Changing the Patterns That Keep You Stuck: Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy (CBT) is a structured talking therapy. It looks at the links between what happens, how you interpret it, how you feel and what you do next. It helps you spot patterns that keep problems going, and practise more helpful ways of responding.

CBT can be especially useful when you know, logically, that something is probably manageable, but your mind and body still react as if it's a threat. It is one of the most researched therapies, and Australian and international guidelines recommend it for many common conditions.

Where did CBT come from?

CBT grew out of two traditions. In the 1960s, psychiatrist Aaron Beck noticed that people with depression often had quick, automatic negative thoughts about themselves, the world and the future. Around the same time, psychologist Albert Ellis developed a similar approach focused on rigid beliefs. These ideas joined with behaviour therapy, which studies how actions are learned and changed. CBT has since grown into a family of approaches designed for specific problems.

How does CBT work?

CBT starts with a shared understanding of the problem. You and your psychologist look at the situations that trigger distress, the meanings you attach to them, and the responses that bring short-term relief but cause longer-term problems.

Say you feel anxious about speaking up in meetings. The thought "I'll make a mistake and everyone will judge me" leads you to stay quiet. That eases the anxiety for a moment. But the fear never gets tested, so the next meeting feels just as hard. CBT helps you examine the prediction and plan a manageable way to learn something new.

Common thinking patterns CBT looks at include:

• Catastrophising: expecting the worst.
• All-or-nothing thinking: seeing things as total success or complete failure.
• Mind reading: assuming you know what others think of you.
• Overgeneralising: drawing big conclusions from one event.
• "Should" rules: strict rules about how you or others must behave.

Everyone thinks this way sometimes. The aim isn't to judge these thoughts. It's to notice when they are driving distress, and check whether they fit the facts.

An example: how CBT might look in practice

The following example is made up to show the process. It is not a real client.

Sam, 34, had avoided driving on the highway since a near-miss two years earlier. In the first sessions, Sam and their psychologist mapped out the pattern: the thought "I'll lose control", a racing heart, and then avoidance, which brought relief but made the fear stronger. Together they built a ladder of steps. Sam started with sitting in the parked car, then drove short distances on quiet roads, then drove on the highway for one exit with a friend. Between sessions, Sam noted what they predicted would happen and what actually happened. After about ten sessions, Sam was driving to Yeppoon on their own. They still felt nervous at times, but it no longer decided where they could go.

Looking beneath automatic thoughts

Some thoughts reflect deeper beliefs about ourselves, other people or the world. Criticism, rejection or unpredictable environments can lead to beliefs like "I'm not good enough" or "the world isn't safe". CBT can help you identify and test these beliefs, using reflection and new experiences.

This is more than swapping a negative thought for a positive one. A useful new view needs to feel believable and fit the facts. And sometimes a worry points to a real problem that needs practical action, support or change, not just a different way of thinking.

Learning through action

The "behavioural" part of CBT matters as much as the talking. Depending on your goals, it might include:

• Exposure: gradually facing situations you've been avoiding.
• Behavioural experiments: testing predictions to see what really happens.
• Behavioural activation: rebuilding activities that bring enjoyment, achievement and connection, especially for low mood.
• Problem-solving: breaking practical problems into manageable steps.
• Skills practice: such as relaxation, assertiveness or sleep strategies.

What can CBT help with?

CBT has good evidence for many problems, including anxiety disorders, depression, OCD, PTSD, insomnia, eating disorders, health anxiety and stress. Specialised forms have their own names, such as ERP for OCD, CBT-I for insomnia and CBT-E for eating disorders. Adapted forms can support people with ADHD, autistic people and people living with chronic pain or illness. CBT can be done one-to-one, in groups, with couples or families, and online.

What does the research show?

CBT has been tested in hundreds of trials. A review of 409 trials found that CBT improves depression, with results similar to other therapies and medication. A large review of treatments for generalised anxiety disorder also supported CBT, with benefits lasting after treatment ended.

Results vary depending on the condition and what CBT is compared with. A 2023 review of newer trials that compared CBT with a placebo found smaller average effects than older reviews. So "research supports it" doesn't mean it works equally well for everyone. CBT is a strong option to discuss, not the only one.

Common questions

Is CBT just "positive thinking"?

No. CBT aims for thinking that is realistic and helpful, not falsely positive. Sometimes the conclusion is that a situation really is hard, and the focus shifts to problem-solving, support or coping.

What if I don't like homework?

"Homework" just means trying things between sessions. It can be as small as noticing one situation or taking one step. Your psychologist should help you find tasks that fit your life, energy and attention.

What to expect

CBT is usually time-limited. Many people attend somewhere between six and 20 sessions, depending on the problem and their goals. Sessions usually include agreeing on priorities, looking at a recent situation and deciding what to try before next time. Your psychologist should explain why they suggest each exercise and ask for your feedback. You don't need to arrive knowing exactly what you think or why you feel the way you do.

If an approach isn't helping, that's a reason to review the plan together. Some people find that other approaches, such as Acceptance and Commitment Therapy, suit them better or work well alongside CBT.

Getting support at Invision Psychology

Our psychologists offer CBT at our clinics in Rockhampton (2/72 Bolsover Street) and Yeppoon (3/26 James Street), and by telehealth for people across Central Queensland and beyond.

• You don't need to know which therapy you want. Your first appointment is a chance to talk about what's happening and what you'd like to change.
• Medicare: with a Mental Health Treatment Plan from your GP, you may be able to claim a Medicare rebate for up to 10 sessions each calendar year. See our fees.
• NDIS: we work with self-managed and plan-managed NDIS participants.

Make an enquiry or call 07 5641 4888.

If you need help now

If you or someone else is in immediate danger, call 000. For 24/7 support:

• Lifeline: 13 11 14
• Beyond Blue: 1300 22 4636
• 13YARN (Aboriginal and Torres Strait Islander people): 13 92 76
• Kids Helpline (ages 5–25): 1800 55 1800

An appointment enquiry is not an emergency service.

About the author

Alex Parkes BPsychSci, GradDipPsych, MPsych, MAAPi
Founder and Principal Psychologist, Invision Psychology. Level 1 trained Internal Family Systems practitioner.

Published September 2026 · Last reviewed September 2026 · Next review due September 2027

This article gives general information based on published research. It is not a substitute for personalised advice from a qualified health professional.

References and further reading

• NHS. Cognitive behavioural therapy (CBT): overview.
• Cuijpers, P., et al. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials. World Psychiatry.
• Papola, D., et al. (2023; corrected 2024). Psychotherapies for generalized anxiety disorder in adults: a systematic review and network meta-analysis of randomized clinical trials. JAMA Psychiatry.
• Bhattacharya, S., et al. (2023). Efficacy of cognitive behavioral therapy for anxiety-related disorders: a meta-analysis of recent literature. Current Psychiatry Reports, 25, 19–30.
• Hofmann, S. G., et al. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research.