What Is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy (CBT) was developed during the 1950s as psychologists began looking at how people’s thoughts could affect their emotions and behaviour. American psychiatrist Aaron Beck was one of the key figures in its development. He found that people experiencing depression often had automatic negative thoughts about themselves, their experiences and the future. His work helped shape a structured form of therapy that focused on changing these patterns.

CBT has since developed into several different approaches and is now used across mental health services in the UK. The NHS recommends CBT for conditions including depression, anxiety, OCD, PTSD and eating disorders, as well as problems involving alcohol and drugs.

This guide explains what CBT involves, how sessions work, how long treatment usually takes and how CBT can support people dealing with addiction.

What Is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy is a type of talking therapy that looks at the connection between your thoughts, feelings and behaviour. A therapist works with you to identify patterns that may be contributing to a problem and helps you develop different ways of responding.

CBT is usually structured around specific problems and goals. Instead of spending every session simply talking about how you feel, you and your therapist may look at a recent situation, examine what you thought and did, and work out what could be changed.

In simple terms, CBT focuses on helping you understand:

• Your thoughts and how they affect the way you feel and behave
• Your feelings and how they can influence your reactions
• Your behaviour and how your actions can affect your thoughts and emotions
• Unhelpful patterns that may keep a problem going
• Practical coping skills that can help you deal with difficult situations
• New ways of responding to thoughts, emotions and situations that cause problems

How Does CBT Work?

CBT is based on the idea that thoughts, feelings and behaviour are closely connected. A difficult situation can lead to a particular thought, which can affect your emotions and influence what you do next. The behaviour that follows can then affect how you feel about the situation.

For example, someone dealing with alcohol addiction may experience stress at work and think, “I need a drink to deal with this.” That thought can increase the urge to drink. Drinking may provide temporary relief, but it can create further problems that add to the person’s stress.

CBT helps the person look closely at this pattern. The therapist may explore what happened before the urge appeared, what thoughts were involved, and what happened after the person acted on the urge.

The person can then learn to recognise the pattern earlier and practise a different response. This might involve challenging the thought, delaying the decision to use alcohol, leaving a high-risk situation or using another coping strategy.

CBT does not mean forcing yourself to think positively. The focus is on looking at thoughts and beliefs more realistically and understanding how they affect your behaviour. NHS guidance describes CBT as a way of questioning unhelpful thoughts and beliefs, considering other ways of looking at situations and changing behaviours that may be causing problems.

What Is CBT Used For?

CBT is used for a wide range of mental health conditions and other problems. The type of CBT used can change depending on the condition being treated.

What Happens During a CBT Session?

CBT sessions are usually structured around the problems you are experiencing and the goals you want to work towards. Sessions are often held once a week or once every two weeks, with individual therapy, group sessions, and online formats all available depending on the service.

1) First Session: Understanding Your Needs and Setting Goals

Your first session usually starts with an assessment. The therapist will ask about the difficulties that brought you to therapy, how they affect your daily life, and what you would like to change.

Depending on why you are having CBT, you may also discuss your mental health, physical health, relationships, work, substance use and previous treatment. You do not have to explain your entire life story, as CBT generally focuses on current problems, although earlier experiences may be discussed when they still affect the way you think or behave.

The therapist will also explain how CBT works and allow you to ask questions. You can then agree on some treatment goals together. These goals give the sessions a clear direction and make it easier to see what you are working towards.

2) Starting With a Check-In

At the beginning of later sessions, your therapist will usually ask how things have been since your previous appointment. You may talk about changes in your mood, difficult situations, symptoms or anything that has happened during the week.

If you have been practising a CBT technique between sessions, this is also a chance to discuss how it went. You can talk about what was useful, what felt difficult, and situations where you struggled to use the technique.

3) Agreeing What to Focus On

CBT sessions are usually organised around a shared agenda. You and your therapist decide which issue needs attention during that appointment instead of trying to cover every problem you are facing.

For example, someone having CBT for addiction may want to discuss a strong craving they experienced during the week. You might look at what happened before the craving, what you were thinking at the time and what you did afterwards.

The focus can also change as treatment progresses. An issue that felt urgent during the first few sessions may become less important once you have developed better ways of managing it.

4) Looking at the Problem in Detail

The main part of the session involves working through the issue you have chosen. Your therapist may help you break down a particular situation into your thoughts, feelings, physical reactions and behaviour.

You may then look at how these parts are connected. For example, a person may experience stress, think that they cannot cope without alcohol, feel an intense urge to drink and then start looking for an opportunity to use alcohol.

The therapist can ask questions to help you examine these thoughts and consider whether there are other ways of understanding the situation. This process is sometimes called guided discovery because you work through the problem together instead of simply being told what to think.

5) Learning and Practising a CBT Technique

Once you have identified a pattern, your therapist may introduce a technique that could help you deal with it differently. The technique will depend on the problem being discussed.

