Approaches / Cognitive and behavioural
Cognitive behavioural therapy (CBT)
A structured family of approaches that look at how thoughts, feelings, physical reactions and behaviour connect.
Overview
Cognitive behavioural therapy is a name for a group of related approaches rather than a single method. They share an interest in how the way a person interprets situations, and what they then do, relates to how they feel.
It is usually time-limited and structured. In the UK it is widely offered through NHS talking therapies; in the US it is offered across many clinical and private settings.
Core ideas
Many forms of CBT work with the idea that interpretations of events, and the behaviours that follow, can keep distress going. Therapist and client usually agree a shared description of the problem, then plan ways to examine unhelpful patterns.
Typical elements include noticing and testing beliefs, planning activities, and gradually approaching situations that are avoided. Which elements are used depends on the problem and the practitioner.
What a session can involve
Sessions often begin by agreeing an agenda and reviewing the time since the last meeting. Work then focuses on one or two topics from that agenda, and the session may end with a summary and an agreed task to try between meetings.
The NHS describes CBT as commonly lasting between 5 and 15 sessions, depending on what it is for (UK).
Formats and settings
CBT can be offered one to one, in groups, through guided self-help, online or by telephone. It is used in primary care, specialist clinics, hospitals and private practice, and has been adapted for children, young people and adults.
How it relates to other approaches
Exposure and response prevention, prolonged exposure, mindfulness-based cognitive therapy, acceptance and commitment therapy and dialectical behaviour therapy are sometimes described as part of, or developed from, cognitive and behavioural traditions. Writers differ on where the boundaries lie, and on whether newer approaches count as CBT or as a separate group.
Limits and open questions
Practice varies. Two people offered CBT may receive quite different work, and the label does not guarantee a particular method. Questions remain about which components matter most, how well manualised programmes fit individual circumstances, and how cultural context shapes the work.
Guidance on when CBT is suggested differs by condition and country, so it should be read from the relevant guideline rather than assumed.
History
Behaviour therapy developed in the mid twentieth century, partly from learning theory. Cognitive therapy was developed from the 1950s and 1960s by Albert Ellis and Aaron Beck, who each emphasised the role of beliefs and interpretations. The two traditions were combined in the 1970s and 1980s, and the combined form was then adapted for many conditions.
More than a set of techniques
David Tolin describes CBT as a collection of conceptual elements and treatments, and emphasises understanding the interacting factors involved in a person’s difficulties. In this account, case conceptualisation helps organise how a practitioner understands a problem and selects methods.
Key people
Aaron Beck and Albert Ellis are the two names most often linked with the cognitive side. Judith Beck is known for work on training and manuals in Beck's tradition. Joseph Wolpe is associated with the behavioural side.
Sources and inspection notes
NHS, Cognitive behavioural therapy (CBT)
Supports: What CBT is used for and the usual number of sessions in NHS services (UK).
BACP, What is cognitive behavioural therapy (CBT)?
Supports: An introductory description of the approach from a UK professional body.
Supports: Publisher record identifies the authors and the 1979 first edition; it is bibliographic evidence, not a clinical effectiveness review.
Tolin, D. F. (2024). Doing CBT (2nd ed.). The Guilford Press, preface p. xi and chapter 1, pp. 9–13.
Supports: David Tolin describes CBT as a collection of conceptual elements and treatments, and emphasises understanding the interacting factors. Page markers were checked in extracted text; the page images have not yet been checked.