Cognitive behaviour therapy | AQA A-Level Psychology Revision

Revision Notes

Aug 3

33 min read

Updated: Sep 9

For 7182 specification, first teach in September 2025

AQA A-Level Psychology | Free Revision Notes

Estimated study time: 45 minutes

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These Cognitive behaviour therapy A-Level Psychology revision notes explain how cognitive behaviour therapy, usually shortened to CBT, treats depression by identifying and challenging irrational or unhelpful thoughts. Clients examine the evidence for their beliefs, develop more balanced alternatives and test their predictions through practical activities. You will learn how CBT draws on Beck’s and Ellis’s explanations, how its principles can be applied to unfamiliar examples and how to evaluate the treatment’s effectiveness, demands and suitability for different clients.

The AQA specification requires CBT as a treatment for depression, including the challenging of irrational thoughts and evaluation of its appropriateness and effectiveness.

Learning Objectives 🎯

By the end of this revision page, you should be able to:

Explain how CBT challenges irrational thoughts.
Describe cognitive restructuring.
Explain Ellis’s ABCDE model within therapy.
Explain Beck’s “patient as scientist” approach.
Apply CBT principles to examples of depressive thinking.
Distinguish realistic negative thoughts from cognitive distortions.
Evaluate the effectiveness of CBT.
Evaluate whether CBT is appropriate for different clients and circumstances.

Revision Notes 📚

Cognitive behaviour therapy A-Level Psychology revision overview

Cognitive behaviour therapy, or CBT, is a psychological treatment that aims to change unhelpful patterns of:

Thought.
Interpretation.
Emotion.
Behaviour.

The treatment is based on the idea that these processes influence one another.

A person’s emotional response is affected not only by what happens but also by:

How they interpret the event.
What they believe it means.
What they predict will happen next.
How they behave afterwards.

A simplified CBT cycle is:

Situation → thought → emotion → behaviour → further consequences

For example:

A student receives a low mark.
They think, “I am completely incapable.”
They feel hopeless.
They stop completing work.
Their performance declines.
The decline appears to confirm the original thought.

CBT attempts to interrupt this cycle.

The cognitive basis of CBT

CBT follows the assumptions of the wider study of internal mental processes.

It assumes that thoughts and interpretations can be:

Identified.
Examined.
Tested.
Modified.
Replaced with more balanced alternatives.

The goal is not to tell the client that every situation is positive.

Instead, the goal is to help the client think in a way that is:

More accurate.
More flexible.
Better supported by evidence.
Less extreme.
More helpful for everyday functioning.

The behavioural basis of CBT

CBT does not rely only on talking about thoughts.

Clients may also test beliefs by changing their behaviour.

For example, a person who believes:

“Nobody wants to speak to me”

may agree to:

Send a message to a friend.
Attend a planned activity.
Record how other people actually respond.
Compare the outcome with their prediction.

The behavioural task provides evidence that can be used to examine the original belief.

This is why the treatment is called cognitive behaviour therapy rather than simply cognitive therapy.

The relationship between thoughts, emotions and behaviour

Thoughts can affect emotions

A person who thinks:

“This mistake proves I am worthless”

may experience:

Lowered mood.
Shame.
Hopelessness.
Reduced self-esteem.

A person who thinks:

“This mistake is disappointing, but it can be corrected”

may still feel upset but is less likely to reach a global negative conclusion.

Thoughts can affect behaviour

A person who predicts certain failure may:

Stop trying.
Avoid challenges.
Withdraw socially.
Remain inactive.
Reject support.

These actions may contribute to the behavioural, emotional and cognitive features of low mood.

Behaviour can affect thoughts and emotions

Behaviour can also feed back into cognition.

For example:

A person believes that no activity will be enjoyable.
They stop leaving home.
They experience fewer rewarding events.
Their mood remains low.
They conclude that life contains nothing enjoyable.

CBT may therefore challenge the thought and encourage a manageable behavioural change.

What does CBT aim to change?

CBT may focus on several kinds of unhelpful cognition.

These include:

Irrational beliefs.
Automatic negative thoughts.
Negative schemas.
Magnification.
Overgeneralisation.
All-or-nothing thinking.
Catastrophic predictions.
Unrealistic demands.
Low frustration tolerance.
Negative views of the self, world and future.

These patterns connect CBT with both:

CBT is not simply positive thinking

A common misunderstanding is that CBT teaches clients to replace every negative thought with a positive one.

This would not necessarily be realistic or helpful.

For example, replacing:

“I will definitely fail”

with:

“I will definitely achieve the highest grade”

does not produce balanced thinking.

A more realistic alternative might be:

“The task will be difficult, but one outcome will not determine my worth. I can prepare and respond to the result.”

The aim is balanced thinking, not forced optimism.

The main stages of CBT

Although treatment is adapted to each client, it often involves:

Assessment.
Developing a cognitive formulation.
Identifying negative or irrational thoughts.
Examining the evidence.
Challenging the thoughts.
Developing alternative beliefs.
Testing beliefs through behaviour.
Practising skills between sessions.
Reviewing progress.
Preparing for future setbacks.

Stage one: assessment

Understanding the client’s difficulties

The therapist begins by identifying:

Current symptoms.
Situations that trigger low mood.
Repeated negative thoughts.
Behavioural patterns.
Effects on daily functioning.
Possible goals for treatment.
Factors that may make participation difficult.

The therapist may ask:

What was happening when your mood changed?
What went through your mind?
What did you feel?
What did you do next?
What did you expect would happen?
What evidence supports that expectation?
How did your behaviour affect the situation?

Assessing everyday functioning

The therapist may consider whether depression affects:

Education.
Employment.
Relationships.
Sleep.
Eating.
Personal care.
Activity levels.
Decision-making.

This connects treatment planning with whether symptoms interfere with daily life.

Identifying treatment goals

Goals should be specific enough to assess.

Examples include:

Attending lessons more consistently.
Re-establishing contact with a friend.
Completing a manageable daily activity.
Reducing the frequency of global self-critical thoughts.
Applying for opportunities despite fear of rejection.
Developing a more balanced response to mistakes.

“Become happy” is too broad to provide a clear treatment target.

Stage two: cognitive formulation

What is a formulation?

A cognitive formulation is an organised explanation of how a client’s:

Experiences.
Beliefs.
Automatic thoughts.
Emotions.
Behaviour.

may be connected.

It is developed collaboratively rather than imposed without discussion.

