Cognitive Behavioural Therapy (CBT) is a type of psychotherapeutic treatment that helps people understand and change unhelpful thoughts, beliefs and behaviours. It’s based on the idea that our thoughts, beliefs, feelings, and behaviours are closely connected. One way of understanding this is the ABC model.
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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.