Understanding CBT for distressing experiences
Learn what CBT sessions for voices, unusual beliefs or feeling under threat involve, how goals and pace are agreed, and how your own explanations are respected.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding CBT for distressing experiences
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What this therapy is
Cognitive behavioural therapy for psychosis (CBTp) is a talking therapy. It can help when experiences such as hearing voices, holding beliefs others do not share, or feeling watched or under threat cause distress. It grew from the work of several groups, including Anthony Morrison, Philippa Garety and Daniel Freeman, and David Kingdon and Douglas Turkington. This handout explains what sessions involve. It supports trained practice and does not replace it.
Your own explanation is welcome
You do not have to accept a diagnosis or a label to take part. You do not have to give up your own explanation. Many people make sense of their experiences through culture, faith or spirituality, and these meanings are respected. Your therapist will not argue with your beliefs or try to prove you wrong. Together, you can look at more than one way of understanding what is happening, and keep what fits.
What sessions involve
You start by agreeing goals that matter to you, such as sleeping better, feeling less frightened or getting out more. You build a shared picture of what has happened, what it meant to you, how you felt and what you did. You look at what already helps you cope, and at stress and life events that make things harder. Later, you plan how to stay well. You choose what to talk about and how fast. You can pause, say no or ask for a break. Fictional illustration: someone hears a critical voice that gets louder when they are tired. Their goal is to walk to the local shop with less fear. They and their therapist look at what has helped before. They do not have to agree on what the voice is.
Working with your care team
CBTp usually sits alongside other support, such as your mental health team or GP. For some people, medication is part of that support. Keep taking any medication as prescribed, and talk to your prescriber before changing it. With your agreement, family or friends can be involved. Your therapist will explain what is kept private, and when information may need to be shared to keep people safe.
If things get harder
If voices or beliefs become stronger or more frightening, or voices tell you to do things, tell your therapist or team. Tell them the same day if this is new or getting worse; otherwise, at your next contact. You do not need to write down what voices say. If someone is harming, threatening or taking advantage of you, tell your therapist or team as soon as it is safe to do so. If you feel at risk of acting on a voice or a belief, or of harming yourself or someone else, contact your mental health team now. If you cannot reach them, or do not have a team, contact your urgent-care service.
If anyone is in danger, call 999.
Questions and support
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
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When to use ‘Understanding CBT for distressing experiences’
‘Understanding CBT for distressing experiences’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for psychosis.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 10 minutes. It moves through six short sections to read:
- What this therapy is: Cognitive behavioural therapy for psychosis (CBTp) is a talking therapy. It can help when experiences such as hearing voices, holding…
- Your own explanation is welcome: You do not have to accept a diagnosis or a label to take part. You do not have to give up your own explanation. Many people make sense of…
- What sessions involve: You start by agreeing goals that matter to you, such as sleeping better, feeling less frightened or getting out more. You build a shared…
- Working with your care team: CBTp usually sits alongside other support, such as your mental health team or GP. For some people, medication is part of that support. Keep…
- If things get harder: If voices or beliefs become stronger or more frightening, or voices tell you to do things, tell your therapist or team. Tell them the same…
- Questions and support: This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Understanding CBT for distressing experiences’ introduces a CBT approach that involves noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Morrison, A. P., Renton, J. C., Dunn, H., Williams, S., & Bentall, R. P. (2004). Cognitive Therapy for Psychosis: A Formulation-Based Approach. Brunner-Routledge.
- Kingdon, D. G., & Turkington, D. (2005). Cognitive Therapy of Schizophrenia. Guilford Press.
- Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31(2), 189-195.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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