What Is Cognitive Behavioural Therapy and How Can It Support Recovery?

Holyoake is committed to providing support to consumers with complex needs and mental illnesses for whom a broad, multifaceted and multidisciplinary approach is required. Providing a range of counselling interventions is at the core of the services offered by Holyoake to you and your family. These include motivational interviews, relapse prevention, narrative therapy, systems and family counselling, cognitive behavioural therapy (CBT) and acceptance commitment therapy (ACT). All interventions are consumer-centred and tailored to your needs.

The History of Cognitive Behaviour Therapy

Cognitive behaviour therapy strategies have been at the forefront of psychological interventions employed over many decades. Originally developed in the 1960s and 1970s by the psychiatrist Dr. Aaron Beck, the goal of ‘cognitive therapy’ was to help clients identify, challenge, and change negative thought patterns. Changing these thought patterns was found to positively impact negative emotions and physical symptoms.

This approach has among the highest levels of empirical support for the treatment of mental health problems such as depression and anxiety, and alcohol and other drug (AOD) problems (Marel et al 2016). Cognitive behavioural therapy has also been used to help people affected by someone else’s AOD problems. Research shows that consistent CBT sessions can significantly improve a person’s emotional health, quality of life, and day-to-day functioning and has been shown to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

The Core Principles of Cognitive Behaviour Therapy

Cognitive behavioural therapy is a short-term form of psychotherapeutic counselling that helps you learn to identify, challenge, and change negative or disturbing thought patterns. People with mental health issues such as anxiety, depression, post-traumatic stress disorder or other traumas may experience these unhelpful thoughts more intensely and more often. Changing these negative thoughts has been described as cognitive restructuring.

CBT is based on several core principles, including that:

Psychological problems are based, in part, on faulty or unhelpful ways of thinking. That is, the way we think and feel affects the way we behave.
Psychological problems are based, in part, on learned patterns of unhelpful behaviour.
People can learn newer, healthier ways of coping that alleviate psychological symptoms and improve their functioning.

When these unhelpful, automatic thoughts occur so frequently that they become a default response, they are considered unhelpful thinking styles. These thoughts may flash through our minds so quickly that we are barely conscious of them. They are a reflection of our core beliefs: those beliefs about ourselves, others and the world.

In essence, what we tell ourselves influences our feelings and our behaviours. Unhelpful patterns of thinking negatively influence feelings and behaviours and are often rooted in incorrect beliefs that can be challenged.

If we think having a drink after a period of abstinence is ‘catastrophic’ because we are “weak-willed,” then we may experience a sense of hopelessness and believe we are incapable of achieving our goal of abstinence. This negative thinking can lead to a lapse that could become a ‘collapse’ or ‘relapse’. If we change how we think about a lapse (e.g., that it was due to being in a high-risk situation and lacking the skills to manage it), we can use the lapse as a learning experience. Viewing a lapse this way reduces the intensity of the feelings and behaviours that follow.

Common Unhelpful Thinking Patterns

CBT can help people recognise thinking patterns that may be adding to their distress, guilt or self-criticism. These patterns can feel automatic, but learning to identify them is often the first step towards developing more balanced thoughts.

Black-and-white thinking: Seeing situations as all good or all bad, such as “I always let everyone down.”
Overgeneralisation: Taking one past experience and applying it to the future, such as “Because I failed at dieting before, I will never be able to manage my weight.”
Jumping to conclusions: Assuming what others are thinking or predicting the worst outcome without enough evidence.
Personalising issues: Taking full responsibility for something that was not entirely, or at all, your fault. For example, someone who has experienced harm or trauma may blame themselves rather than recognising that responsibility sits with the person who caused the harm.
Emotional reasoning: Believing something must be true because it feels true, such as “I feel guilty, so I must have done something wrong.”

When these thinking patterns go unchallenged, they can contribute to distress, shame, guilt and low self-worth. Over time, they may also play a role in anxiety, depression and other mental health concerns.

What CBT Strategies Can You Expect at Holyoake?

