The ABC model of Cognitive Behavioural Therapy (CBT)

The ABC model is used to understand how thoughts, feelings, and behaviours are interconnected. It helps individuals identify and change negative patterns by examining these components.

Here’s a breakdown:

• A (Activating event): The activating event or trigger is what initiates the chain. This is commonly an external event but can also be a thought (such as suicidal thoughts) or a feeling.
• B (Beliefs): The thoughts or beliefs about the event. This is how we interpret the A (Activating event). We may be aware of these at the time (Thoughts) or they may be deeper ingrained and automatic (beliefs).
• C (Consequence): The emotional or behavioural response resulting from the beliefs about the event.

I describe the relationship between these elements mathematically;

A x B = C

To give an example; Bob has to give a presentation at work (A), Bob believes his colleagues will negatively judge him (B). which makes him very nervous (C).

If Bob held a different belief (B) about the presentation (A), such as ‘I’m great at presentations and everyone is going to think I’m amazing’, he is more likely to feel excitement (C).

By identifying and analysing the beliefs (B) that link the event (A) to the emotional or behavioural consequences (C), individuals can work to challenge and modify unhelpful beliefs, leading to healthier emotional responses and behaviours. However, changing a belief (B) is rarely as simple as just telling yourself a different story, you have to believe in that new belief, so how do we create this change?

Cognitive Behavioural Therapy (CBT) changing beliefs through actions

Unfortunately,  a lot of thoughts and beliefs appear to happen automatically and simply trying to think differently can seem naïve to people who have been attempting to do that most of their life. As such, CBT has adopted and developed a number of tools and approaches to aid in this change.

Realistic new belief

Most unhelpful beliefs don’t come from nowhere, if we find something difficult its often because, for us at least, it is hard, but probably not as hard as we believe. To put it another way, Bob, from the earlier example, probably isn’t one of life’s natural presenters and if he just believes he’s brilliant at presenting he probably won’t suddenly become brilliant. However, probably can, when calm, present to a sufficient degree. So we formulate the belief accordingly, ‘I don’t enjoy presenting, but I can do it, and it’s generally fine’.

Alternatively, we might emphasis coping and survival as part of the new belief formulation. This is based on the idea that we often tell ourselves that something is terrible or a disaster, when in fact the consequences fall a long way short of this. In this instance Bob’s proposed new belief might be, “I prefer to give good presentations, and when I don’t it is disappointing, but it’s not the end of the world and I can cope with not always being perfect”.

The emphasis is upon making the belief realistic, which makes it easier to accept.

Another way to address this is to take practical measures which raise your ability, so Bob might learn more about how to give a good presentation. By learning this his ability to accept that the presentation will be good increases.

Behavioural experiments

It can be hard to change an automatic reaction, but less hard to deliberately enter a situation with a pre-planned belief that you are rehearsing as you enter that situation. By doing this the person disrupts the old belief, giving the new one some chance to embed. Simultaneously, they are learning that the consequence is not what they believed it would be. By repeating this multiple times they may embed the new belief and become more comfortable in those situations.

The aforementioned Bob could volunteer for presentations and in gently reminding himself of his new belief would find overtime that the new realistic belief is indeed true.

Systematic desensitization

Systematic desensitisation is a process in which a patient is moved through a progressively more challenging series of anxiety provoking situations (A’s) whilst in a relaxed state. The move into a relaxed state fundamentally alters the patients experience of the situation allowing them to lay down new beliefs in relation to the trigger (A).

Bob, could be guided into a physically relaxed state and then be taken through the build up to the presentation, and the presentation itself, in his imagination whilst relaxed. At each stage the guiding therapist would endeavor to help Bob obtain a state of relaxation and calm before moving onto the next stage. Subsequently, Bob may be taught to relax himself so that he can enter a relaxed state more effectively himself and reinforce this as he approaches and gives the presentation.

These are mainstream CBT approaches, but how does hypnotherapy help?

Cognitive Behavioural Therapy (CBT) and hypnotherapy

So how do hypnotherapy and CBT interact? There are a number of ways

• Hypnotic relaxation and questioning can make identifying the and problematic beliefs more easily.
• Hypnosis can be used to help integrate new beliefs. Traditional hypnosis can be used to give direct suggestions for the agreed new beliefs. EMDR can be particularly useful at helping with this change.
• Enabling deeper relaxation to aid with processes like systematic desensitisation

What is Cognitive Behavioural Therapy (CBT) helpful with?

