Demystifying CBT: helping employees feel more confident accessing mental health support

Paul Murray, Clinical Business Advisor at Aviva, explains how Cognitive Behavioural Therapy (CBT) works, helping advisers better understand one of the most widely used forms of psychological support and enabling more informed conversations with employer clients about encouraging engagement with wellbeing support.

Published: 04 Nov 2026 5 mins read

In a recent webinar on men’s mental health, it occurred to me that often if men can understand how something works, they are more likely to engage in it. Talking treatments are often available as part of employee benefits and as a I practised as a therapist prior to joining Aviva I thought a brief explanation might take some of the anxiety out of engaging in this type of intervention.

Cognitive Behavioural Therapy (CBT) is one of the most widely used and researched forms of psychological therapy in the world. It is based on the idea that the way people think, feel, and behave are closely connected. When someone develops unhelpful patterns of thinking, these patterns can influence their emotions and actions, often creating a cycle that maintains psychological distress. CBT aims to help people identify these patterns, challenge them, and replace them with more balanced and constructive ways of thinking and behaving.

The heart of CBT

At the heart of CBT is the belief that situations themselves do not directly determine how we feel. Instead, our interpretation of those situations has a major influence on our emotional response. For example, imagine that a person sends a message to a friend and does not receive a reply. One person might think, “My friend is busy and will reply later,” and feel relatively calm. Another person might think, “My friend is upset with me,” leading to anxiety, sadness, or worry. The same event has occurred, but different thoughts produce different emotional reactions. CBT focuses on examining these thoughts and understanding how they affect feelings and behaviour.

A key concept in CBT is the idea of automatic thoughts. These are the immediate thoughts that arise in response to a situation. They often occur so quickly that people may not even notice them. Automatic thoughts can be helpful, neutral, or unhelpful. When someone experiences conditions such as anxiety or depression, automatic thoughts are often negative and biased. For example, a person who makes a small mistake at work may automatically think, “I am useless,” rather than recognising that everyone makes mistakes occasionally. CBT helps individuals become aware of these automatic thoughts and evaluate whether they are realistic and supported by evidence.

CBT also examines underlying beliefs and assumptions that shape how people view themselves, others, and the world. These beliefs may develop during childhood or through significant life experiences. A person who repeatedly received criticism growing up may develop a core belief such as “I am not good enough.” This belief can influence how they interpret events throughout their life. For instance, a minor setback may be seen as proof of inadequacy. CBT helps people identify these deeper beliefs and assess whether they are accurate, fair, or useful.

CBT techniques

One of the most important techniques in CBT is cognitive restructuring. This process involves identifying unhelpful thoughts and examining them more critically. Therapists often encourage clients to ask questions such as: What evidence supports this thought? What evidence contradicts it? Is there another way to understand the situation? What would I say to a friend who had this thought? By learning to evaluate thoughts objectively, individuals can develop more balanced perspectives. The goal is not to replace negative thoughts with unrealistic positive ones but to develop thoughts that are more accurate and helpful.

CBT also recognises that behaviour plays a crucial role in maintaining psychological difficulties. People often cope with distress by avoiding situations that make them uncomfortable. While avoidance may provide short-term relief, it often reinforces fear and prevents people from learning that they can manage challenging situations. For example, a person with social anxiety may avoid social gatherings because they fear embarrassment. Each time they avoid such situations, they miss the opportunity to discover that the feared outcome may not occur. CBT encourages gradual exposure to feared situations, helping individuals build confidence and reduce anxiety over time.

Behavioural experiments are another common CBT technique. These are practical exercises designed to test beliefs and assumptions in real-world situations. Suppose someone believes, “If I speak up in a meeting, everyone will think I am incompetent.” A therapist might help them test this prediction by contributing a comment during a meeting and observing the outcome. Often, people discover that their fears are exaggerated or inaccurate. These experiences provide valuable evidence that challenges unhelpful beliefs and promotes change.

For individuals experiencing depression, CBT often focuses on increasing engagement in meaningful activities. Depression can lead people to withdraw from activities they once enjoyed, resulting in reduced pleasure and accomplishment. This withdrawal can deepen depressive feelings. A CBT approach known as behavioural activation encourages individuals to gradually reintroduce activities that provide enjoyment, connection, or a sense of achievement. Even small changes, such as taking a daily walk or meeting a friend for coffee, can have a positive impact on mood and motivation.

CBT is typically a structured and goal-oriented therapy. At the beginning of treatment, the therapist and client usually work together to identify specific problems and develop clear goals. Sessions often follow a consistent format, including reviewing progress, discussing current challenges, learning new skills, and planning activities to practise between sessions. Homework assignments are an important part of CBT because they allow individuals to apply what they have learned in therapy to everyday life. Research suggests that practising CBT skills outside of sessions contributes significantly to successful outcomes.

Tools for life, not just for therapy

One reason CBT is so effective is that it teaches practical, lifelong skills. Rather than relying solely on discussions about problems, it provides tools that people can continue using after therapy ends. Clients learn to recognise negative thinking patterns, challenge cognitive distortions, manage emotional reactions, and engage in behaviours that support wellbeing. These skills can help prevent relapse and improve resilience when facing future challenges.

CBT has been shown to be effective for a wide range of mental health conditions, including depression, generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), eating disorders, and insomnia. It is also used to help people manage stress, chronic pain, health-related anxiety, and difficulties adjusting to life changes. While CBT may not be the best approach for every individual or every problem, it has a strong evidence base and is often recommended as a first-line treatment.

It is important to note that CBT does not aim to eliminate all negative thoughts or emotions. Experiencing sadness, worry, frustration, or disappointment is a normal part of life. Instead, CBT helps people respond to these experiences in healthier and more constructive ways. The goal is to reduce unnecessary distress, improve coping abilities, and enhance overall quality of life.

Final thoughts

In conclusion, CBT works by helping people understand the connections between their thoughts, feelings, and behaviours. Through techniques such as identifying automatic thoughts, challenging unhelpful beliefs, conducting behavioural experiments, and gradually changing behaviours, individuals can break cycles that contribute to emotional difficulties. By developing more balanced thinking patterns and healthier coping strategies, many people are able to improve their mental wellbeing and gain greater control over their lives. CBT is not simply a treatment for mental health problems; it is a practical framework for understanding and changing the patterns that influence how we think, feel, and act every day.