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  • Lemuel Tan

Cognitive Behaviour Therapy

Updated: Feb 23, 2020

We often hear of Cognitive Behaviour Therapy or CBT for short. What is CBT and how does it work?

CBT was pioneered by Aaron T. Beck in the 1960s. He studied psychoanalysis (a form of psychotherapy technique that explores the sub-conscious mind). During the World War II era, there was a strong psychology movement whereby Behaviour Psychology (how we behave) dominated the landscape. CBT naturally came after this era, combining both Behaviour Psychology and Cognitive Psychology (how we think). There are hundreds of studies which suggest the effectiveness of CBT in psychology, mental health and psychiatry.

In its simplest form, CBT suggests that the “Thoughts” in our heads impact our “Behaviours/Emotions”. The “Behaviours/Emotions” in turn impact the “Consequence” of our actions. There are many variations of CBT. The diagram below is a simple example of how CBT works.

CBT notes that a lot of unhealthy “Behaviours/Emotions” stem from our own unhelpful “Thoughts” and that through changing our “Thoughts” we can change our “Behaviour/Emotions” and “Consequence.” We would most probably be okay if we have one or two negative thoughts swirling inside our head. However, when we begin repeating those thoughts over and over again, it starts becoming an unhealthy pattern resulting in distress, helplessness and hopelessness.

The difference between positive thinking (e.g Life is not all bad, there are some good things in my life) and CBT is that at the core of CBT, the clinician works with the clients on evaluating how accurate their thinking is, how helpful their thoughts are and finding alternate ways of thinking (not just thinking positive). It is in the exploring of these factors and really challenging the thoughts that makes CBT different from positive thinking. CBT requires an individual to be intentional about tracking their thoughts. Many CBT practitioners would give homework sheets for clients to track their thoughts.

Below are some pros and cons of CBT. These are not exhaustive but it helps paint a picture of the nature of CBT.


  • Simplicity - CBT is simple to understand and can be taught relatively quickly. Due to its tight structure and concepts, it allows clients to easily track and follow the different components (“Situation”, “Thoughts”, “Behaviours”, “Feelings” and “Consequence”).

  • Flexibility - You can start CBT in any part of the therapeutic journey and it can be done in various formats, for example: Drawing of diagrams, self-help workbooks, apps on your digital devices, audio guidance, etc. The flexibility of the model allows the clinician and client to start on any part of the components.

  • Present - It focuses on the here and now and helps clients challenge individual thoughts without necessary going into past issues.


  • Capacity - CBT assumes that clients are motivated and have the capacity to track the different components. It assumes that clients with some encouragement and exploration can make the changes they want. However, not all clients have the resources or have the physical, emotional or cognitive capacity to sit down and challenge these thoughts.

  • Therapeutic relationship - The relationship with the clinician may not necessary be an active component in the therapy process. Some clients with complex trauma, childhood difficulties and attachment problems may struggle to develop healthy relationships and the best place to assess, mirror, explore and treat these issues is the therapeutic relationship itself, which may be neglected by CBT.

  • Overt focus on thoughts - CBT assumes that clients can change their behaviour and emotions through the analysis of thoughts. However, what it also forgets is that clients are humans who may carry big emotional or entrenched beliefs that may not be easily shifted. Issues such as hopelessness, heightened fear/anxiety responses, deep seated beliefs about who they are as an individual may give rise to these negative thoughts.

In conclusion, CBT is an effective tool in helping clients understand their thoughts, behaviours, emotions and actions. It can be easily deployed and allows the client and clinician to share a similar and simple language when exploring. Several clients reported to me that their experiences of “pure classical CBT only treatment” sessions were long and dry and they felt that the clinician was too much of a technician and that they did not really connect with their therapist. Further to this, it is somewhat unfortunate that the media and the medical sphere tend to over prescribe CBT due to its huge research and popularity. However, like most treatment models it would be reticent to deploy CBT as the only tool in any psychological treatment and it would be recommended that CBT be used as a tool in conjunction with other treatment modalities.

Disclaimer: The material on this blog is not to be used by any commercial or personal entity without expressed written consent of the blog's author. The article above is an opinion of an individual clinician and should not be taken as full clinical advice. The statements on this blog are not intended to diagnose, treat, cure or prevent any mental health or mental illnesses. Always consult your doctor for medical advice or seek professional therapy.

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