Example formulation

A client experienced repeated criticism during childhood.

They developed the belief:

“I am never good enough.”

A criticism at work activates this belief.

The client thinks:

“I have failed completely.”

They feel hopeless and avoid work.

The unfinished work creates further difficulties, which appear to confirm the belief.

The formulation identifies a cycle that treatment can target.

Formulation is individual

Two people with similar symptoms may have different patterns.

One may focus on:

Failure.

Another may focus on:

Rejection.

Another may focus on:

Loss of control.

CBT should therefore be based on the client’s particular thoughts and experiences.

Stage three: identifying automatic negative thoughts

What is an automatic negative thought?

An automatic negative thought is an unhelpful cognition that occurs rapidly and may feel immediately true.

Examples include:

“I always ruin everything.”
“Nobody could like me.”
“Nothing will ever improve.”
“I cannot cope.”
“This proves I am a failure.”
“Everybody is judging me.”

The thought may occur so quickly that the person initially notices only the emotional consequence.

Separating events from interpretations

CBT helps the client distinguish between:

What happened.
What they thought it meant.

For example:

Event	Interpretation
A friend did not reply for two hours	“They dislike me.”
One application was rejected	“I will never succeed.”
A teacher suggested an improvement	“My work is completely worthless.”
A person looked away during a conversation	“I am boring.”

The first column contains observable events.

The second contains interpretations.

Thought records

A client may use a thought record to identify patterns.

A simple record might include:

Situation	Automatic thought	Emotion	Behaviour
Received one criticism	“The whole project is a failure.”	Shame and low mood	Deleted the work
Friend replied briefly	“They no longer like me.”	Sadness	Stopped messaging
Found a task difficult	“I am incapable.”	Hopelessness	Gave up

Recording thoughts can help the client notice repeated:

Themes.
Cognitive distortions.
Triggers.
Behavioural consequences.

Stage four: challenging irrational thoughts

The AQA specification specifically identifies challenging irrational thoughts as part of CBT.

The therapist does not simply state that the client is wrong.

Instead, the thought is examined through questions, evidence and behavioural testing.

Official AQA marking guidance identifies rational confrontation, empirical and logical argument, Ellis’s ABCDE model and Beck’s patient-as-scientist method as creditworthy ways of challenging irrational thoughts.

Rational confrontation

What is rational confrontation?

Rational confrontation involves directly examining whether a belief is logical, realistic and helpful.

The therapist may ask:

What evidence supports this belief?
What evidence contradicts it?
Does the conclusion follow logically?
Are you applying one event to every situation?
Would you judge another person in the same way?
Is the belief a preference or an absolute demand?
What is the most realistic outcome?
How does holding this belief affect your behaviour?

Confrontation does not mean aggression

The term confrontation refers to challenging the belief.

It should not involve:

Humiliating the client.
Mocking their thoughts.
Becoming hostile.
Dismissing genuine difficulties.

Effective CBT should remain:

Collaborative.
Respectful.
Evidence-based.
Sensitive to the client’s circumstances.

Empirical disputing

What is empirical disputing?

Empirical disputing challenges a belief by examining evidence.

The therapist asks whether the facts support the client’s conclusion.

For example:

“What evidence shows that everybody dislikes you?”

The client may identify:

One cancelled meeting.

The therapist may then explore evidence such as:

Other friends making contact.
Previous invitations.
Supportive messages.
Alternative reasons for the cancellation.

Example

Irrational belief:

“I always fail at everything.”

Empirical questions:

Have you ever completed a task successfully?
Did every part of this task go badly?
What evidence supports the word “always”?
What evidence does not fit the belief?

The client is encouraged to compare the belief with actual experience.

Logical disputing

What is logical disputing?

Logical disputing examines whether the conclusion follows logically from the available information.

For example:

“You made one mistake. Does it logically follow that you are worthless as a person?”

The answer is no.

A specific outcome cannot logically determine the person’s entire value.

Example

Belief:

“I was rejected once, so every future application will fail.”

Logical challenge:

One application provides information about one outcome.
It does not determine all future outcomes.
Different applications involve different organisations, requirements and circumstances.
The conclusion is therefore broader than the evidence allows.

Pragmatic disputing

What is pragmatic disputing?

Pragmatic disputing asks whether holding the belief is helpful.

For example:

Does thinking “I must never fail” help you prepare?
What happens when you treat every mistake as a catastrophe?
Does the belief encourage useful action or complete withdrawal?
Is there a more helpful belief that still recognises the difficulty?

A belief may be challenged because it is:

Inaccurate.
Illogical.
Unhelpful.

Socratic questioning

Therapists may use guided questions rather than supplying every answer.

The client is encouraged to examine their own reasoning.

Questions might include:

Is there another explanation?
What would you say to a friend in this situation?
Are you confusing a thought with a fact?
What is the evidence for the worst-case prediction?
What happened in similar situations previously?
Are you using words such as always, never or everyone?
What might a more balanced conclusion be?

The purpose is to develop independent thinking skills.

Ellis’s ABCDE model in therapy

Ellis’s explanation begins with the ABC model:

A: Activating event.
B: Beliefs.
C: Emotional and behavioural consequences.

Therapy extends this to ABCDE:

D: Disputing irrational beliefs.
E: Effective new belief or effect.

D: Disputing the belief

The therapist helps the client challenge beliefs through:

Empirical argument.
Logical argument.
Practical examination.
Rational confrontation.

E: Effective new belief

The irrational belief is replaced with a more flexible alternative.

For example:

“I must succeed at everything”

may become:

“I strongly prefer to succeed, but occasional failure does not make me worthless.”

Complete example

A: Activating event

One application is rejected.

B: Irrational belief

“I had to succeed. Rejection proves I am incapable.”

C: Consequence

Hopelessness.
Reduced activity.
Refusal to apply again.

D: Disputation

Does one rejection prove complete incapability?
Have any previous applications been successful?
Is success a preference or something that must happen?
How does refusing to apply affect future opportunities?

E: Effective belief

“I wanted this opportunity, but one rejection does not determine my ability or future. I can review the application and consider other choices.”

Naming ABCDE is not enough

In an examination, simply writing:

“The therapist uses ABCDE”

does not demonstrate how the treatment works.

AQA’s mark scheme states that naming the model without elaboration is not creditworthy.

A developed answer should explain:

What is disputed.
How it is disputed.
What new belief may result.

