop skills and strategies for becoming and staying healthy.

Cognitive-Behavioural Therapy focuses on the here-and-now— on the problems that come up in your day-to-day life today. Cognitive-Behavioural Therapy will help you examine how to make sense of what is happening around you and how your perceptions affect the way you feel.

Cognitive-Behavioural Therapy is:

  • Structured
  • Time-limited (usually 6-20 sessions)
  • Problem-focused
  • Goal-oriented
  • Teaches strategies and skills
  • Based on a proactive, collaborative therapeutic relationship between cousellor and client

How does Cognitive-Behavioural Therapy work?

In Cognitive-Behavioural Therapy, clients learn to identify, question and change the thoughts, attitudes and beliefs related to the emotional and behavioural reactions that cause them difficulty.
By monitoring and recording thoughts during upsetting situations, people learn how they think can contribute to emotional problems such as depression and anxiety. CBT helps to reduce these emotional problems by teaching clients to:

  • Identify distortions in their thinking
  • See thoughts as ideas about what is going on, rather than as facts
  • Stand back from their thinking to consider situations from different viewpoints.

The Issues Cognitive-Behavioural Therapy Addresses

There has been a lot of research on CBT. Evidence suggests that it is particularly effective in treating anxiety and depression. CBT has also been tailored to other specific problems.

For example, CBT is also used to treat:

  • Bipolar disorder
  • Eating disorders
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Panic disorder
  • Post-traumatic stress disorder
  • Schizophrenia and psychosis
  • Specific phobias
  • Substance use disorders

What are Core Beliefs?

Core beliefs are a person’s most central ideas about themselves, others, and the world. These beliefs act like a lens through which every situation and life experience is seen. Because of this, people with different core beliefs might be in the same situation, but think, feel, and behave very differently.

Even if a core belief is inaccurate, it still shapes how a person sees the world. Harmful core beliefs lead to negative thoughts, feelings, and behaviors, whereas rational core beliefs lead to balanced reactions.

What techniques are used with Cognitive-Behavioural Therapy?

The fundamental principle behind Cognitive-Behavioural Therapy is that your thought patterns affect your emotions, which, in turn, can affect your behaviours.

For instance, Cognitive-Behavioural Therapy highlights how negative thoughts can lead to negative feelings and actions. If you reframe your thoughts more positively, this can lead to more optimisim and encourage productive behaviours.

Cognitive-Behavioural Therapy teaches you how to make changes you can implement right now. These are skills you can continue to use for the rest of your life.

Depending on the issue you’re dealing with and your goals, there are several ways to approach Cognitive-Behavioural Therapy.

Whatever approach you take, it will include:

  • Identifying specific problems or issues in your daily life.
  • Becoming aware of unproductive thought patterns and how they can impact your life.
  • Identifying negative thinking and reshaping it in a way that changes how you feel.
  • Learning new behaviours and putting them into practice .
  • Cognitive Restructuring or Reframing
  • Cognitive restructuring or reframing involves taking a hard look at negative thought patterns.

Perhaps you tend to over-generalize, assume the worst will happen or place far too much importance on minor details. Thinking this way can affect what you do, and it can even become a self-fulfilling prophecy. Your therapist will ask about your thought process in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts to be more positive and productive.

For example: “I blew the report because I’m completely useless” can become “That report wasn’t my best work, but I’m a valuable employee, and I contribute in many ways.”

Guided Discovery

In guided discovery, the therapist will acquaint themselves with your viewpoint. Then they’ll ask questions designed to challenge your beliefs and broaden your thinking.

The counsellor will ask you to give evidence that supports your assumptions and proof that does not.

In the process, you’ll learn to see things from other perspectives, especially ones that you may not have considered before. These new perspectives can help you choose a more helpful path.

Exposure Therapy

Exposure therapy is a technique for confronting fears and phobias. This technique gradually and incrementally exposes you to the things that provoke fear or anxiety while being taught how to tolerate and become comfortable with them in the present moment.

Exposure therapy progresses in small increments. Eventually, exposure can make you feel less vulnerable and more confident in your coping abilities.

Journaling and Thought Records

Writing is a time-honoured way of getting in touch with your thoughts.

You may be asked to list negative thoughts that occurred to you between sessions, as well as positive thoughts you can choose instead.

Another writing exercise is to keep track of the new thoughts and new behaviours you put into practice since the last session. Putting the details in writing helps you track how far you’ve come

Activity Scheduling and Behaviour Activation

If you tend to delay or avoid an activity because of fear or anxiety, getting these activities on your calendar can help you confront what you fear. Once you don’t feel you have to decide, you may be more likely to follow through.

Activity scheduling can help establish positive habits and give you ample opportunity to put what you’ve learned into practice.

Behavioural Experiments

Behavioural experiments are an approach that’s suited to treat anxiety disorders where you find yourself spiralling into catastrophic thinking.

Before embarking on a task that usually makes you anxious, you’ll be asked to predict what will happen.

Over time, you’ll talk about whether the prediction came true. You may start to see that the predicted catastrophe is unlikely to happen. You’ll likely begin with lower-anxiety tasks and build up from there.

Relaxation and Stress Reduction Techniques

Progressive relaxation techniques are frequently taught to clients undergoing Cognitive-Behavioural Therapy. These progressive relaxation techniques include:

  • Deep breathing exercises
  • Muscle relaxation
  • Imagery

You’ll learn practical skills to help lower stress and increase your sense of control. Relaxation and stress reduction can help deal with phobias, social anxieties, and other stressors.


Role-playing can help you work through different behaviours in potentially tricky situations.

By acting out possible scenarios you can reduce fear and anxiety so you can:

  • Improve problem-solving skills
  • Become more familar with and gain confidence navigating challenging situations
  • Practice your social skills
  • Become more assertive
  • Improve your communication skills
  • Successive Approximation
  • Roleplaying involves taking tasks that seem overwhelming and breaking them into smaller, more achievable steps.

Each successive step builds upon the previous steps, so you progressively build confidence as you safely move forward, step by step.


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