Cognitive Behavioural Therapy (CBT) - How it works

Authored by Dr Colin Tidy, 03 May 2017

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The Information Standard

Reviewed by:
Dr Laurence Knott, 03 May 2017

Cognitive behavioural therapy (CBT) can help you make sense of difficult problems by breaking them down into smaller parts. In CBT, problems are broken down into five main areas:

  • Situations
  • Thoughts
  • Emotions
  • Physical feelings
  • Actions

CBT is based on the idea that these five areas affect each other. For example, your thoughts about a certain situation can often affect how you feel physically and emotionally, as well as how you act in response. CBT helps you to identify specific problems so that you can try to solve them.

Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation. Some thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself. This can make you feel hopeless, lonely, depressed and tired. You may become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.

CBT aims to stop negative cycles such as these by breaking down the things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

Exposure therapy

Exposure therapy is a form of CBT that is mainly used for people with phobias or obsessive compulsive disorder (OCD). Exposure therapy involves starting with items and situations that cause anxiety, but the anxiety is kept at a level that you feel able to cope with. You need to stay in this situation for one to two hours or until the anxiety reduces for a prolonged period. You will need to repeat this exposure exercise regularly. After the first few times, you'll find your anxiety isn't as bad and doesn't last as long. You'll then be ready to move to a more difficult situation. This process should be continued until you have tackled all the situations you want to overcome.

Further reading and references

  • Computerised cognitive behaviour therapy for depression and anxiety; NICE Technology Appraisal Guidance, February 2006 (last updated May 2013)

  • Gartlehner G, Gaynes BN, Amick HR, et al; Comparative Benefits and Harms of Antidepressant, Psychological, Complementary, and Exercise Treatments for Major Depression: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016 Mar 1164(5):331-41. doi: 10.7326/M15-1813. Epub 2015 Dec 8.

  • Pompoli A, Furukawa TA, Imai H, et al; Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database Syst Rev. 2016 Apr 134:CD011004. doi: 10.1002/14651858.CD011004.pub2.

  • James AC, James G, Cowdrey FA, et al; Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2015 Feb 182:CD004690. doi: 10.1002/14651858.CD004690.pub4.

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