Musterbation in therapy

Musterbation is Ellis’s term for rigid demands involving words such as:

Must.
Should.
Have to.

Examples include:

“I must always succeed.”
“Everyone must approve of me.”
“Life must always be fair.”
“I must never make a mistake.”

The therapist may help the client convert a demand into a preference.

Irrational demand	Rational preference
“I must succeed.”	“I would strongly prefer to succeed.”
“Everyone must approve of me.”	“I would like approval, but I do not require it from everybody.”
“Life must always be fair.”	“I prefer fairness, but unfair events can occur.”
“I must never make mistakes.”	“I want to perform well, but mistakes are possible and can be addressed.”

The rational alternative recognises the client’s goal without treating it as an absolute necessity.

Challenging low frustration tolerance

A person may think:

“I cannot stand rejection.”
“I cannot cope with criticism.”
“This situation is unbearable.”
“I will never manage this feeling.”

The therapist may examine:

Has the person coped with difficult experiences previously?
Does “unpleasant” mean “impossible to tolerate”?
Is the discomfort permanent?
What strategies could make it more manageable?
What would happen if the client remained engaged rather than withdrawing?

A balanced alternative might be:

“This is extremely difficult, but difficult does not mean impossible to tolerate.”

Challenging awfulising

Awfulising involves treating an event as completely catastrophic.

Example:

“This mistake has destroyed everything.”

The therapist may ask:

What exactly has been affected?
Which areas remain unchanged?
Can any part of the situation be corrected?
Is this the worst outcome imaginable?
What is the likely long-term impact?
Are you magnifying the consequence?

A more balanced thought might be:

“The mistake has consequences, but it has not destroyed every part of my life.”

Shame-attacking exercises

What are shame-attacking exercises?

A shame-attacking exercise is a planned and harmless behavioural activity used to challenge an excessive need for approval.

The client may complete a mildly embarrassing but safe action and observe what actually happens.

The purpose is to test beliefs such as:

“Everybody must approve of me.”
“I cannot tolerate embarrassment.”
“If someone judges me, it will be unbearable.”

AQA mark-scheme guidance recognises shame-attacking exercises as one possible CBT method associated with Ellis.

Ethical use

The exercise should not involve:

Humiliation.
Genuine danger.
Harassment.
Harm to other people.
Violation of important boundaries.

It should be:

Agreed with the client.
Proportionate.
Safe.
Relevant to the belief being tested.

Example

A client believes that making a small social mistake will lead to universal rejection.

A suitable task might involve asking a harmless question that feels slightly awkward.

Afterwards, the client records:

How people actually responded.
Whether the predicted rejection occurred.
Whether embarrassment was tolerable.
What was learned.

Beck’s cognitive therapy

Beck’s version of cognitive therapy focuses on:

Automatic negative thoughts.
Negative schemas.
Faulty information processing.
The negative triad.
Testing the accuracy of beliefs.

The patient-as-scientist approach

What does patient as scientist mean?

In the patient-as-scientist approach, the client treats a negative belief as a hypothesis to be tested rather than an unquestionable fact.

For example:

“Nobody wants to speak to me”

becomes a testable prediction.

The client and therapist identify:

What evidence would support it.
What evidence would contradict it.
How information could be collected.
Whether another explanation is possible.

Official AQA guidance identifies data gathering to test irrational thoughts and reinforcement of positive beliefs as features of Beck-based CBT.

The thought becomes a hypothesis

Instead of saying:

“Nobody likes me.”

the client learns to say:

“I am predicting that nobody will respond positively. What evidence would allow me to test that prediction?”

This introduces psychological distance between:

The person.
The thought.

The person is having the thought, but the thought is not automatically treated as reality.

Data gathering

The client may collect information by:

Recording positive and negative interactions.
Comparing predictions with outcomes.
Asking for appropriate feedback.
Completing planned activities.
Monitoring changes in mood.
Recording evidence that does not fit the negative schema.

Example

Belief:

“Every task I attempt ends in failure.”

Possible data:

Tasks completed.
Parts completed successfully.
Help used appropriately.
Improvements over time.
Feedback from others.
Situations in which the prediction was inaccurate.

The goal is not to collect only positive information.

The client should examine the full pattern.

Behavioural experiments

A behavioural experiment is a planned activity used to test a prediction.

Example 1: social rejection

Prediction:

“If I message a friend, they will reject me.”

Experiment:

Send an ordinary message.
Record the response.
Consider alternative explanations if the reply is delayed.
Compare the result with the prediction.

Example 2: complete failure

Prediction:

“I cannot complete any useful task.”

Experiment:

Select one manageable activity.
Divide it into small stages.
Record what was completed.
Compare the outcome with the word “any”.

Example 3: intolerable criticism

Prediction:

“I cannot cope with feedback.”

Experiment:

Request one specific piece of feedback.
Record the emotional response.
Identify whether the discomfort decreased.
Use the feedback to make one change.

Behavioural experiments should test a belief

Simply telling the client to be more active is not enough.

The activity should connect to a specific prediction.

For example:

“I will receive no enjoyment from any activity”

can be tested by completing several manageable activities and rating mood before and after each one.

Activity scheduling

Depression may involve:

Reduced activity.
Social withdrawal.
Loss of routine.
Avoidance of responsibilities.
Fewer rewarding experiences.

CBT may include planning manageable activities.

These could involve:

Personal care.
A short period of study.
Contact with a supportive person.
A practical household task.
A previously valued activity.
A necessary appointment.

Graded tasks

A large activity may be divided into smaller steps.

Instead of:

“Complete the entire assignment”

the plan may be:

Open the document.
Read the task.
Write one heading.
Work for ten minutes.
Review what was completed.

Completing smaller tasks may provide evidence against beliefs such as:

“I cannot do anything.”

Activities and pleasure

The client may record:

Predicted enjoyment.
Actual enjoyment.
Predicted difficulty.
Actual difficulty.
Mood before and after.

The result may show that the person’s negative prediction was not completely accurate.

Reinforcement of balanced beliefs

When evidence supports a more balanced belief, the therapist helps the client recognise it.

For example:

Original belief:

“I fail at every task.”

New evidence:

The client completed two stages.
They asked for help effectively.
The task was difficult but not impossible.

Balanced belief:

“I find some tasks difficult, but I can complete parts of them and improve with support.”

The aim is not to praise the client without evidence.

It is to strengthen conclusions supported by actual experience.

