CBT, what’s all the fuss about ?

Well.. most rumours are actually true. At least according to Frontiers of Psychiatry (the January 2018 edition) CBT is the gold standard in the field of psychotherapy, because of its clear research support and continuous development and improvement based on research findings. It presently dominates the international guidelines for psychosocial treatments, making it a first-line treatment for most disorders, as noted by the National Institute for Health and Care Excellence’s guidelines ² and American Psychological Association.³

CBT is no longer the new kid on the block. Although it was one of the later psychotherapies to emerge, its origins can be traced back to the 1960s, when a number of influential clinicians and researchers began challenging the dominant psychoanalytic models of the time.

One of the key figures was Aaron T. Beck, an analytically trained psychiatrist whose work on depression led to the development of Cognitive Therapy, a structured and evidence-based approach that would later become one of the foundations of modern CBT. Around the same time, my good friend and mentor Donald Meichenbaum was developing innovative cognitive-behavioural interventions. His early work, including the influential paper “How to Train Schizophrenics to Talk to Themselves”, laid the foundations for later models such as Cognitive Behaviour Modification, Stress Inoculation Training, and his extensive work on psychological resilience and post-traumatic growth. Albert Ellis was also making significant contributions through the development of Rational Emotive Behaviour Therapy (REBT), a model strongly influenced by Stoic philosophy and focused on identifying and challenging irrational beliefs.

It soon became clear that this new way of understanding emotional distress represented more than just another therapeutic technique. Cognitive-behavioural approaches offered a practical, measurable, and research-driven framework for understanding how thoughts, emotions, physiology, and behaviour interact. Over the following decades, CBT continued to evolve, expand, and absorb new ideas from clinical practice and scientific research.

Today, CBT is best understood as an umbrella term encompassing a broad family of evidence-based therapies. While these approaches differ in emphasis and technique, they share common roots in learning theory, cognitive science, behavioural psychology, and emotional processing. This family includes therapies such as Schema Therapy, Stress Inoculation Training (SIT), Prolonged Exposure (PE), Metacognitive Therapy (MCT), Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT), Acceptance and Commitment Therapy (ACT), Compassion-Focused Therapy (CFT), and many others. What began as a relatively focused treatment for depression has evolved into one of the most influential and widely researched traditions in modern psychotherapy.

CBT is a pretty fast paced, short-term, modern therapy with flexible therapeutic boundaries. Yes that’s correct fellow therapists, behaviourists have always steered away from traditional psychotherapeutic boundaries – in my humble opinion, these dated boundaries are probably still rooted in an unworkable Freudian-psychoanalytical approach. I am sure this is a gross exaggeration, but nonetheless it does not change the fact that CBT does not necessarily adhere to the traditional therapeutic boundaries. Whilst some therapists still wonder over the usefulness of shaking hands with their patients or comforting someone crying, we stick our hands down the toilet to demonstrate to our OCD patients that germs don’t instantly kill.. and then we shake their hands! Sessions can take place in the comfort of a clinic (if we are lucky enough) or in patient’s residence or outdoors or at patient’s work place. It all depends on the type pf exposure exercises or social experiments that we would have agreed on, in advance, with the patient.

The formal term used in CBT is ‘collaboration’. Indeed CBT therapists collaboratively agree on most, if not all, social experiments and treatment goals, but the clinical reality and the level of chronicity faced in therapy, often demand an approach that is more direct, symptoms focus, problem-solving and goal oriented, relying on a lot of teaching and a clearly prescribed, evidence-informed treatment plan facilitated by an expert therapist (‘expert’ in mental health problems and potential solutions, not in clients’ lives). The therapy methods used, from exposure to cognitive restructuring, are steeply rooted in behaviourism, learning theories and even physiology. The works of Skinner BF, Watson J, Pavlov I, Jacobson E, Salters A and a few other creative but not always popular (or even ethical by today’s standards) behavioural psychologists from the beginning and middle of the 20th century, form a solid foundation for all CBT approaches.

Nowadays cognitive-behavioural practitioners describe methods which evolved over years of research in three distinct waves of CBT. There are whispers about a fourth wave even. The first wave is steeped into the experimental work and research of early behaviourists, the second-wave was kicked off by pioneers such as Aaron T Beck, Albert Ellis and Donald Meichenbaum, this is when the term ‘CBT’ begins to stand out in both research and clinical practice, in fact this would be ‘the CBT’ that most people are familiar with and challenge in research to this day.

Third-wave CBT is marked by a slight departure from earlier methods with the arrival of imagery-based and philosophically informed approaches such as mindfulness and acceptance therapy. The family of CBT therapies is rather large today and packed with acronyms such as MBCT, DBT, ACT, CFT, etc. Even though though mindfulness, acceptance and compassion-based therapies are associated with the Buddhist philosophy it is important to acknowledge that the main drivers that underpin these methods, developed by true visionaries like Jon-Kabat Zinn (MBCT), Marsha Linehan (DBT), Steven Hays (ACT), or Paul Gilbert (CFT), are not the philosophical aspects of our daily living as much as, a covert focus on training the attention with the purpose of affect regulation.

What do all CBT these therapies have in common, would be a topic worthy of a whole new article, please continue to read…

Disclaimer: this site and article are not intended as a self-help manual; the intention with all NA-CBT articles is to help and to develop knowledge. All case studies described are a combination of facts and very little fiction from different sources including personal clinical experiences. Similar work and other great resources for inspiration, can be found on Ted – education, Brene Brown, Roz Shafran, Christine Padesky, Donald Meichenbaum’s research on resilience, and others.

This particular article contains might describe real life situations for learning and authenticity purposes, it may also follow anonymised cases who received NeuroAffective-CBT … this is all part of a series of free handouts offered to students on doctoral or advanced training programs in Integrative-CBT; as already explained, certain details have been changed in order to maintain anonymity.