Rose Maria Hall. M.Sc., PgDip., B.Sc., DipHE.

How CBT Works

Cognitive Behaviour Therapy is a collection of research-based treatment processes for depression and anxiety states. When people meet with a CBT Therapist the focus of the assessment and treatment is on the way in which that individual’s thoughts (cognitions), feelings and behaviour interact. The process is a cycle where events can trigger body feelings (such as lethargy) leading to automatic thoughts (for instance ‘I’m useless’ ‘People are sick of me’) and then to behaviour (Staying in, staying away from people). Any of the three components of thoughts feelings and behaviour can drive the cycle.

Cognitive Therapy

This looks at the ways in which people’s thoughts (cognitions) can affect their mood and feelings and therefore their behaviour.  Cognitions can be automatic thoughts [either positive or negative], assumptions or core beliefs. If life events or our actions or feelings cause discord with our assumptions or core beliefs then we experience anxiety or depression. People are encouraged to look for the evidence for and against their beliefs about themselves and others, their negative automatic thoughts and their negative predictions. Acceptance and Commitment Therapy encourages people to accept what cannot be changed and commit to moving forward in a new direction that incorporates those things which cannot be changed.

Behaviour Therapy

People tend to repeat cycles of behaviour even if they know that they are not helpful because we all feel more comfortable with what/where/who we already know, especially when we feel anxious or low in mood and vulnerable.  Behaviour therapy is based upon the idea of antecedents to behaviour, the behaviour and the consequences; that behaviour will be repeated if it is rewarded. CBT will look at the way in which unhelpful behaviours may unwittingly bring rewards. Carrying out a cost-benefit analysis helps the client to identify why unhelpful behaviours are repeated. A young person’s capacity for complexity of thinking develops through childhood, so research has demonstrated that behaviour therapy is more effective with children.


Feelings are experienced in our body. When working with anxiety a therapist will examine with the client what they notice about the feelings in the different part of their body when anxious, such as a fast-beating heart and shaky legs and hands. Similarly, when people are depressed they will feel lethargic, eye contact is difficult the body is stooped and there is a lack of appetite.  A cognitive behaviour therapist will help the client to gain overcome the physiological symptoms, helping to build confidence and optimism. Mindfulness focusses upon our awareness and relationship with our own body and thus build our self-concept and our confidence.  Systemic Experiential Embodied Reprocessing (SEER) relates directly to the trauma experience in the body thus by-passing cognitions that trigger the re-experiencing of trauma and dissociation in the therapeutic setting.