Homework in CBT

CBT usually requires practice outside therapy sessions.

Possible homework includes:

Completing thought records.
Monitoring mood.
Testing a prediction.
Practising a balanced response.
Completing a graded activity.
Recording evidence.
Applying a coping strategy.

Why homework matters

The client’s difficulties occur outside the therapy room.

Practising between sessions helps determine whether skills transfer into everyday life.

Homework must be manageable

A task that is too demanding may:

Remain incomplete.
Appear to confirm failure beliefs.
Reduce engagement.
Increase shame.

Tasks should therefore be:

Specific.
Agreed collaboratively.
Realistic.
Connected to the formulation.
Reviewed without judgement.

The therapeutic relationship

Collaboration

Effective CBT should involve cooperation between:

Therapist.
Client.

The therapist provides:

Structure.
Psychological knowledge.
Guided questioning.
Support.
Feedback.

The client provides:

Personal experience.
Goals.
Observations.
Participation.
Feedback about what is manageable.

The therapist should not simply lecture

CBT is not most effective when the therapist says:

“Your thinking is irrational, and this is the correct thought.”

Instead, the client should be encouraged to examine the evidence and reach a more balanced conclusion.

Trust and openness

The client may need to discuss thoughts involving:

Worthlessness.
Rejection.
Failure.
Guilt.
Hopelessness.

A respectful therapeutic relationship may make it easier to disclose and examine these beliefs.

Applying CBT to Beck’s negative triad

Negative view of the self

Belief:

“I am completely worthless.”

Possible CBT questions:

What evidence supports the word “completely”?
Are you judging your entire identity from one event?
What qualities would other people identify?
Would you describe another person as worthless for the same mistake?

Balanced alternative:

“I made a mistake, but this does not determine my total worth.”

Negative view of the world

Belief:

“Nobody will ever help me.”

Possible CBT questions:

Has anybody offered help previously?
Are there people you have not yet asked?
Are you interpreting one person’s response as evidence about everyone?
What practical sources of support exist?

Balanced alternative:

“Some people may not help, but support may be available from others.”

Negative view of the future

Belief:

“Nothing will ever improve.”

Possible CBT questions:

What evidence predicts the whole future?
Have circumstances changed before?
What small change would count as improvement?
What happens to the future if no action is attempted?

Balanced alternative:

“I cannot know exactly what will happen, but change remains possible and there are actions I can try.”

Applying CBT to Ellis’s irrational beliefs

Musterbation

Belief:

“I must always succeed.”

Challenge:

Why must success occur every time?
Is this a preference or a law?
Does failing mean that the person has no value?

Balanced belief:

“I strongly want to succeed, but occasional failure is possible and does not define me.”

Low frustration tolerance

Belief:

“I cannot stand criticism.”

Challenge:

Is criticism unpleasant or genuinely impossible to tolerate?
Have you managed difficult feedback before?
What coping strategies could you use?

Balanced belief:

“Criticism can be uncomfortable, but I can examine it and decide what is useful.”

Utopianism

Belief:

“Life must always be fair.”

Challenge:

Is the world guaranteed to be fair?
Can unfairness be challenged without requiring perfect fairness?
Does one unfair event make all life worthless?

Balanced belief:

“I strongly value fairness, but unfair events can occur and I can decide how to respond.”

Complete application examples

Scenario 1: low examination mark

Amelia receives one low mark and says:

“I always fail. I am completely incapable, and there is no point studying.”

Identifying the cognition

“Always” suggests overgeneralisation.
“Completely incapable” represents a negative view of the self.
“No point studying” reflects a negative prediction about the future.

Challenging the belief

The therapist might ask:

Has Amelia failed every previous task?
Did every part of this answer receive no credit?
Does one result prove complete incapability?
What might happen if she reviews the feedback?

Behavioural experiment

Amelia could:

Identify one specific area to improve.
Complete a short practice question.
Compare her prediction with the outcome.

Balanced belief

“This result was disappointing and shows areas I need to improve, but it does not prove that I always fail.”

Scenario 2: unsuccessful application

Ben is unsuccessful in one application and says:

“I had to get this opportunity. Rejection is unbearable, and I will never succeed.”

Identifying the cognition

“Had to” suggests musterbation.
“Unbearable” suggests low frustration tolerance.
“Never succeed” suggests overgeneralisation and a negative view of the future.

Disputing the belief

Was receiving this particular opportunity an absolute necessity?
Is rejection painful or impossible to tolerate?
Can one outcome predict every later application?

Behavioural task

Ben might:

Request appropriate feedback.
Identify one change.
Complete one further application.
Record whether the prediction of certain failure is supported.

Scenario 3: delayed reply

Carla sends a message and receives no immediate reply.

She thinks:

“Nobody wants to talk to me.”

Cognitive challenge

One delayed reply does not provide evidence about everybody.
Several alternative explanations are possible.
The belief uses an absolute conclusion from limited evidence.

Behavioural experiment

Carla could:

Wait for an agreed period.
Record the eventual response.
Contact another appropriate person.
Compare actual outcomes with her prediction.

Scenario 4: inactivity

Dev thinks:

“I will not enjoy anything, so there is no reason to leave bed.”

Behavioural task

The therapist may agree one small activity.

Dev records:

Expected enjoyment: 0 out of 10.
Actual enjoyment.
Mood before and after.
Whether the prediction was completely accurate.

The goal is not to demand that Dev completes an exhausting programme.

It is to gather evidence through manageable action.

Scenario 5: genuine hardship

Elena is experiencing serious financial difficulty and thinks:

“My situation is difficult and I am frightened about what will happen.”

CBT should not automatically label this thought irrational.

The therapist should distinguish:

Realistic concern.
Unsupported catastrophic predictions.
Practical problems requiring action.
Beliefs that increase distress unnecessarily.

Treatment might combine:

Practical problem-solving.
Appropriate support.
Examination of predictions such as “nothing can possibly help”.

Measuring progress

CBT effectiveness should be assessed using more than one indicator.

Symptom measures

The client may complete standardised measures of:

Low mood.
Hopelessness.
Negative thinking.
Activity.
Everyday functioning.

Thought records

Progress may include:

Fewer automatic negative thoughts.
Reduced belief in extreme conclusions.
Faster recognition of cognitive distortions.
Greater ability to generate alternatives.

Behavioural change

The client may begin:

Attending lessons.
Completing tasks.
Contacting friends.
Applying for opportunities.
Returning to valued activities.
Managing personal care.

