Your Guide to Cognitive Behavioural Therapy

Every psychologist will know of Cognitive Behavioural Therapy (CBT), as it is one of the most commonly practised and studied across mental health professionals. 

It works on the principle that an accurate comprehension of our thoughts will intentionally change our actions and feelings. That is, our internal thoughts are the mechanisms for behavioural and emotional change.

Simply put, when one learns how to identify a thought that might have a negative influence on behaviour and emotions, one might successfully transform outcomes by challenging and replacing initial thoughts with more objective and realistic ones.

behaviour thoughts feelings
Figure 1. Basic principle behind CBT.

CBT is carried out by talking to a therapist over a number of sessions. The therapist will help extricate and help one become aware of inaccurate or negative thinking in other to start reassessing them more effectively. 

Types of Cognitive Behavioural Therapy

There are various ways of adopting CBT. All of them address thoughts, emotions and behaviours.

Cognitive Behavioural Therapy

Cognitive therapy

The focus is on noticing and reassessing untrue or distorted thinking processes, emotional responses and behaviours. 

Some cognitive distortions include:

  • Personalisation: Attributing external negative feelings to themselves.
  • Fallacy of change: Assuming that others will change to suit them.
  • Emotional reasoning: Assuming that if one feels a certain way, that must be true.
  • Fallacy of fairness: Using an imaginary ruler of fairness which maybe result in resentful feelings as others may not agree with the same yardstick.
  • Polarisation: Seeing things in either black or white, all or nothing. If one doesn’t succeed, he/she is a failure. 
  • Overgeneralisation: Broadly concluding based on a single event. 
  • Control fallacies: When attributing external actions as a cause of their own behaviour. For example, thinking that your work is not up to par because of disruptive co-workers 
  • Jumping to conclusions: assuming irrationally about situations.

Dialectical behavioural therapy

This modified type of CBT aims to teach on how to live in the moment, develop healthy ways to cope with stress through emotional regulation and mindfulness. 

Read our article on “Dialectical behavioural therapy” for details. 

Multimodal therapy

Focuses on seven different but interconnected modalities: behaviour, affect, sensation, imagery, cognition, interpersonal factors and drug/biological considerations.

Rational emotive behavioural therapy (REBT)

Seeks to identify irrational beliefs and challenging them. 

Read our article on “ What is rational emotive behavioral therapy: techniques” for details. 

How does CBT work?

The therapist and client should have an honest and trusting relationship, enough for the client to explain problems and outline expectations. The therapist will then be clear of the goals of the sessions. With comprehension and sharing, the therapist will then be able to identify unhelpful thought processes. 

trusting relationship

According to this therapy, a person’s habitual course of thoughts depends on how we see the world – just like wearing a pair glasses to view the world as more rose-tinted, or dark. 

Hence, CBT’s mission is to transform destructive thoughts that inhibit positive outcomes. Depression is like a murky piece of filter that distorts a person’s view of situations and the world. This distorted view lead to cognitive distortions as listed above. 

The therapist will introduce ways to assess the thoughts, via relaxation exercises and problem-solving strategies. The client may be taught some problem-solving skills to manage life stressors. 

Problem solving often involves five steps:

  1. Identification
  2. Proposition of possible solutions
  3. Evaluation of each solution
  4. Choice of solution
  5. Implementation of solution

If the individual changes their way of thinking and places him/herself in an objective stance when analysing that thought, the distress decreases and he/she can function in a way that is more beneficial to self or others. 

In order to achieve this outcome, the therapist may encourage journaling, role-playing, relaxation techniques or mental distractions. 

The therapist and the client must work closely together to counter maladaptive behaviours. Goals (short- and long-term) may be set for the client to attain. These goals are SMART (specific, measurable, attainable, relevant, time-based) and realistic. 

The sessions between the therapist and the client may be critical, but the time the client spends outside these sessions are also crucial. The client has to learn how to monitor him/herself and this can be down by journaling. 

