Introduction

In simple terms, “Cognitive Behavioural Therapy” (CBT) is like a personal trainer for your mind where it helps identify and modify your unhelpful thought patterns by testing how valid and reasonable those thought patterns are, and in the end, helps you build healthier and more realistic thought patterns [1].

A Short History of CBT

CBT has its roots in two influential psychological approaches: behaviourism and cognitive psychology. Behaviourism emerged in the early 1900s and focused on observable behaviours, which essentially are things we can see happening and the different ways these behaviours could be modified through learning principles like conditioning [2-3]. This behavioural-focused approach to psychology laid the groundwork for what is now known as the first wave of therapy, which mainly aimed to change maladaptive behaviours through different techniques like reinforcement and punishment [4].

In the 1960’s, a cognitive revolution shifted the focus from just looking at observable behaviours, to including the complex process of human thought around an event. Aaron Beck, often referred to as the father of CBT, introduced the second wave by integrating the thought process of humans in events they experience (e.g., a close friend sitting with someone else during lunchtime rather than you), and the cognitive insights from that into therapy. Beck’s work highlighted the impact of people’s dysfunctional thoughts – such as catastrophising and all-or-nothing thinking – on their emotions and behaviours, providing a framework to help clients identify and challenge/restructure these ways of thinking [5].

Now we reach the third wave of CBT, emerging in the late 20th century, which expanded the scope of this therapy, including mindfulness and acceptance strategies. It wasn’t just about the dysfunctional thoughts now; the third wave of CBT brought approaches focused on helping individuals build a sort of compassionate awareness and clarity around their thoughts and feelings in the ‘now’ rather than focusing on challenging the thoughts directly. An example of a third-wave approach is “Acceptance and Commitment Therapy” (ACT), which emphasises psychological flexibility throughout the therapy and a present-moment awareness of one’s thoughts and feelings regarding something which is giving the individual psychological distress, coupled with a focus on positive transformative change moving forward [6-7].

As you can see, CBT has evolved from its behaviourist beginnings into modern acceptance-based techniques, cementing its place in psychology as a versatile therapeutic approach.

Applications of CBT For Students

Now, we get to the stuff most relevant for students. Stress peaks for many students during the busy mid-term and finals seasons, often accompanied by negative/dysfunctional thought patterns like “I’m going to fail” or “I am not smart enough to do this”. CBT equips students with techniques to identify and challenge these dysfunctional thoughts, replacing them with healthier alternatives. For example, a student who has a big exam coming up has a classic case of all-or-nothing thinking and thinks, “If I don’t get an A, I am a failure”. The student might then grab a notebook and start to identify this main thought coming up repeatedly and may reframe this thought into “I’ve prepared well for this exam and can now focus on doing my best”, which is a more balanced and healthier thought for the student. Research supports this approach, showing that cognitive restructuring is a powerful method for reducing anxiety [8]. The beauty of CBT is that these techniques don’t have to be used exclusively for students in the context of academic stress; they are applicable in any situation that creates these dysfunctional thoughts, which then create psychological distress, for example, thoughts you may get that you will mess up badly while speaking publicly.

Future Directions: Toward a Fourth Wave?

We know that CBT has continually evolved over the decades, adapting to the societal needs of the time it has been used. However as technology advances, researchers speculate that a fourth wave of CBT could emerge, integrating technology such as artificial intelligence (AI) and virtual reality (VR) to create more personalised and accessible therapeutic experiences for all.

AI-driven chatbots and other digital therapy platforms are already making CBT more widely available to the public. Apps like Woebot use programming to guide users through different CBT techniques, offering real-time interventions for stress and anxiety [9]. The potential for future AI developments in this space is exciting, as it could allow for more nuanced conversations between the person and the chatbot, as well as tailored interventions based on that person’s specific thought patterns and emotions, with the core of it all being about people receiving immediate support at any time.

Meanwhile, VR is revolutionising the idea of exposure therapy, which is a key CBT technique for many different anxieties and phobias. VR allows the user to be in a controlled and completely immersive environment while having that targeted intervention relating to that one anxiety or phobia [10]. Coming back to the student context, VR-based CBT could provide an immersive exam environment, helping them practice coping strategies in real-time. And there are many more anxieties and phobias that VR-based CBT can help treat that we haven’t even touched on, such as simulating social scenarios to help with social anxiety or having highly detailed, life-like bugs in a simulation to help treat specific phobias such as arachnophobia.

As these technologies become more advanced and sophisticated, it can lead to CBT shifting from a one-size-fits-all approach to a more individualised and tailored approach to therapy, which will, in turn, make CBT more engaging and effective in its treatment as a therapy.

Although there is always the question of human therapists becoming obsolete due to these advancing technologies, CBT started from human thinking and interaction and continued to evolve, with human interaction and conversation still being at the centre of it all. And so, while human therapists remain irreplaceable due to that human-to-human connection being extremely vital, the fourth wave of CBT could blend technology with traditional techniques, providing a new and potentially improved era of mental support for society.