CBT is an approach amongst a suite of psychological treatment options utilised at Holyoake. Counsellors will work with you to challenge and dispute any unhelpful or destructive automatic thoughts using cognitive restructuring exercises – in other words, retraining the brain. This approach helps weaken the impact of these thoughts and their tendency to lead to negative feelings and potentially destructive behaviours.

The benefit of cognitive restructuring is that, in addition to reducing the frequency and intensity of unhelpful thinking, clients can learn to distance themselves from their thoughts and question how rational these thoughts are. Counsellors will help you to explore alternative explanations.

Cognitive behavioural therapy is not for everyone. As with many counselling interventions, it has its share of strong advocates and detractors. Detractors may believe that only intensive and long-term intervention is effective. At Holyoake, we offer shorter interventions (generally from 6 to 10 therapy sessions) and believe that CBT has a strong impact in helping consumers address their AOD problems and related mental health challenges. At Holyoake, CBT is embedded in a trauma-informed approach, which is based on the principles of:

Providing safety;
Maximising trustworthiness;
Maximising choice and control;
Collaborating and empowering; and
Understanding cultural and gender issues.

Through this approach, consumers are empowered to make decisions that reduce their trauma symptoms through collaboration and choice.

Support for AOD Users and Their Loved Ones

If you are an AOD user, counsellors will undertake a comprehensive assessment with you to identify the significant issues impacting your life and contributing to your AOD use. This comprehensive assessment will form the basis of any intervention that is required, including the development of your recovery plan and all related treatment, as well as coordination across multiple services to deliver holistic care.

If you are someone affected by someone else’s AOD problems, you will be assisted to understand how to better manage the stress and distress caused by a loved one’s AOD use. Coping strategies will be explored to see if they are helpful. Holyoake understands that as a significant other deeply concerned about your family or friend’s AOD use, you may require support and counselling in your own right. Counsellors understand that you are at increased risk of stress-related physical and psychological problems.

Counselling Tailored to Your Needs

No matter what techniques counsellors at Holyoake employ, a client-centred approach is at the core of any treatment provided. Treatment is non-judgmental, non-confrontational and compassionate. Our counsellors understand that change can be difficult and will tailor their intervention to suit your needs.

If you believe cognitive behavioural therapy could suit you and your mental health needs, reach out to our supportive team at Holyoake and discover healthier thinking patterns.

Frequently Asked Questions

Cognitive therapy is a structured form of talk therapy that helps you understand how your thoughts can affect your emotions, behaviour and physical responses. CBT has its origins in “behaviourism.” This theory assumes that human behaviour is learned and can therefore be changed. With CBT, it can help you notice unhelpful thinking patterns, question them more realistically and develop healthier ways to respond to stress, anxiety, low mood or difficult life experiences.

A simple way to understand CBT is through these five core steps:

Identify the problem or negative situation.
Recognise the feelings and behaviours that are linked.
Identify the thoughts about the situation that are underlying these feelings.
Evaluate and challenge the accuracy of these thoughts.
Make a decision on whether your thought is accurate or not and take action.

Cognitive therapy helps people change unhelpful thinking patterns so they can respond to challenges in healthier, more practical ways.

Cognitive behavioural therapy is a type of therapy, not a separate alternative to therapy. The main difference is that CBT is usually more structured, goal-focused and practical than some other forms of counselling. It often includes exercises, worksheets or strategies to practise between sessions.

CBT may be partly covered by Medicare in Australia if it is provided by an eligible mental health professional under a Mental Health Treatment Plan or another eligible referral pathway. Under the Better Access initiative, eligible people can claim Medicare benefits for a limited number of mental health treatment services each calendar year. Out-of-pocket costs depend on the provider’s fees and the Medicare rebate available.

