What Is CBT Therapy and How Does It Work?
Cognitive behavioural therapy in Oakville is something many people come across when researching therapy for anxiety, depression, stress or other mental health concerns. But knowing that CBT is a common form of therapy doesn’t necessarily explain what actually happens when you sit down with a therapist.
Will you spend the entire session talking about your past? Will you be given homework? Is the therapist going to tell you that your thoughts are wrong? And how is CBT different from simply talking through what you’re experiencing?
Cognitive behavioural therapy, commonly called CBT, is a structured form of psychotherapy that explores the connections between thoughts, emotions and behaviours. Rather than simply telling yourself to “think positively,” CBT can help you recognize patterns that may be contributing to distress and develop practical ways of responding differently.
Here’s what that can look like in therapy.
What Is Cognitive Behavioural Therapy?
CBT is a form of psychotherapy that focuses on the relationship between the way we think, the way we feel and the way we behave.
The basic idea is that these areas can influence one another.
Imagine you send a message to a friend and don’t receive a response.
You might immediately think, They’re upset with me.
That thought could lead to anxiety, embarrassment or sadness. In response, you might send several more messages, replay your last conversation repeatedly or avoid contacting that person again.
But there are many possible explanations for why someone hasn’t responded.
CBT helps people become more aware of these automatic interpretations and examine whether there are other ways to understand or respond to a situation.
According to the Centre for Addiction and Mental Health’s guide to cognitive behavioural therapy, CBT is a structured, problem-focused and goal-oriented form of psychotherapy that helps people examine how their thoughts, attitudes and beliefs relate to emotional and behavioural reactions.
What Happens During a CBT Therapy Session?
CBT sessions vary depending on the person, their concerns and their treatment goals.
Early sessions will typically involve talking about what brought you to therapy and identifying the difficulties you would like to work on.
You and your therapist may discuss:
- Situations that trigger difficult emotions
- Thoughts that tend to appear in those situations
- Behavioural patterns or coping strategies
- How those patterns affect your daily life
- Goals you would like to work toward
CBT tends to be collaborative. Rather than the therapist simply telling you what to do, you work together to understand patterns and develop strategies for changing them.
At The Therapy Centre, treatment plans are individualized according to a client’s needs, goals and circumstances rather than applying the same approach to everyone.
Is CBT Just About Changing Negative Thoughts?
No. This is one of the most common misconceptions about CBT.
The goal isn’t to replace every uncomfortable thought with a positive one.
If you’re experiencing something genuinely difficult, telling yourself that everything is wonderful probably won’t be particularly helpful.
Instead, CBT can help you examine whether your interpretation of a situation is accurate, useful or influenced by an established thinking pattern.
For example:
Automatic thought: “I made a mistake at work. I’m terrible at my job.”
CBT might encourage you to examine that conclusion.
Did one mistake actually mean you’re terrible at your job? Is there evidence that contradicts that thought? Would you reach the same conclusion if a colleague made the same mistake?
The objective isn’t forced positivity.
It’s developing a more balanced way of evaluating thoughts rather than automatically treating every thought as a fact.
What Can CBT Help With?
CBT has been studied extensively and is used for a variety of mental health concerns.
CAMH notes that research particularly supports CBT for anxiety and depression, while CBT has also been adapted for concerns including obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, specific phobias and other difficulties.
Depending on the person and their needs, CBT may be used when working with:
- Anxiety
- Depression
- Panic attacks
- Phobias
- Obsessive-compulsive disorder
- Stress
- Low self-esteem
- Perfectionism
- Emotional regulation
- Sleep difficulties
- Certain trauma-related concerns
The Therapy Centre has clinicians trained in CBT who work with a range of concerns, including anxiety, mood difficulties, OCD, stress, perfectionism and relationship issues.
That doesn’t mean CBT will automatically be the best approach for every person experiencing one of these concerns. The appropriate treatment depends on the individual, their symptoms, their goals and other factors a qualified clinician can assess.
How Does CBT Help With Anxiety?
Anxiety provides a useful example of how thoughts and behaviours can reinforce one another.
Suppose you’re nervous about speaking during a meeting.
You think:
I’m going to embarrass myself.
That thought increases your anxiety.
You decide not to speak.
Avoiding the situation provides immediate relief, which can make avoidance feel like the safest choice the next time.
Over time, the cycle can continue.
CBT may involve identifying the thoughts contributing to the anxiety while also gradually changing behavioural responses.
Depending on the anxiety concern, treatment may incorporate strategies such as exposure, where a person gradually and systematically faces situations they have been avoiding.
If anxiety is what brought you to this article, you can also learn more about anxiety treatment and therapy at The Therapy Centre.
Does CBT Focus on the Past?
CBT generally focuses more heavily on what is happening in your life now and what may be maintaining a current difficulty.
That doesn’t mean your past is ignored.
Previous experiences can influence beliefs, expectations and behavioural patterns. Understanding where those patterns came from may be relevant to therapy.
However, CBT usually places significant emphasis on identifying what you can work on in the present.
For someone who wants to understand a current pattern and develop practical strategies for changing it, that present-focused approach may be useful.
What Is the Difference Between CBT and Talk Therapy?
“Talk therapy” is a broad term rather than one specific form of treatment.
Many different types of psychotherapy involve talking with a therapist, and CBT is one of them.
What makes CBT distinctive is its relatively structured and goal-oriented approach.
You may identify a specific difficulty, explore the thoughts and behaviours connected to it, practise strategies and review what happened between sessions.
