The Stages of CBT

Cognitive Behavioural Therapy (CBT) is based on the idea that our thoughts, emotions, behaviours, and physical sensations are all closely connected. When we are struggling with anxiety, trauma, low self-esteem, or depression, it’s common to get caught in unhelpful patterns that can keep us feeling stuck.

Often, these patterns develop earlier in life as ways of coping. While they may have made sense at the time, they can continue into adulthood and begin to affect how we think, feel, and respond to situations today.

CBT helps you understand these patterns and where they come from, while also focusing on how to change them in the present. Together, we work to identify and challenge unhelpful beliefs, and develop healthier, more supportive ways of coping.

CBT is a structured, evidence-based therapy. People often ask me what a course of CBT therapy actually looks like, so I’ve written this blog post to give you an overview of the different stages of CBT and what sessions with me might involve.

Assessment

At the beginning of sessions, I want to understand your particular difficulties and what has brought you to therapy.

We will explore:

• the unhelpful thoughts you may be experiencing

• the emotions and physical sensations connected to them

• what you do (or avoid doing) in response

• how these patterns may be affecting your daily life

Depending on what has brought you to therapy, we might talk about:

• getting caught up in worry or overthinking

• being very self-critical

• avoiding certain situations because of anxiety

• struggling with distressing memories, flashbacks, or dreams

• feeling overwhelmed, low, or emotionally exhausted

We will also explore earlier life experiences and relationships to begin making sense of why certain situations affect you in the way they do, and where these unhelpful patterns may have originated.

Goal Setting

CBT is a goal-orientated therapy. Together, we will talk about where you would like to be by the end of therapy - and beyond.

Having a clear direction helps keep sessions focused on the changes that matter most to you and the kind of life you want to move towards.

People often come to therapy wanting to:

• feel less anxious in everyday situations

• stop avoiding things that feel scary or overwhelming

• process painful past experiences

• build confidence and self-esteem

• become less self-critical

• feel more balanced and enjoy life again

  
  

For some people, goals might involve going out for a meal, travelling, speaking up more confidently, or trying something new. For others, it may be about finally feeling able to move forward from difficult experiences or relationships.

Formulation

This is one of the most important stages of CBT therapy.

Together, we build a shared understanding of what may be keeping your difficulties going. We map out the “vicious cycles” that can maintain anxiety, low mood, overwhelm, or low self-worth.

We also explore your earlier experiences and the beliefs you may have developed about yourself as a result. These are often called core beliefs and can sound like:

• “I’m not good enough”

• “I’m a failure”

• “I’m not lovable”

These beliefs can feel like facts rather than opinions, and often trigger strong emotional reactions.

To protect ourselves from painful beliefs, we often develop strict rules or coping strategies, such as:

• “I must always stay in control”

• “I can’t make mistakes”

•  “I must keep everyone happy”

Understanding the links between your past experiences, core beliefs, coping strategies, and present-day difficulties can make patterns much clearer. It also helps us begin to challenge those old rules, develop more balanced beliefs, and try out new ways of responding.

Making Changes

This is the more active stage of CBT, where we begin testing out new ways of thinking and responding so that you can break free from the cycles that have been keeping you stuck.

Most CBT sessions focus on this stage, as CBT is a practical, change-focused therapy that aims to help you make meaningful changes in the present.

There are many different CBT techniques we might use, including:

• challenging unhelpful thoughts

• behavioural experiments

• reducing avoidance

• building self-compassion

• gradually facing fears

• developing healthier coping strategies

• processing distressing memories using imagery techniques

Sometimes this means stepping slightly outside of your comfort zone in a safe and supported way, so that we can test anxious predictions and build confidence through experience.

We may also look at restoring balance in your life, increasing motivation, and helping you reconnect with activities that bring a sense of enjoyment, achievement, or meaning.

There are many different CBT approaches and interventions, and therapy is always tailored to your individual needs and goals.

Therapy Blueprinting (Relapse Prevention)

Throughout therapy, I am working towards helping you become your own therapist.

CBT aims to give you the tools and skills you need to manage difficulties independently and continue moving towards the life you want beyond the end of therapy.

Towards the end of our work together, we will create a “blueprint” of what you have learned in therapy, including:

• your triggers and early warning signs

• patterns you want to watch out for

• the coping strategies that work best for you

• ways to manage future setbacks or “wobbles”

The aim is not to never struggle again, it’s to feel more confident in understanding yourself and responding to difficulties in a healthier, more compassionate way.

Want to Talk About How CBT Could Work for You?

If you’re considering CBT therapy for anxiety, trauma, low self-esteem, or depression, you’re welcome to get in touch.

I offer CBT and EMDR therapy online across the UK and face-to-face in Norfolk.

You can book a free introductory call to talk about what’s been going on for you, whether CBT might be a good fit, and what sessions with me might look like.