(CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

How Cognitive Behavioral Therapy Works

Cognitive Behavioral Therapy can appear to be a complex form of treatment. However, once engaged, you can begin reaping the many successes that come as a result of your therapeutic involvement.

CBT generally includes participation in numerous steps that help change problematic thoughts, emotions, and behaviors. First, you will work with your therapist to identify your prominent areas of concern. This can include anything from feeling overly angry to experiencing panic attacks.

For some, there might be more than one issue that plagues them. However, working to identify issues with a therapist can help you decide which issues you want to address first.

Once the main areas of concern are identified, your therapist will work with you to help you become aware of your thoughts and emotions surrounding these issues. This process will be prompted by your therapist, who will encourage you to communicate as much as you can about your thoughts and feelings. This can include determining your personal beliefs, your values, and your perception of the world and others.

Examining self-talk — which is what a person thinks about themselves, their feelings, and their behavior — is also common during this step. It is suggested that you keep a journal at this time so you can document your thoughts.

In CBT, a therapist helps you recognize any negative patterns of thinking or behavior that you communicate or record. A therapist will also work to get you in tune with your physical and emotional responses in preparation for change. Your therapist helps you recognize any negative patterns of thinking and behavior and asks you to challenge your self-talk to impact your behavior.


What happens during CBT sessions

If CBT is recommended, you’ll usually have a session with a therapist once a week or once every 2 weeks.

The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 60 minutes.

During the sessions, you’ll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.

You and your therapist will analyze these areas to work out if they’re unrealistic or unhelpful, and to determine the effect they have on each other and on you.

Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviors.

After working out what you can change, your therapist will ask you to practice these changes in your daily life and you’ll discuss how you got on during the next session.

The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.

This should help you manage your problems and stop them having a negative impact on your life, even after your course of treatment finishes.

Pros and cons of CBT

Cognitive behavioural therapy (CBT) can be as effective as medication in treating some mental health problems, but it may not be successful or suitable for everyone.

Some of the advantages of CBT include:

  • it may be helpful in cases where medication alone hasn’t worked
  • it can be completed in a relatively short period of time compared with other talking therapies
  • the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps (you can find mental health apps and tools in the NHS apps library)
  • it teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished

Some of the disadvantages of CBT to consider include:

  • you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
  • attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
  • it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions
  • it involves confronting your emotions and anxieties – you may experience initial periods where you’re anxious or emotionally uncomfortable
  • it focuses on the person’s capacity to change themselves (their thoughts, feelings and behaviours) – this doesn’t address any wider problems in systems or families that often have a significant impact on someone’s health and wellbeing

Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn’t address the possible underlying causes of mental health conditions, such as an unhappy childhood.

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Thinking for a Change (T4C) program is made up of activities and concepts that group members learn to apply to their daily life situations. This curriculum has 25 lesson plans with the option of AFTERCARE lessons. AFTERCARE groups would be defined by a group time when participants could meet and practice/apply the tools and skills learned to their real life problems/situations.


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Cognitive behavioral therapy is a treatment that focuses on patterns of thinking and the beliefs, attitudes and values that underlie thinking. CBT has only recently come into prominence as one of the few approaches to psychotherapy that has been broadly validated with research, although it has been used in psychological therapy for more than 40 years. It is reliably effective with a wide variety of personal problems and behaviors, including those important to criminal justice, such as substance abuse and anti-social, aggressive, delinquent and criminal behavior.

Unlike other approaches to psychotherapy, CBT places responsibility in the hands of clients while supplying them with the tools to solve their problems, focusing on the present rather than the past. People taking part in CBT learn specific skills that can be used to solve the problems they confront all the time as well as skills they can use to achieve legitimate goals and objectives. CBT first concentrates on developing skills to recognize distorted or unrealistic thinking when it happens, and then to changing that thinking or belief to mollify or eliminate problematic behavior.

The programs, often offered in small group settings, incorporate lessons and exercises involving role play, modeling or demonstrations. Individual counseling sessions are often part of CBT. Clients are given homework and conduct experiments between sessions. These components are used to gauge the individual’s readiness for change and foster engagement in that change. A willingness to change is necessary for CBT or any other treatment to be effective in reducing further criminal behavior.

Brand name programs often limit clients to 20-30 sessions, lasting over a period of up to 20 weeks. The more treatment provided or the more sessions participants attend over time, the greater the impact on and decrease in recidivism.

The typical CBT program is provided by trained professionals or paraprofessionals. Training for non-therapist group facilitators often involves 40 hours or more of specialized lessons and skill building. Licensed and certified therapists are often part of cognitive programs, especially those involving individual counseling.

Characteristics of the counselor are important to a program’s effectiveness. Counselor honesty, empathy and sensitivity are helpful traits. Support and encouragement, partnership or alliance, and acceptance are necessary in establishing effective rapport, which is especially important in CBT because counselors often take on the role of coach. It is important that counselors be consistent in modeling and expressing the pro-social attitudes and behaviors, moral values and reasoning that are often part of CBT with criminal offenders.

Positive findings from research on CBT are common. Over the years, studies have shown the therapy is effective with various problems, including mood disorders, anxiety and personality and behavioral disorders. Unlike other traditional and popular therapies, CBT has been the subject of more than 400 clinical trials involving a broad range of conditions and populations. It has successfully addressed many issues experienced by children, including disruptive or noncompliant behavior, aggressiveness, oppositional defiant disorder and attention deficit hyperactivity disorder. For adults, CBT has been shown to help with marital problems, sexual dysfunction, depression, mood disorders and substance abuse. It has also been shown to be as useful as antidepressant medication for individuals with depression and appears to be superior to medication in preventing relapses.