You might work on questioning an unhelpful thought, looking for evidence that supports or challenges a belief, changing a behaviour or practising a different response to a difficult situation.

In addiction treatment, CBT can include work around cravings, high-risk situations, alcohol, or drug-related thoughts and coping strategies. NICE guidance describes CBT for alcohol problems as focusing on areas such as alcohol related thoughts and behaviours, high-risk situations, and coping skills.

6) Agreeing on Between-Session Practice

Towards the end of the appointment, your therapist may suggest something to practise before the next session. CBT often involves this type of between-session work because the techniques need to be used in everyday situations, not just discussed during therapy.

You might be asked to keep a thought diary, record situations that trigger cravings, practise a new coping technique or test a different way of responding to a problem.

The exercise should relate to the work you have done during the session. At your next appointment, you can discuss what happened and work out what to try next.

7) Reviewing the Session and Planning Ahead

The session usually finishes with a short review of what you have covered. You and your therapist may summarise the main points, check that you understand the technique you have been practising and agree on what you will work on before the next appointment.

You can also tell your therapist if something did not feel useful or if you want to spend more time on a particular issue. CBT is a collaborative process, so your feedback can help shape the following sessions.

Over time, the aim is to become more confident using the skills yourself. NHS guidance explains that people are encouraged to continue using the skills they learn after their course of CBT has finished.

How Long Does CBT Take?

A typical CBT session lasts around 30 to 60 minutes, and sessions are commonly held once a week or once every two weeks. The NHS says people usually have 5 to 15 sessions, while some NHS services describe courses lasting around 5 to 20 sessions.

For depression, the NHS gives an example of around 8 to 16 sessions, depending on the person’s condition and treatment needs. Addiction-focused CBT can follow a different structure, particularly when it forms part of a wider rehabilitation programme.

A short course may be enough for some problems, while more sessions can be used when the difficulties are more complex. The therapist will normally review progress throughout treatment and decide whether further sessions are appropriate.

What Are the Benefits of CBT?

CBT is widely used because it gives people practical ways to understand and manage problems. It can also teach skills that can continue to be used after formal therapy has finished.

For someone receiving addiction treatment, CBT can be particularly useful for understanding patterns linked to substance use and developing responses to cravings and high-risk situations. NICE guidance describes CBT approaches for alcohol problems that include identifying high-risk situations, changing expectations around alcohol and developing coping strategies.

Key benefits can include:

• Understanding thought patterns and recognising thoughts that may contribute to distress or harmful behaviour
• Learning practical coping skills for difficult emotions and stressful situations
• Managing cravings by recognising triggers and developing alternative responses
• Changing harmful behaviours that can keep a problem going
• Improving emotional awareness by recognising the connection between thoughts, feelings and actions
• Dealing with high-risk situations that may increase the urge to drink or use drugs
• Building problem-solving skills that can be applied to everyday difficulties
• Developing skills for long-term recovery that can continue to be used after therapy ends

How AnorMed Can Help You Find Addiction Treatment

CBT can be part of addiction treatment, but it is only one type of support available. The right treatment plan depends on the substance involved, the person’s physical and mental health, level of dependence and previous treatment.

AnorMed is an independent addiction treatment referral service, not a rehab centre or therapy provider. Our advisors can help you explore suitable rehabilitation providers across the UK and Europe based on your circumstances.

If you are looking for addiction treatment that includes CBT or other psychological therapies, we can help you compare suitable treatment options and understand what different providers offer. This can include residential rehab, outpatient treatment, detoxification and aftercare.

FAQs

Is CBT the same as counselling?

CBT and counselling are both talking therapies, but they use different approaches. CBT is usually structured around specific problems, thoughts and behaviours, while counselling may provide more space to discuss personal difficulties and explore feelings with a trained professional.

Can I choose my CBT therapist?

If you are paying for CBT privately, you can usually choose which therapist you want to work with. NHS services work differently because you are normally matched with a therapist through the service. You can still ask questions about the therapist’s experience and the type of CBT they provide.

What qualifications should a CBT therapist have in the UK?

When looking for a private therapist, check their professional training and registration. The NHS recommends using an accredited CBT therapist and provides information about the UK CBT Register. You can also check professional registers such as the British Association for Behavioural and Cognitive Psychotherapies (BABCP)

Is everything I say during CBT confidential?

CBT sessions are normally confidential, and therapists should explain how your information is handled before treatment begins. Confidentiality has limits in situations involving serious safety or safeguarding concerns, or where information must legally be disclosed. Your therapist should explain these limits to you.

Can CBT be done in a group instead of one-to-one?

Yes. CBT can be delivered individually or as part of a group programme. Group CBT allows participants to work with a therapist alongside other people experiencing similar difficulties. The format used depends on the condition being treated and the service providing the therapy.