Functional improvement

Treatment may be particularly valuable when it helps the person:

Meet ordinary responsibilities.
Improve relationships.
Regain independence.
Participate in education or employment.

Follow-up

A follow-up assessment examines whether improvement continues after therapy ends.

This is important because:

Symptoms may return.
New stressful events may reactivate old beliefs.
Skills may not transfer into every situation.
The client may depend on the therapist.

Relapse prevention

What is relapse?

Relapse means the return of difficulties after improvement.

CBT may prepare clients for future setbacks by helping them identify:

Warning signs.
Common triggers.
Recurring beliefs.
Strategies that have worked.
Sources of support.
Actions to take before the cycle becomes severe.

Creating a plan

A relapse-prevention plan might include:

Continuing occasional thought records.
Reviewing common cognitive distortions.
Maintaining helpful routines.
Repeating behavioural experiments when old beliefs return.
Seeking support early.
Remembering that a setback is not total failure.

A setback is not the same as complete relapse

All-or-nothing thinking may cause a client to interpret one difficult day as:

“The treatment has completely failed.”

CBT can challenge this conclusion.

A more balanced interpretation is:

“One difficult period does not erase the progress made. I can use the strategies again.”

Effectiveness of CBT

What does effectiveness mean?

Effectiveness concerns whether CBT produces meaningful improvement.

Possible evidence includes:

Reduced depressive symptoms.
Less extreme negative thinking.
Increased activity.
Improved everyday functioning.
Reduced relapse.
Benefits continuing at follow-up.
Improvement compared with no treatment or another intervention.

Strength: CBT targets the proposed cognitive cause

CBT follows logically from cognitive explanations.

If depression is partly maintained by:

Negative schemas.
Irrational beliefs.
Faulty information processing.
The negative triad.

then identifying and challenging these processes should reduce symptoms.

The therapy has strong theoretical coherence because:

Beck’s explanation identifies the cognitive vulnerability.
Ellis’s explanation identifies irrational beliefs.
CBT directly targets these cognitions.

Limitation of this argument

A treatment working does not prove that the factor it targets was the original cause.

For example:

Negative thinking may have developed after low mood.
Biological factors may have contributed.
Social circumstances may have triggered the depression.

CBT may alter an important maintaining factor without explaining the whole disorder.

Strength: CBT teaches transferable skills

Clients learn methods that may be used after treatment ends.

These include:

Identifying automatic thoughts.
Examining evidence.
Recognising absolute language.
Generating alternatives.
Testing predictions.
Breaking tasks into smaller stages.

This may help clients respond to future difficulties independently.

Possible long-term value

A client may become less dependent on the therapist because they can apply the method themselves.

However, this depends on:

Understanding the skills.
Practising them.
Continuing to use them.
Being able to recognise future warning signs.

Strength: CBT is collaborative

The client actively participates in:

Identifying thoughts.
Setting goals.
Designing behavioural tasks.
Reviewing evidence.
Developing alternatives.

This may create a sense of:

Control.
Agency.
Participation.
Personal understanding.

The person is not treated as a passive recipient of treatment.

Limitation

Active participation is also a demand.

A client must be able and willing to engage with the process.

Strength: progress can be assessed

CBT produces outcomes that can be examined through:

Questionnaires.
Thought records.
Behavioural activity.
Attendance.
Task completion.
Follow-up measures.

This supports systematic evaluation.

Measurement caution

Self-report scores may be affected by:

Social desirability.
Current mood.
Desire to please the therapist.
Different interpretations of scale points.

Behavioural improvement should therefore also be considered.

Strength: CBT addresses cognition and behaviour

Depression involves both negative thinking and behavioural change.

CBT can target:

Irrational beliefs.
Reduced activity.
Social withdrawal.
Avoidance.
Loss of routine.

This may be more comprehensive than a treatment focusing on only one part of the depressive cycle.

Limitation: CBT requires motivation

Clients may need to:

Attend sessions.
Discuss distressing thoughts.
Complete records.
Practise between sessions.
Carry out behavioural tasks.
Challenge long-held beliefs.

Depression may itself involve:

Reduced motivation.
Low energy.
Poor concentration.
Hopelessness.
Withdrawal.

The symptoms being treated may therefore make participation difficult.

Implication

CBT may be less appropriate when a client is currently unable to:

Concentrate during sessions.
Complete agreed tasks.
Engage in discussion.
Imagine that treatment could help.

Treatment may need to be:

Slower.
More supportive.
Adapted.
Combined with other appropriate assistance.

Limitation: treatment takes time

CBT usually involves:

Assessment.
Several sessions.
Homework.
Review.
Repeated practice.

This creates costs involving:

Therapist time.
Appointments.
Travel.
Time away from work or education.
Waiting lists.

A treatment may be effective but difficult to access.

Limitation: access depends on trained therapists

CBT requires a practitioner able to:

Develop an accurate formulation.
Ask effective questions.
Challenge beliefs sensitively.
Plan suitable behavioural tasks.
Recognise realistic external difficulties.
Monitor risk and progress.

Poorly delivered CBT may become:

Formulaic.
Invalidating.
Overly confrontational.
Focused on worksheets rather than the person.

Treatment effectiveness may therefore depend partly on therapist skill.

Limitation: homework may not be completed

Homework is important because the client must apply skills outside sessions.

However, tasks may remain incomplete because of:

Low motivation.
Poor concentration.
Lack of time.
Difficult living circumstances.
Fear of failure.
Misunderstanding.
Tasks being too demanding.

A possible negative cycle

If homework is not completed, the client may think:

“I have failed therapy as well.”

The therapist should avoid reinforcing this belief.

Instead, they should examine:

Why the task was difficult.
Whether it should be divided into smaller steps.
Whether another form of practice is more suitable.

Limitation: CBT may focus too heavily on the individual

Some clients experience genuinely difficult circumstances involving:

Poverty.
Discrimination.
Unsafe housing.
Abuse.
Bereavement.
Unemployment.
Social isolation.

Changing thoughts cannot remove every external problem.

Risk of invalidation

A therapist should not treat every negative statement as distorted.

For example:

“I do not have enough money to pay this bill”

may be factually accurate.

The therapy might instead examine:

Catastrophic predictions extending beyond the evidence.
Global self-blame.
Practical problem-solving.
Appropriate sources of support.

Limitation: risk of blaming the client

CBT may appear to suggest:

“You are depressed because you think incorrectly.”