Tracking down behaviours, symptoms, experiences outside the therapy sessions and sharing them with the therapist is integral. For instance, keeping track of what feelings or thoughts emerge when faced with stress at work. 

What CBT is commonly used for?

CBT is a popular method used for depression. People with depression tend to lose interest in activities that previously excite them. A therapist may schedule activities that the client used to enjoy and encourage him/her to engage in them again.

People with depression

“I have used CBT to help a client with depression. We came to see that he tended to catastrophise events. Together, we worked to recognise these ‘hot thoughts’ that distressed him. 

We then re-analysed them and gave himself a kinder, more neutral belief about the situations. 

The next time these triggering events occurred, he was able stop himself from giving them inaccurately-negative interpretations and instead view them in a more balanced manner, says Yvonne, a certified counsellor and coach.

An example of how CBT is used for anxiety disorder is exposing them to the triggers and providing training to control their response in those situations. 

For instance, a person who gets anxious taking public transport may be led to public-facing scenarios while the therapist navigates his/her reactions to more positive ones.

“I have had a client with social anxiety and low self-esteem and I used CBT to re-evaluate his automatic negative thoughts and irrational beliefs. With logical reasoning, we reshaped his maladaptive thinking and replaced it with healthier thoughts. We also used role-play and visualization to practice for real-life events, so that he would have the skills for more successful encounters. This way, his self-confidence increased and his anxiety diminished, allowing him a better quality of life,” shares Yvonne.

low self esteem

Often, therapists also incorporate mindfulness into CBT and encourage clients to focus on the present instead of brooding over past experiences. This helps shift their thinking patterns. 

CBT is generally used to counter mental disorders including: 

  • Depression
  • Anxiety disorders
  • Phobias
  • PTSD
  • Sleep disorders
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Substance use disorders
  • Bipolar disorders
  • Schizophrenia
  • Sexual disorders

What to expect?

The development of CBT can be traced back to as early as 1913. With over a century of research and development, it is one of the most well-studied forms of treatment today. It has shown to be effective but there are important factors to note in order to increase its efficacy.


Work together with your therapist

It is most effective when you set goals together with your therapist like in a partnership. Come to agreement in methods and decisions to progress effectually. 

Be honest

Letting your therapist into your deeper feelings and thoughts or fears always proves to be more effective. This is definitely possible only if you have found a therapist you trust. If you have reservations about sharing, also let your therapist know. 

Stick to your treatment plan

It might be tempting to skip your session if you feel down or unmotivated. Push yourself to attend all sessions in order not to impede progress.

Be patient with yourself

It requires hard work to change cognitive behaviour, especially when working on emotional issues. Usually it takes several sessions before marked improvements can be seen. 

Do your homework

Your therapist might give you assignments to do outside your sessions. Be diligent and keep that journal or be consistent in tackling your thoughts as much as possible. 

Communicate with your therapist

If you are not seeing improvements, speak to your therapist. He/she may alter the approach to suit you better. 

“Relatively speaking, CBT is a short-term, structured process that can take as little as 6 – 12 sessions. The duration of treatment does depend on the individual’s condition and how quickly progress is made. Clients can expect to see results quickly because CBT is focused on addressing the immediate issues at hand, rather than on analysing the past,” Yvonne concludes.

Be patient with yourself

Importantly, one must be willing to change for CBT to be effective. Progress may be slow and gradual but if you work hard with your therapist, you should see affirmative development in your condition.


Yvonne Yeow is a certified counsellor and coach. A member of the Association of Psychotherapists and Counsellors (Singapore) and of the Asia Pacific Alliance of Coaches, she is also a volunteer as a pro bono coach to NGOs and non-profit organisations. She graduated from The University of Western Australia, where she studied Anthropology,  Psychology and Philosophy. Some of her other qualifications are Certified Solution-Focused Brief Therapy Practitioner, Certified Mindfulness and Meditation Teacher and Certified Children’s Character, Confidence and Courtesy Coach®.



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