Cognitive behavioural therapy (CBT)
It is the most studied psychological approach. It is based on a simple idea: what we think, what we feel and what we do are linked, and changing one helps to change the others. I explain what it involves, what research says and how it works in practice.
What is CBT?
Cognitive behavioural therapy brings together two traditions. Behavioural techniques, based on the laws of learning, work on what we do: exposure, relaxation, skills training. Cognitive techniques, developed by Albert Ellis and Aaron Beck, work on the way we interpret what happens to us. It is a structured, present-focused therapy, with concrete goals defined with the person.
Its basic principles
Everything is connected
Thoughts, emotions, physical sensations and behaviours influence each other.
It is not only what happens
According to Ellis’s ABC model, it is not events (A) that directly produce emotions (C), but the way we interpret them (B).
Measurable goals
We set concrete goals and assess progress with data, not just impressions.
CBT is one of the few psychotherapies that have been systematically evaluated in controlled clinical trials for decades.
How CBT understands difficulties
Aaron Beck proposed that our way of thinking is organised on three levels: automatic thoughts, which pop up quickly in each situation; the processes by which we interpret information, sometimes with distortions (overgeneralising, black-and-white thinking, mind reading…); and core beliefs, deep ideas about ourselves, others and the world, which form early in life.
On the behavioural side, many difficulties are maintained by what we do to feel better in the short term, such as avoiding what frightens us. CBT seeks to identify these cycles and break them.
The three waves of cognitive behavioural therapies
CBT is not a fixed model: it has evolved in three main waves. The first wave is behaviour therapy, based on the laws of learning (exposure, reinforcement, skills training). The second brought in cognition with Beck and Ellis: this is what is often called “classic” CBT. The third wave, also known as contextual therapies, appeared in the 1990s and emphasises the relationship we have with our thoughts and emotions, acceptance, mindfulness and values. It includes acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT) and mindfulness-based cognitive therapy (MBCT).
In my practice, I integrate these three waves. I have specific training in third-wave therapies, especially ACT, mindfulness and DBT, which I combine with classic techniques according to each person’s needs. I explain this in more detail on the page about third-wave therapies.
What research supports
CBT is the reference treatment for many difficulties in clinical guidelines. A few examples:
Anxiety disorders
Strong research support for generalised anxiety and social anxiety, and exposure therapy for specific phobias (APA Division 12).
Post-traumatic stress
Trauma-focused CBT is strongly recommended by the APA (2020) and NICE (2018).
Depression
It is one of the psychological treatments recommended by international clinical guidelines.
Other difficulties
Insomnia, relationship difficulties, addictions, chronic pain or eating disorders, among others, with specific protocols.
A review of 269 meta-analyses (Hofmann and colleagues, 2012) concluded that the evidence for CBT is very extensive, especially for anxiety disorders.
The main techniques
A toolbox adapted to each situation
CBT is not a single technique, but a set of procedures chosen according to the formulation of each case:
Cognitive restructuring
Spotting the thoughts that cause distress and examining them: what evidence do I have? is there another explanation? is it useful to think this way?
Exposure
Gradually and safely approaching what frightens you, so that the fear loses its strength.
Skills training
Assertiveness, communication, problem solving or stress management, with practice and feedback.
Physiological regulation
Breathing and muscle relaxation to manage the body’s activation.
An example of restructuring: someone spills their coffee in a café and thinks “how awful, they’re laughing at me” (anxiety, embarrassment). On examining it, they get to “it would be awkward, but not terrible” (annoyance). The interpretation changes, and so does the emotion.
What research says
Some references from the main institutions:
APA, NICE and WHO
CBT is among the recommended treatments for anxiety, depression and post-traumatic stress in the main international guidelines.
A very broad evidence base
Hundreds of trials and meta-analyses support it; its effectiveness is particularly solid for anxiety disorders.
It does not work the same for everyone
Some people do not respond or relapse. That is why we assess progress and, if needed, integrate other approaches, such as ACT.
The fact that an approach has a lot of evidence does not mean it is the only valid one: what matters is choosing what best suits each person and each difficulty.
CBT in practice
Assessment
Understanding the difficulty, when it appears and what keeps it going, often with validated questionnaires.
Formulation and goals
Intervention
Structured sessions where you learn and practise techniques, with exercises between sessions.
Maintenance
We review what you have learnt and prepare relapse prevention.
In my practice, I integrate CBT with ACT and, in cases of trauma, with EMDR. Sessions take place online, in English, French or Spanish.
What CBT is not
It is not “positive thinking”
It is about thinking in a more realistic and useful way, not denying problems.
It is not an advice session
It is collaborative work: you are the one who knows your life best.
It does not ignore the past
It focuses on the present, but takes into account how beliefs were formed.
It is not mechanical
The techniques are adapted to each person, and the therapeutic relationship is essential.
Gonzalo Garzo
Clinical psychologist · integrative approach
I have been a clinical psychologist since 2018, and I am also an anthropologist. For years I combined psychology with management positions (see my LinkedIn profile), before dedicating myself fully to clinical work.
I work with an integrative approach: third-wave CBT (ACT, DBT, mindfulness) and EMDR, adapted to each person’s needs.
I have lived in several countries and I work in English, French or Spanish, online or in La Rochelle.
Frequently asked questions
How long does CBT last?
It depends on the difficulty. Some protocols involve between 12 and 20 sessions; other situations take longer. We decide after the assessment.
Do I have to do exercises between sessions?
Yes, usually. Practising in your daily life is an important part of what makes CBT effective.
Does it work online?
Yes. Most techniques are applied in the same way by video call, and exposure is planned so that you can do it in your own environment.
Is it the same as Beck’s cognitive therapy?
Beck’s cognitive therapy is one of the pillars of CBT, which also includes behavioural techniques and other developments.
Shall we talk?
Sources
- Olivares, J., Maciá, D., Rosa, A. I. and Olivares-Olivares, P. J. (2013). Intervención psicológica: estrategias, técnicas y tratamientos. Pirámide.
- Ruiz, M. A., Díaz, M. I. and Villalobos, A. (2013). Manual de técnicas de intervención cognitivo conductuales. Desclée de Brouwer.
- Caballo, V. (Dir.) (2002). Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos, vol. 1. Siglo XXI.
- Society of Clinical Psychology, APA Division 12 (2016). Treatment Targets.
- American Psychological Association (2020). Clinical Practice Guideline for the Treatment of PTSD.
- National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NG116).
- Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T. and Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
- Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639-665.
- Pérez Álvarez, M. (2014). Las terapias de tercera generación como terapias contextuales. Síntesis.
This page is for information only and does not replace a professional assessment.