This can place responsibility on the client while overlooking:

Biological vulnerability.
Trauma.
Loss.
Social circumstances.
Lack of support.

A more appropriate interpretation is:

Unhelpful thoughts may be one factor contributing to or maintaining depression, and changing them may provide one route to improvement.

The person did not necessarily choose the thinking pattern.

Limitation: challenging beliefs may cause discomfort

Some beliefs are:

Long-standing.
Connected with painful experiences.
Central to the person’s identity.
Difficult to discuss.

Questioning them may temporarily increase:

Distress.
Anxiety.
Shame.
Defensiveness.

This does not mean that CBT is inappropriate, but it requires:

Trust.
Pacing.
Sensitivity.
Informed participation.

Limitation: relapse can occur

CBT does not guarantee permanent recovery.

Old beliefs may return following:

Stress.
Rejection.
Loss.
Illness.
Major change.
Reduced use of coping strategies.

Long-term effectiveness should therefore be assessed through follow-up rather than immediately after treatment.

Limitation: not every client prefers a structured approach

CBT often uses:

Goals.
Records.
Planned tasks.
Session structures.
Evidence review.

Some clients may value this clarity.

Others may find it:

Too formal.
Too focused on current thoughts.
Insufficiently attentive to past experiences.
Difficult to use when emotions are intense.

Appropriateness depends partly on the individual’s preferences and needs.

Appropriateness of CBT

What does appropriateness mean?

Appropriateness concerns whether the therapy is suitable for:

The particular client.
Their symptoms.
Their circumstances.
Their goals.
Their ability to participate.
Their preferences.
The available resources.

Effectiveness and appropriateness are not identical.

A treatment may work in research but be unsuitable for a particular client.

Appropriate feature: treatment is individualised

The formulation can be based on the client’s:

Triggers.
Schemas.
Irrational beliefs.
Behaviour.
Goals.
Everyday circumstances.

Two clients with depression do not need to receive identical behavioural tasks.

Appropriate feature: the client develops practical skills

CBT may be appropriate for clients who want:

A structured approach.
Clear goals.
Practical exercises.
A focus on current difficulties.
Skills they can practise independently.

Appropriate feature: treatment can address everyday problems

Behavioural tasks may be linked directly to:

Work.
Education.
Social contact.
Personal care.
Daily routines.

This can make treatment relevant to the client’s actual functioning.

Appropriateness limitation: cognitive demands

CBT requires the client to:

Identify thoughts.
Follow discussion.
Compare evidence.
Record experiences.
Generate alternatives.
Remember strategies.

Severe difficulties with concentration or motivation may make this challenging.

Appropriateness limitation: language and communication

The treatment relies heavily on:

Verbal discussion.
Understanding abstract distinctions.
Describing private thoughts.
Completing written or structured activities.

The therapist may need to adapt the treatment when the client:

Has communication needs.
Finds written records difficult.
Uses a different first language.
Prefers visual or practical methods.

Appropriateness limitation: cultural assumptions

Ideas about rationality, independence and self-expression may differ across cultures.

A therapist should avoid assuming that:

One style of thinking is universally correct.
Individual goals are always more important than collective responsibilities.
Family interdependence is unhealthy.
Emotional disclosure has the same meaning for everyone.

The client’s beliefs should be understood within their social and cultural context.

Appropriateness limitation: realistic negative thoughts

CBT is most suitable when it distinguishes:

Unsupported cognitive distortion.
A realistic appraisal of a difficult situation.

For example:

“I have experienced discrimination in this setting”

may be supported by evidence.

The therapist should not dispute reality.

They might instead examine thoughts such as:

“Because this happened here, everybody everywhere will reject me forever.”

CBT and positive mental health

CBT may also support some aspects of positive psychological wellbein.

For example, treatment may help a client develop:

More realistic self-perception.
Greater autonomy.
Improved coping.
Increased environmental mastery.
Renewed progress towards personal goals.

However, CBT should not require the client to achieve an unrealistic standard of perfect wellbeing.

Studying CBT effectiveness

Treatment group and control group

Researchers may compare:

CBT with no immediate treatment.
CBT with another psychological intervention.
Different forms of CBT.
CBT with additional support.

A control or comparison group helps determine whether improvement exceeds:

Natural recovery.
Repeated assessment.
Expectation.
General attention from a professional.

Random allocation

Random allocation helps reduce systematic differences between groups.

Without it, people choosing CBT might be:

More motivated.
More able to engage.
Less severely affected.
More confident about psychological treatment.

These characteristics could influence outcomes.

Standardisation and individualisation

CBT research faces a tension.

A standardised treatment:

Improves reliability.
Makes groups easier to compare.

An individualised treatment:

Matches the client’s beliefs.
May be more appropriate.
Reflects real clinical practice.

Highly standardised research may not represent flexible everyday therapy.

Outcome measures

Researchers may use:

Depression questionnaires.
Interviews.
Activity records.
Attendance data.
Relapse rates.
Follow-up scores.

Each measure has limitations.

Attrition

Attrition occurs when participants leave a study before it ends.

If people who find CBT difficult withdraw, the final results may include mainly those who responded well.

This could exaggerate apparent effectiveness.

Researchers should report:

Completion rates.
Reasons for withdrawal.
Outcomes for as many participants as possible.

Follow-up duration

An immediate reduction in symptoms does not prove long-term effectiveness.

Follow-up may take place after:

Several weeks.
Several months.
A longer period.

Longer follow-up provides stronger evidence about relapse.

Interpreting treatment data

Suppose a study records mean depression scores before treatment, after treatment and at a six-month follow-up.

Higher scores indicate more severe symptoms.

Group	Before treatment	After treatment	Six-month follow-up
CBT	27.4	13.1	14.2
Waiting-list group	26.9	24.8	23.7

A careful interpretation would state:

Both groups began with similar mean scores.
The CBT group showed a larger reduction.
Most of the CBT improvement remained at follow-up.
The waiting-list group showed a smaller reduction.
The data are consistent with CBT being effective.

However, the table does not show:

Sample size.
Individual differences.
Completion rates.
Statistical significance.
How participants were allocated.
Whether researchers knew each participant’s treatment.
Whether the groups received other support.

The figures therefore support a conclusion but do not prove it by themselves.