Other therapeutic approaches may focus differently on relationships, emotions, past experiences, identity or patterns that develop within the therapeutic relationship.
One isn’t automatically better than another.
The appropriate approach depends on the person and what they are hoping to address.
Do You Get Homework in CBT?
Sometimes.
CBT doesn’t necessarily stop when the therapy session ends.
A therapist may suggest practising a strategy or paying attention to particular patterns between appointments.
That might include:
- Recording thoughts that occur during difficult situations
- Practising a coping strategy
- Trying a different behavioural response
- Gradually facing an avoided situation
- Tracking mood or behaviour
- Completing a worksheet
- Practising a skill discussed during therapy
CAMH identifies practising change strategies between sessions as one characteristic of CBT and notes that people considering the approach should be comfortable with this active component.
The purpose isn’t to give you schoolwork.
It’s to take what you’re learning in therapy and begin applying it to situations that happen in everyday life.
How Long Does CBT Take?
There isn’t one number of sessions that applies to everyone.
CBT is generally considered a time-limited form of psychotherapy, but the length of treatment depends on the concern being addressed, its severity and complexity, the person’s goals and how treatment progresses.
CAMH describes CBT as typically involving approximately 6–20 sessions and notes that treatment length can vary considerably.
Someone working on one specific difficulty may have a very different treatment plan from someone experiencing several overlapping concerns.
A therapist can give you a better idea of what treatment might involve after learning more about what you’re experiencing.
What Does a CBT Therapist Actually Do?
A CBT therapist isn’t simply there to listen, although feeling heard and understood remains important.
The therapist may help you:
- Identify patterns
- Understand connections between thoughts, feelings and behaviour
- Set treatment goals
- Question assumptions
- Develop coping strategies
- Practise new behaviours
- Review progress
- Adjust strategies that aren’t working
The relationship should still be collaborative.
CBT therefore doesn’t have to feel cold or clinical simply because it is structured.
Is CBT the Same for Everyone?
No.
Two people could both attend CBT for anxiety and have very different therapy experiences.
One person may struggle primarily with persistent worry. Another may experience panic attacks. Someone else may avoid social situations because they fear being judged.
The underlying patterns aren’t identical, so treatment shouldn’t be identical either.
CBT also includes specialized approaches and techniques for certain concerns.
For example, exposure and response prevention (ERP) may be incorporated into CBT for obsessive-compulsive symptoms. The Therapy Centre has clinicians trained in CBT as well as ERP and other evidence-based approaches.
This is one reason an individualized assessment is important.
How Do You Know if CBT Might Be Right for You?
You don’t need to diagnose yourself or decide on a specific therapy before speaking with a professional.
However, CBT may be worth discussing if you’re interested in understanding patterns in your thoughts and behaviours and learning practical strategies you can use outside therapy.
You might appreciate CBT if you prefer:
- Having identifiable therapy goals
- Learning practical skills
- Understanding why certain patterns continue
- Practising strategies between sessions
- A collaborative approach
- Some structure within therapy
On the other hand, you may prefer another therapeutic approach, or your clinician may recommend incorporating several approaches based on your needs.
CAMH notes that people often begin to understand within the first few sessions whether CBT feels comfortable and appropriate for their treatment needs.
What Should You Ask a CBT Therapist Before Starting?
Finding someone who offers CBT is only one part of choosing a therapist.
It can also be helpful to ask:
- What experience do you have with the concern I’m experiencing?
- How do you typically use CBT for this type of concern?
- What might sessions look like?
- Will there be work to practise between appointments?
- How will we know whether therapy is helping?
- What happens if CBT doesn’t feel like the right approach?
- Do you incorporate other therapy approaches when appropriate?
You can also ask about the therapist’s professional credentials and experience.
The therapeutic relationship matters. Even when a treatment approach is supported by research, you still need to feel comfortable enough with the therapist to discuss difficult experiences and participate in the process.
Can You Receive CBT Virtually?
Yes, CBT can be provided virtually when appropriate.
The Therapy Centre offers secure virtual therapy throughout Ontario in addition to in-person services at its Oakville, Hamilton and Toronto locations.
For some people, virtual therapy can make regular appointments easier to fit into work, family or commuting schedules.
Whether virtual or in-person therapy is preferable will depend on your needs, circumstances and the type of treatment being provided.
What Should You Expect From Cognitive Behavioural Therapy in Oakville?
If you’re considering cognitive behavioural therapy in Oakville, you don’t need to arrive at your first appointment already knowing exactly which thoughts or behaviours need to change.
The beginning of therapy is an opportunity to explain what you’re experiencing and what you would like to be different.
From there, you and your therapist can identify patterns, establish goals and determine whether CBT or another therapeutic approach is appropriate.
The Therapy Centre’s Oakville location includes psychologists and other clinicians providing evidence-based mental health care, with CBT among the approaches offered by several clinicians.
Understanding CBT Before You Begin
CBT isn’t about being told to stop thinking negatively.
It’s a structured approach to understanding how thoughts, emotions and behaviours can interact and learning ways to respond differently when certain patterns are causing difficulty.
For some people, that may mean questioning an automatic assumption. For others, it may mean gradually approaching something they’ve been avoiding, changing an established behaviour or practising a new coping skill.
Most importantly, therapy should be adapted to the person rather than forcing the person into a predetermined formula.
Understanding what CBT actually involves can make it easier to ask informed questions and decide, together with a qualified mental health professional, whether it makes sense for what you’re experiencing.