CBT is commonly used for a range of different disorders and mental illnesses. The main ones that benefit include:

Anxiety and panic attacks – Patients learn more about things and methods that can make them feel calmer when they feel anxious.
Depression – For example, a person who has developed depressive thoughts may start to withdraw from family and neglect their hobbies. This can often cause them to feel even more isolated and sad. CBT aims to disrupt this pattern of thinking and explore ways in which they can become more active and involved again.
Stress management – Counsellors will work with you to identify what is triggering the stress and find methods to reduce these feelings.
Obsessive-compulsive disorder – when CBT is used to treat OCD patients, a specialised subtype called Exposure and Response Prevention (ERP), which aims to break the obsessive cycles by 1) deliberately facing the thoughts that are triggering the stress or obsession, and 2) training the brain to actively choose not to engage in these compulsive behaviours or rituals.

The cognitive approach to schizophrenia looks at how a person interprets unusual experiences, such as hearing voices, suspicious thoughts or distressing beliefs. Rather than arguing with the person, therapy helps them explore these experiences safely, reduce distress and build coping strategies.

Cognitive enhancement therapy is a structured treatment approach designed to improve thinking and social functioning in people with schizophrenia. CET focuses on cognitive function and aims to enhance attention, memory, problem-solving, social understanding and the skills needed for everyday life. It is quite curriculum-driven, and patients learn theory and social processing through computerised games.

Cognitive behavioural therapies for schizophrenia or psychosis may include:

Exploring beliefs gently and collaboratively
Reality testing in a safe way
Coping strategies for voices or intrusive experiences
Reducing avoidance and isolation
Managing stress and triggers
Problem-solving everyday challenges
Building relapse prevention plans
Strengthening confidence and daily routines

You can learn many CBT skills on your own through reputable workbooks, online programmes and guided exercises. Self-guided CBT can be helpful for mild stress, worry or low mood. However, if symptoms are severe, ongoing, trauma-related or affecting daily life, it is safer to work with a qualified mental health professional.

Schizophrenia is usually treated with a combination of approaches.

Medication – Antipsychotic medicines are the main treatment for schizophrenia. They are essential for reducing or eliminating “positive symptoms” like hallucinations and delusions.
Cognitive behavioural therapy – CBT for psychosis can be really helpful for some patients, especially when focused on reducing distress, testing the reality of thoughts and developing effective coping strategies.
Family therapy – Aims to support the person with schizophrenia and the people they live with or are close to, such as partners or family members.
Art therapy – These are designed to promote creative expression with schizophrenia experiences and have been shown to alleviate emotional challenges.
Psychoeducation – The purpose is to increase the patient’s knowledge of their illness and treatment to empower patients and improve medication adherence.

The 3 C’s of CBT are often described as:

Catch the thought
Check whether it is accurate or helpful
Change it to a more balanced response

This simple framework helps people pause, question automatic thoughts and practise a more realistic way of thinking.

Cognitive behavioural therapies for trauma are structured therapies that help people process traumatic experiences, reduce distressing symptoms and rebuild a sense of safety. They may include trauma-focused CBT, cognitive processing therapy, exposure-based approaches and skills for managing triggers, avoidance, anxiety and intrusive memories.

Trauma-focused CBT is a specialised form of CBT that helps people understand and manage the effects of trauma. It often includes education about trauma responses, emotional regulation, gradual processing of traumatic memories, coping skills and support to rebuild confidence and safety.

CBT exercises for trauma may include grounding techniques, thought records, trigger tracking, breathing exercises, gradual exposure tasks, safety planning and identifying unhelpful beliefs linked to the trauma. These exercises should be used carefully, especially when trauma symptoms are strong. Working with a trauma-informed therapist can help make the process safer and more supportive.

References

Marel C, Mills KL, Kingston R, Gournay K, Deady M, KayLambkin F, Baker A, Teesson M (2016). Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (2nd edition). Sydney, Australia: Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales.

Stone, J., Marsh, A., Dale, A., Willis, L., O’Toole, S., Helfgott, S., Bennetts, A., Cleary, L., Ditchburn, S., Jacobson, H., Rea, R., Aitken, D., Lowery, M., Oh, G., Stark, R.,& Stevens, C. (2019). Counselling Guidelines: Alcohol and other drug issues (4th ed.). Perth, Western Australia: Mental Health Commission.