Comparing Ellis-based and Beck-based CBT

Ellis-based therapy	Beck-based therapy
Focuses on irrational beliefs	Focuses on automatic thoughts and negative schemas
Extends ABC to ABCDE	Uses collaborative evidence gathering
May use rational confrontation	Often uses guided questioning
Challenges musterbation and low frustration tolerance	Challenges negative views of self, world and future
Uses empirical and logical disputing	Uses patient-as-scientist tasks
Develops effective rational beliefs	Develops balanced alternative beliefs
May use shame-attacking exercises	May use behavioural experiments and thought records

The approaches overlap considerably.

Both aim to help the client:

Identify unhelpful cognition.
Test its validity.
Replace it with more balanced thinking.
Change behaviour that maintains low mood.

Mistake: Describing Ellis’s explanation instead of the therapy

Why this does not fully answer the question:

The ABC model explains depression. CBT must show how beliefs are changed.

How to improve:

Extend ABC to ABCDE and explain disputation.

Exam-Style Questions ✍️

Question 1

Which one of the following best describes cognitive restructuring?

A. Avoiding situations that produce low mood

B. Identifying and modifying unhelpful patterns of thinking

C. Pairing a feared stimulus with relaxation

D. Increasing neurotransmitter activity using medication

[1 mark]

reveal mark scheme and indicative content

Answer: B. Identifying and modifying unhelpful patterns of thinkingMark scheme

AO1 = 2

2 marks: Clear outline referring to challenging an irrational belief by examining whether there is evidence to support it.
1 mark: Limited or partial outline.

Indicative content

The therapist asks the client to consider the evidence for and against their belief.
The belief is tested against real experience rather than simply accepted as true.

AQA specifically accepts empirical argument as a way of challenging irrational thoughts.

Example answer

Empirical disputing involves challenging an irrational belief by asking what evidence supports or contradicts it. The client examines whether the belief is actually consistent with their experiences.

Question 2

Outline what is meant by empirical disputing in cognitive behaviour therapy.

[2 marks]

reveal mark scheme and indicative content

Mark scheme

AO1 = 2

2 marks: Clear outline referring to challenging an irrational belief by examining whether there is evidence to support it.
1 mark: Limited or partial outline.

Indicative content

The therapist asks the client to consider the evidence for and against their belief.
The belief is tested against real experience rather than simply accepted as true.

AQA specifically accepts empirical argument as a way of challenging irrational thoughts.

Example answer

Question 3

Explain the role of D and E in Ellis’s ABCDE model.

[4 marks]

reveal mark scheme and indicative content

Mark scheme

AO1 = 4

Award up to 2 marks for D and 2 marks for E.

Indicative content

D, disputing

Irrational beliefs identified at B are actively challenged.
This can involve empirical or logical arguments.

E, effect

Effective disputing reduces or replaces irrational thinking.
This should produce healthier emotional and behavioural consequences.

AQA's 2021 mark scheme explicitly identifies D as dispute and E as the effect, involving reduction of irrational thoughts.

Example answer

D stands for disputing irrational beliefs. The therapist challenges whether these beliefs are logical or supported by evidence. E is the effect of successful disputing, where irrational thinking is reduced and replaced by more rational beliefs, leading to healthier emotional consequences.

Question 4

Explain how the patient-as-scientist approach may be used to challenge an irrational thought.

[4 marks]

reveal mark scheme and indicative content

Mark scheme

AO1 = 4

Award 1 mark each for:

The client treats their negative belief as a hypothesis rather than a fact.
They identify a prediction that follows from the belief.
They gather evidence through experience or homework.
They compare the evidence with the prediction and modify the belief if it is not supported.

Indicative content

For example, someone who believes "nobody wants to talk to me" might initiate conversations and record how people respond.

AQA credits hypothesis testing, the patient as scientist and gathering data through homework as components of CBT.

Example answer

The client treats an irrational thought as a hypothesis that can be tested. They make a prediction based on the thought and collect evidence through homework or behavioural experiments. If the evidence does not support the prediction, the therapist helps the client replace the original belief with a more realistic one.

Question 5

Following one unsuccessful application, Sam says:

“I must always succeed. This rejection proves that I am completely incapable, and I will never get another opportunity.”

Explain how a CBT therapist could challenge Sam’s thinking.

[6 marks]

reveal mark scheme and indicative content

Mark scheme

AO2 = 6

Award credit for clear application of CBT techniques to Sam's thoughts.

Indicative content

The therapist would identify Sam's negative or irrational thoughts through thought catching.
"I must always succeed" is a rigid irrational demand and could be disputed.
The therapist might use empirical disputing by asking whether Sam has always succeeded and whether one rejection proves incapability.
Logical disputing could question whether one unsuccessful application logically means he is completely incapable.
"I will never get another opportunity" could be treated as a prediction to test.
Sam could gather evidence about other opportunities and previous successes.
The aim is cognitive restructuring, replacing the irrational beliefs with more realistic ones.

Example answer

The therapist could first help Sam identify his irrational thoughts. His belief that he "must always succeed" could be challenged by asking whether it is realistic to expect success every time. The therapist could also use empirical disputing by asking what evidence shows that one rejection proves he is completely incapable. Sam's prediction that he will never have another opportunity could be tested by looking for future opportunities and recording what happens. This evidence could help him restructure his thinking into a more realistic belief, such as "this application was unsuccessful, but that does not mean I am incapable or will always fail."

Question 6

A client predicts that completing any activity will produce no enjoyment.

Describe one behavioural experiment that could be used to test this prediction. Explain how the results might be used in therapy.

[4 marks]

reveal mark scheme and indicative content

Mark scheme

AO2 = 4

Award 1 mark each for:

The client selects a manageable activity, for example meeting a friend or taking a short walk.
Before completing it, they predict how much enjoyment they expect.
They complete the activity and record their actual enjoyment.
The therapist compares the prediction with the outcome and uses any discrepancy to challenge the original belief.

Example answer

The client could predict that taking a short walk will give them no enjoyment, perhaps rating expected enjoyment as 0 out of 10. They then complete the walk and record how they actually felt. If they rate their enjoyment as 4 out of 10 afterwards, this provides evidence that the original belief was too extreme and can be used to develop a more realistic prediction about future activities.

Question 7

The table shows mean depression scores for two groups. Higher scores indicate more severe symptoms.

Group	Before treatment	After treatment	Six-month follow-up
CBT	28.1	13.6	14.4
Waiting-list control	27.8	25.2	24.6

Describe the pattern shown in the table. Explain one conclusion and one limitation of the results.

