What a Typical CBT Session Looks Like

Cognitive Behavioural Therapy (CBT) sessions are structured to help you make gradual, lasting changes by exploring your personal goals, identifying patterns in thoughts and behaviours, practising CBT techniques, and reinforcing these skills with practical homework assignments. Each session builds on the last, with the therapist guiding you through a collaborative process to develop strategies that address your specific challenges.

In this chapter, we’ll take a closer look at what happens in a typical CBT session. Even if you’re working on your own, this guide can help you structure your practice similarly, allowing you to benefit from the CBT framework. By understanding the purpose of each session element—goal setting, thought and behaviour review, skill practice, and homework—you’ll be better prepared to apply these techniques independently.

1. Goal Setting
   Each session typically begins by setting or revisiting specific goals, ensuring that your focus aligns with the areas you most want to improve. Goals provide direction and allow you to track progress over time.

   • Examples of Goals:

     • Reduce anxiety: “I want to feel more comfortable in social settings without constantly fearing judgement.”

     • Increase self-esteem: “I want to build a more positive self-view by challenging self-critical thoughts.”

     • Manage panic symptoms: “I want to learn techniques to manage my anxiety before it escalates to a panic attack.”

2. Reviewing Thoughts and Behaviours
   Next, the therapist will help you identify situations where unhelpful thought patterns or behaviours emerged since the previous session. This reflective step builds awareness and provides real-life examples to apply CBT techniques.

   • Example Review:

     • Situation: “I felt anxious before a meeting and thought, ‘I’ll say something wrong, and everyone will think I’m incompetent.’”

     • Emotion: “I felt nervous and self-conscious.”

     • Behaviour: “I stayed quiet and avoided participating.”

     • Reflection: This situation reveals a thinking trap (mind reading) and an avoidance behaviour, both of which reinforce social anxiety.

3. Skill Practice
   The therapist introduces specific CBT skills based on your goals, which you then practise during the session. This could include thought-challenging, exposure exercises, relaxation techniques, or behavioural activation.

   • Example Skills:

     • Thought-Challenging: “What’s the evidence for and against my thought that everyone will judge me?”

     • Exposure Practice: Plan a graded approach to facing social fears, such as speaking up in small, familiar groups before larger settings.

4. Homework Assignment
   Homework is a key part of CBT, as practising new skills between sessions reinforces learning and helps you apply CBT techniques in real-world situations. Homework often involves recording thoughts and behaviours, practising a specific CBT skill, or completing exposure exercises.

   • Example Homework:

     • Thought Record: Write down any negative or self-critical thoughts that arise during the week and challenge them.

     • Behavioural Activation: Schedule a small, enjoyable activity each day to improve mood if you’re experiencing low motivation.

Consider the following questions to help you clarify what you would want from a CBT session, and how you’d feel about practising skills independently:

1. What goals might you set if you were in a CBT session?
   Reflect on specific areas you’d like to improve, such as reducing social anxiety, building self-esteem, or managing stress. How would reaching these goals impact your life?

2. How do you feel about practising skills outside of a session?
   Change often requires effort outside the sessions. Think about any challenges you might have with practising skills independently. How could you make it easier to incorporate CBT techniques into your daily routine?

To simulate a CBT session, the following exercises guide you through the steps of setting goals, practising skills, and using homework to reinforce new insights. Working through these exercises will help you build confidence in applying CBT techniques on your own.

1. Session Mock-Up
   Create a mini-session for yourself, following the CBT structure of goal setting, thought and behaviour review, skill practice, and homework. Take each step seriously and write down your reflections and plans.

   • Step 1: Set a Goal
     Choose one specific goal you want to focus on. Think about why this goal is important and how achieving it might change your experiences.

     • Example Goal: “I want to build confidence in social settings by reducing my anxiety about judgement.”

   • Step 2: Review a Recent Situation
     Think about a situation that aligns with this goal where you noticed negative thoughts or unhelpful behaviours. Use the following prompts:

     • Situation: Describe the event (e.g., attending a work meeting).

     • Thought: Write down the thought that arose (e.g., “I’ll embarrass myself if I speak”).

     • Emotion: Note the primary feeling (e.g., nervousness).

     • Behaviour: Describe your action (e.g., stayed quiet).

   • Step 3: Practise a CBT Skill
     Based on your situation and goal, choose a CBT technique to practise.

     • Example Skill: Thought-challenging.

       • Ask: “What evidence supports this thought? What evidence contradicts it?”

       • Balanced Thought: “Most people are focused on their own work, and they won’t judge me harshly if I contribute.”

   • Step 4: Plan Homework
     Set a homework task that encourages you to practise this skill outside of your “session.” For instance, you could plan to speak up at least once in a meeting or social situation over the next week and reflect on the outcome.

   Reflection: After completing the mock session, reflect on what you learned and how you felt using these techniques. Was there anything surprising or challenging?

2. Homework Commitment Exercise
   Choose a CBT technique to practise daily for one week, observing your progress and any changes in your mood, thoughts, or behaviour. Use a journal to record each day’s practice and reflect on any insights.

   • Technique: Select a technique that feels relevant to your goals, such as thought-challenging, behavioural activation, or exposure.

   • Daily Log Template:

     • Day & Date: Write the day and date of your practice.

     • Technique Used: Describe the technique you practised.

     • Situation: Briefly note the context in which you used the technique.

     • Outcome: Describe the outcome or any change in your mood, thoughts, or behaviour.

   Example Entry:

   • Day: Monday

   • Technique: Thought-challenging

   • Situation: Felt anxious about sending a work email, thinking, “My boss will think I’m incompetent.”

   • Outcome: After challenging the thought (“I’ve handled similar tasks well before, and my boss hasn’t expressed any concerns”), I felt more at ease and sent the email with less anxiety.

   At the end of the week, review your entries. Did practising CBT skills impact your reactions or experiences? This exercise highlights the importance of consistency and shows how small changes accumulate over time.

3. Personal Goal Tracker
   A longer-term exercise, this tracker allows you to monitor progress on your CBT goals. Use this tracker to record sessions, progress, and any adjustments to your goals as you go through your CBT journey.

   • Goal: Write down the specific goal you’re working on.

   • Steps to Achieve Goal: Break the goal down into smaller, achievable steps. For instance, if your goal is to build confidence, the steps might include speaking in a small group, participating in meetings, or practising positive self-talk.

   • Progress Notes: After each “session” or practice, note any progress or challenges.

   • Adjustments: Update your approach if needed. If certain steps feel too challenging, break them down further or adjust the techniques.

   Example:

   1. Goal: Feel less anxious in social situations.

   2. Steps to Achieve Goal: 1) Attend social events with close friends, 2) Practise introducing yourself in small groups, 3) Share opinions in group settings.

   3. Progress Notes: This week, I attended a small gathering with a friend. I felt nervous but introduced myself to a few new people, which went well.

Adjustments: Next week, I’ll try attending a similar event alone, focusing on relaxed, brief interactions.

In this chapter, you explored the typical structure of a CBT session, including setting goals, reviewing thoughts and behaviours, practising skills, and completing homework. Each component builds on the last to reinforce progress, helping you gain confidence in applying CBT techniques independently. This structured approach allows for measurable growth, offering a roadmap for making consistent, positive changes. The exercises provide practical tools for practising CBT techniques outside of a formal session, promoting self-awareness, resilience, and self-efficacy.