In theory CBT can help with any psychological problem, or physical problem with psychological impact. Specifically, CBT is most well researched for anxiety(1), depression(2), PTSD(3) substance abuse(4) anorexia nervosa (5) and coping with cancer(6).  However, there are a wealth of other problems for which it has been successfully applied and has probably the most substantial body of evidence for its effectiveness of any psychotherapeutic intervention.

Cognitive Behavioural Therapy (CBT)

Hopefully this brief overview has helped you get an understanding of what Cognitive Behavioural Therapy (CBT) is and how it could be of use.

A note of caution and final thought

Despite the mass of evidence for its beneficial effects this does not mean that it works equally well for everyone with every condition. Further, the enthusiasm with which CBT has been deployed in health services around the world, often in short interventions, may mean that many people have encountered it do so in less favorable circumstances, leaving them with a poor perception of it. CBT is a therapeutic tool which fits well into the kit of a generalist, but as with any tool it is not right for ever job and an integrative therapist will use it as and when it appears appropriate.

References

1. Bhattacharya S, Goicoechea C, Heshmati S, Carpenter JK, Hofmann SG. Efficacy of cognitive behavioral therapy for anxiety-related disorders: A meta-analysis of recent literature. Current psychiatry reports. 2023;25(1):19-30.
2. Werson AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults. Journal of affective disorders. 2022;319:189-201.
3. Zainal NH, Soh CP, Van Doren N, Benjet C. Do the effects of internet-delivered cognitive-behavioral therapy (i-CBT) last after a year and beyond? A meta-analysis of 154 randomized controlled trials (RCTs). Clinical psychology review. 2024;114:102518.
4. Boness CL, Votaw VR, Schwebel FJ, Moniz-Lewis DI, McHugh RK, Witkiewitz K. An evaluation of cognitive behavioral therapy for substance use disorders: A systematic review and application of the society of clinical psychology criteria for empirically supported treatments. Clinical Psychology: Science and Practice. 2023;30(2):129.
5. Duggan HC, Hardy G, Waller G. Cognitive-behavioural therapy (CBT) for outpatients with anorexia nervosa: a systematic review and meta-analysis of clinical effectiveness. Cognitive behaviour therapy. 2025:1-46.
6. Xiang L, Wan H, Zhu Y. Effects of cognitive behavioral therapy on resilience among adult cancer patients: a systematic review and meta-analysis. BMC psychiatry. 2025;25(1):204.

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If you have irritable bowel syndrome (IBS) and want to consider natural IBS treatment options here are 5 of the most cutting edge:

Dietary exclusion

Cut down fermentable carbohydrates! if you are not familair with fermentable carbohydrates, these are found in; vegetables, milk, breads, cereals, pasta, legumes and certain fruits, such as apples, pears, nectarines, peaches, plums, apricots and cherries (livestrong). This is the basis for the FODMAP diet, which has been demonstrated to produce good results (Ross et al 2016, Schumann et al 2019) comparable to counselling (Jankovich & Watkins 2016). However the need to consult a specially trained FODMAP Dietician is stressed, and it appears to work best for IBS-D. (Schumann et al 2019).

Probiotics

Topping up with a bit of healthy gut bacteria is beneficial for many people. A recent review of studies published by the British Dietetic Association found that 59% of randomised control trials (RTC’s) for the use of probiotic treatment showed some benefit, either to symptoms or quality of life. This also means that 41% showed no benefit and they were unable to identify a particular strain which proved more beneficial than any other. The pattern of some effect but generally lower than most interventions  was confirmed by a review of 37 clinical research trials. (Ford.a et al 2018) However, it can be beneficial and a short course of probiotic therapy is cheap so it’s probably more than worth it. (Mckenzie et al 2016)

 Acupuncture

A much anticipated follow up study by MacPherson et al  in 2016 found no significant difference between the treatment as usual group and the acupuncture groups. This doesn’t mean that acupuncture doesn’t work for IBS, it simply doesn’t appear to be any better than the normal treatments, a fact confirmed by an analysis of 27 randomised controlled trials of acupuncture for IBS.(Wu 2019)

Hypnotherapy

Hypnotherapy has been part of National Institute of Care Excellence (NICE) guidelines for the treatment of IBS since 2008. It is specifically recommended for people who have had IBS for over a year with little or no benefit from conventional treatment. Using a process called Gut-directed hypnotherapy. This typically takes 6-12 sessions and combines imagery and suggestions to calm the digestion and reduce pain and discomfort. A review of psychological therapies for IBS confirmed that hypnotherapy was effective.(Ford.b. 2018) Perhaps the most interesting thing about hypnotherapy is the variety of ways in which it can be done, with research demonstrating it’s success with groups (Flik et al 2019) and via Skype. (Hasan et al 2019).