[6 marks]

reveal mark scheme and indicative content

Mark scheme

AO2/AO3 = 6

Award up to 2 marks for describing the pattern, 2 marks for a conclusion and 2 marks for a limitation.

Indicative content

Pattern

Both groups begin with similar depression scores, 28.1 and 27.8.
The CBT group's score falls substantially to 13.6 after treatment and remains relatively low at 14.4 after six months.
The waiting-list group's score falls only slightly to 25.2, then 24.6.

Conclusion

CBT appears effective at reducing depressive symptoms.
Most of the improvement appears to be maintained six months later.

LimitationCredit one appropriate limitation, for example:

A waiting-list control does not control for therapist attention or expectations.
Depression scores may be based on self-report.
Mean scores hide individual differences.
The table does not indicate whether participants were randomly allocated.

Example answer

The groups have similar scores before treatment, 28.1 for CBT and 27.8 for the waiting-list group. After CBT, the mean falls to 13.6 and remains relatively low at 14.4 six months later. The control group falls only slightly to 24.6. This suggests that CBT may substantially reduce depression and that the effect is largely maintained. However, a waiting-list group does not control for factors such as therapist attention, so the improvement cannot necessarily be attributed specifically to cognitive restructuring.

Question 8

Explain one reason why CBT may be inappropriate for a client experiencing severe problems with motivation and concentration.

[4 marks]

reveal mark scheme and indicative content

Mark scheme

AO3 = 4

Award credit for one clearly developed reason.

Indicative content

CBT requires the client to participate actively.
Clients need to identify thoughts, discuss them, test predictions and often complete homework.
Severe depression may involve poor concentration and very low motivation.
The client may therefore struggle to engage with or complete the therapy, reducing its appropriateness or effectiveness.

Example answer

CBT requires considerable active participation because clients need to identify and challenge thoughts and complete tasks between sessions. Severe depression can involve poor concentration and very low motivation. A client experiencing these symptoms may struggle to engage with the cognitive work or complete homework, making CBT less appropriate at that stage.

Question 9

Explain one strength and one limitation of CBT as a treatment for depression.

[6 marks]

reveal mark scheme and indicative content

Mark scheme

AO3 = 6

Award up to 3 marks for the strength and 3 marks for the limitation.

Indicative content

Strength

CBT directly targets the negative and irrational thoughts proposed by cognitive explanations.
It teaches clients strategies for identifying, testing and restructuring their own thoughts.
These skills may continue to be used after formal treatment ends, potentially helping maintain improvement.

Limitation

CBT requires motivation, concentration and active participation.
Some severely depressed clients may find thought challenging, behavioural experiments or homework difficult.
This may reduce completion or effectiveness for those clients.

Also credit appropriate discussion of research evidence, relapse, individual differences, therapist competence or comparisons with other treatments.

Example answer

One strength is that CBT gives clients practical skills for identifying and challenging negative thinking. These strategies can continue to be used after therapy ends, which may help clients manage future negative thoughts and reduce relapse.

One limitation is that CBT requires active engagement. A severely depressed client may have very low motivation and poor concentration, making it difficult to complete homework or challenge complex thoughts. CBT may therefore be less appropriate for some clients until their symptoms are more manageable.

Question 10

Discuss the appropriateness and effectiveness of cognitive behaviour therapy as a treatment for depression.

[8 marks]

reveal mark scheme and indicative content

Mark scheme

Suggested allocation: AO1 = 3, AO3 = 5

7 to 8 marks: Knowledge of CBT is accurate and detailed. Discussion of both appropriateness and effectiveness is thorough and effective. Specialist terminology is used appropriately.

5 to 6 marks: Knowledge is generally accurate and discussion is mostly effective, although some points lack development.

3 to 4 marks: Some relevant knowledge is present, but discussion is limited or mainly descriptive.

1 to 2 marks: Very limited knowledge or discussion.

0 marks: No relevant content.

Indicative content

AO1

CBT aims to identify and challenge negative or irrational thoughts associated with depression.
Clients may use thought catching to identify negative cognitions.
Beck's approach may involve patient-as-scientist hypothesis testing and gathering evidence through homework.
Cognitive restructuring replaces unhelpful thoughts with more realistic alternatives.
Ellis's REBT can extend ABC to ABCDE, with D representing disputing and E representing the effect of successful disputing.
Disputing may involve empirical and logical arguments.

These features closely match AQA's indicative content for CBT.

AO3, effectiveness

Successful CBT is consistent with the cognitive approach because changing maladaptive thinking can reduce depressive symptoms.
CBT gives clients cognitive skills they can continue using outside therapy.
Follow-up evidence is important because immediate symptom reduction does not necessarily demonstrate long-term effectiveness.
Treatment improvement cannot automatically establish that negative thinking was the original cause of depression.
CBT contains several elements, so improvement may not result solely from challenging cognitions.

AO3, appropriateness

CBT does not rely on medication and directly involves the client in managing their own thoughts.
It may therefore appeal to clients who prefer a psychological treatment.
It requires active participation, concentration and motivation, which may make it less appropriate for people with particularly severe depressive symptoms.
Clients must be willing to discuss distressing thoughts and complete between-session tasks.
Effectiveness may depend partly on therapist skill and the therapeutic relationship.
Different clients may therefore require different treatments or combinations of treatments.

The specification explicitly requires students to evaluate therapies in terms of both appropriateness and effectiveness, rather than discussing symptom reduction alone.

Example answer

Cognitive behaviour therapy aims to reduce depression by identifying and challenging negative or irrational thinking. In Beck's approach, clients may use thought catching and act as a "patient as scientist", treating negative beliefs as hypotheses and gathering evidence to test them. Cognitive restructuring is then used to replace distorted thoughts with more realistic alternatives. Ellis's approach can involve disputing irrational beliefs using empirical or logical arguments.

One strength of CBT is that it gives clients practical strategies that can continue to be used outside therapy. If negative thoughts return, clients may be able to recognise and challenge them, which could help maintain improvement. However, CBT requires considerable motivation and concentration. These are often impaired in severe depression, so some clients may struggle to engage with therapy or complete homework. Successful CBT also does not prove that irrational thinking originally caused the depression because treatment can be effective without targeting the original cause, and other aspects of therapy may contribute to improvement. Overall, CBT can be an effective and appropriate treatment for many people with depression, but its suitability depends on the individual's symptoms and ability to participate actively.