One form of psychotherapy stands out in the criminal justice system.

Cognitive behavioral therapy reduces recidivism in both juveniles and adults.

The therapy assumes that most people can become conscious of their own thoughts and behaviors and then make positive changes to them. A person’s thoughts are often the result of experience, and behavior is often influenced and prompted by these thoughts. In addition, thoughts may sometimes become distorted and fail to reflect reality accurately.

Cognitive behavioral therapy has been found to be effective with juvenile and adult offenders; substance abusing and violent offenders; and probationers, prisoners and parolees. It is effective in various criminal justice settings, both in institutions and in the community, and addresses a host of problems associated with criminal behavior. For instance, in most cognitive behavioral therapy programs, offenders improve their social skills, means-ends problem solving, critical reasoning, moral reasoning, cognitive style, self-control, impulse management and self-efficacy.

Recently, Mark Lipsey of Vanderbilt University examined the effectiveness of various approaches to intervention with young offenders.[1] His review analyzed the results of 548 studies from 1958 to 2002 that assessed intervention policies, practices and programs.

Lipsey grouped evaluations into seven categories:

  • Counseling
  • Deterrence
  • Discipline
  • Multiple coordinated services
  • Restorative programs
  • Skill building
  • Surveillance

When he combined and compared the effects of these interventions, he found that those based on punishment and deterrence appeared to increase criminal recidivism. On the other hand, therapeutic approaches based on counseling, skill building and multiple services had the greatest impact in reducing further criminal behavior.

Lipsey also examined the effectiveness of various therapeutic interventions. In particular, he compared different counseling and skill-building approaches. He found that cognitive behavioral skillbuilding approaches were more effective in reducing further criminal behavior than any other intervention.

In a different research review, Nana Landenberger and Lipsey showed that programs based on cognitive behavioral therapy are effective with juvenile and adult criminal offenders in various criminal justice settings, including prison, residential, community probation and parole.[2] They examined research studies published from 1965 through 2005 and found 58 that could be included in their review and analysis. The researchers found that cognitive behavioral therapy significantly reduced recidivism even among high-risk offenders.

Perceptions Affect Behavior

Beliefs, attitudes and values affect the way people think and how they view problems. These beliefs can distort the way a person views reality, interacts with other people and experiences everyday life.

Cognitive behavioral therapy can help restructure distorted thinking and perception, which in turn changes a person’s behavior for the better. Characteristics of distorted thinking may include:

  • Immature or developmentally arrested thoughts.
  • Poor problem solving and decision making.
  • An inability to consider the effects of one’s behavior.
  • An egocentric viewpoint with a negative view or lack of trust in other people.
  • A hampered ability to reason and accept blame for wrongdoing.
  • A mistaken belief of entitlement, including an inability to delay gratification, confusing wants and needs, and ignoring the rights of other people.
  • A tendency to act on impulse, including a lack of self-control and empathy.
  • An inability to manage feelings of anger.
  • The use of force and violence as a means to achieve goals.

Therapy can help a person address and change these unproductive and detrimental beliefs, views and thoughts.[3]

Cognitive Behavioral Therapy and Criminal Offenders

Landenberger and Lipsey found that even high-risk behavior did not reduce the therapy’s effectiveness. For example, some of the greatest effects were among more serious offenders. It may be that the therapy’s enabling, self-help approach is more effective in engaging typically resistant clients, that it increases their participation and therefore the benefits of participation. The therapy is more effective in reducing further criminal behavior when clients simultaneously receive other support, such as supervision, employment, education and training, and other mental health counseling.

The cognitive behavioral therapy approach has recently been used in many prepackaged, brand name programs, such as “Reasoning and Rehabilitation,” “Aggression Replacement Therapy,” “Thinking for Change” and others. The National Institute of Corrections recently published a thorough and comprehensive review of cognitive behavioral therapy, which provides detailed descriptions of these and other programs.[4] Interestingly, although the Landenberger and Lipsey review showed these programs were effective, no single program was superior in reducing recidivism.

More research is needed to determine if it would be effective for offenders to receive cognitive behavioral therapy earlier in their criminal careers or as part of early intervention or parenting training programs.


Dr. Anthony Komaroff,
2012 San Luis Obispo Tribune, writes:

“Cognitive Behavioral Therapy, or CBT, is the leading form of therapy for anxiety.  It attempts to correct ingrained patterns of negative thoughts and behaviors.  Some studies indicate that it is as effective or more effective than medication.
    As the name suggests CBT has two parts.  Cognitive therapy helps you change negative patterns of thinking.  Behavior Therapy works to change your reactions in situations that trigger anxiety.
    Negative thoughts and behaviors tend to crop up when you’re under stress, so the first step in CBT is to help you recognize when you’re stressed.
    Your therapist will ask you to record your thoughts and anxiety levels in certain situations.  Then you and the therapist will discuss your thoughts.  You’ll evaluate how realistic they are.  And you’ll work together to substitute more productive thoughts.
    The behavioral component of CBT has two main strategies.  The first involves having you face your fears directly.  The reasoning is that avoiding anxiety-causing situations reinforces fears or false beliefs.  In real life situations you can practice substituting more realistic thoughts for your negative ones.  With repeated exposure, you should become desensitized to fear-provoking situations.
    The other main strategy is teaching practical skills to help you feel more in control.
    For many people with anxiety, two treatments are better than one.  In particular  many doctors recommend both CBT and medication.  This dual approach can offer longer-lasting results than either medication or therapy alone.