Cognitive Behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) looks to adjust assumptions about IBS and it’s triggers and symptoms with an aim to improve patients ability to tolerate it whilst reducing stress induced symptoms.  Research confirms that most people using it experience benefits (Ford.b. et al 2019), what is interesting is that for many this appears to be because of the symptoms changing rather than a change in psychological distress

Conclusion

Most of the findings are positive. However, there is a lack of clarity to which approach is the best. One possible route for research in the future is a combination of dietary and psychological therapies to maximise positive outcomes. (Radu et al 2018)

The author

Matt Krouwel is a hypnotherapist with a PhD in treating IBS with hypnosis. To find out more about hypnotherapy for IBS  

or to book a free consultation with Matt Regarding your IBS call 0778 909 7741 / +44778 909 7741 (non-uk) or email mattkrouwel@gmail.com

References

Boersma, K., Ljótsson, B., Edebol-Carlman, H., Schrooten, M., Linton, S. J., & Brummer, R. J. (2016). Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects. Cognitive Behaviour Therapy, 1-16.

a.Ford, A. C., Harris, L. A., Lacy, B. E., Quigley, E. M., & Moayyedi, P. (2018). Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Alimentary pharmacology & therapeutics, 48(10), 1044-1060.

b.Ford, A. C., Lacy, B. E., Harris, L. A., Quigley, E. M., & Moayyedi, P. (2018). Effect of antidepressants and psychological therapies in irritable bowel syndrome: an updated systematic review and meta-analysis. The American journal of gastroenterology, 1.

Flik, C. E., Laan, W., Zuithoff, N. P., van Rood, Y. R., Smout, A. J., Weusten, B. L., … & de Wit, N. J. (2019). Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. The Lancet Gastroenterology & Hepatology, 4(1), 20-31.

Hasan, S. S., Pearson, J. S., Morris, J., & Whorwell, P. J. (2019). SKYPE HYPNOTHERAPY FOR IRRITABLE BOWEL SYNDROME: Effectiveness and Comparison with Face-to-Face Treatment. International Journal of Clinical and Experimental Hypnosis, 67(1), 69-80.

Jankovich, E., & Watkins, A. M. (2016). Is the restriction of Fermentable Short Chain Carbohydrate (FODMAP) a credible solution for the Irritable Bowel Syndrome patient?. South African Gastroenterology Review, 14(1).

http://www.livestrong.com/article/507667-what-are-fermentable-carbohydrates/ – accessed 1 July 2016

MacPherson, H., Tilbrook, H., Agbedjro, D., Buckley, H., Hewitt, C., & Frost, C. (2016). Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial. Acupuncture in Medicine, acupmed-2015.

McKenzie, Y. A., Thompson, J., Gulia, P., & Lomer, M. C. E. (2016). British Dietetic Association systematic review of systematic reviews and evidence‐based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). Journal of Human Nutrition and Dietetics.

Radu, M., Moldovan, R., Pintea, S., Băban, A., & Dumitrașcu, D. (2018). Predictors of outcome in cognitive and behavioural interventions for irritable bowel syndrome. A meta-analysis. Journal of Gastrointestinal & Liver Diseases, 27(3).

Ross, E., Lam, M., Andrews, C., & Raman, M. (2016). The Low FODMAPS Diet and IBS: A Winning Strategy. Journal of Clinical Nutrition & Dietetics.

Shahbazi, K., Solati, K., & Hasanpour-Dehkordi, A. (2016). Comparison of Hypnotherapy and Standard Medical Treatment Alone on Quality of Life in Patients with Irritable Bowel Syndrome: A Randomized Control Trial. Journal of Clinical & Diagnostic Research, 10(5).

Schumann, D., Klose, P., Lauche, R., Dobos, G., Langhorst, J., & Cramer, H. (2018). Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Nutrition, 45, 24-31.

Wu, I. X., Wong, C. H., Ho, R. S., Cheung, W. K., Ford, A. C., Wu, J. C., … & Chung, V. C. (2019). Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis. Therapeutic advances in gastroenterology, 12, 1756284818820438.

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