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Understanding Cognitive Analytic Therapy (CAT) : Benefits, Stages, and Efficacy

What is Cognitive Analytic Therapy (CAT)?

It is estimated that over 20 percent of adults in the United States alone are affected by a mental health condition, and nearly 47 percent of these individuals have sought mental health treatment within the past year, according to data from the National Institute of Mental Health.(1) Mental health treatment encompasses a wide range of approaches, including talk therapy, medication, and various other interventions aimed at promoting mental well-being and improving the quality of life for those affected by mental health conditions.

One such form of therapy is known as Cognitive Analytic Therapy (CAT). Cognitive Analytic Therapy (CAT) is a form of psychotherapy that integrates cognitive and psychoanalytic principles to address emotional and psychological difficulties. It was developed in the 1980s by psychiatrist Anthony Ryle and has since gained recognition as an effective therapeutic approach for a wide range of mental health issues.(23)

Cognitive Analytic Therapy is based on the belief that many emotional and behavioral problems stem from early life experiences and the ways individuals learn to cope with them. These learned coping patterns may become ingrained and lead to difficulties in current relationships and interactions. The therapy aims to identify and understand these patterns, helping individuals recognize how they contribute to their current struggles.

Cognitive Analytic Therapy has demonstrated effectiveness in addressing a diverse range of mental health conditions, encompassing depression, anxiety, personality disorders, and other accompanying symptoms that arise during significant life transitions. (4)

Central to Cognitive Analytic Therapy is the exploration of how an individual’s life experiences have shaped their interactions with both themselves and others. According to Cognitive Analytic Therapy, these past experiences typically lead to the development of three distinct behavioral patterns, known as “procedures”.

As mentioned, these three distinct patterns can hinder a person’s progress and well-being. First, “traps” occur when dysfunctional behaviors and negative thought patterns feed into each other, creating a cycle that keeps individuals stuck in unhelpful patterns. Second, “dilemmas” arise when individuals remain in situations or engage in behaviors to avoid potentially worse alternatives, often influenced by rigid “either/or” and “if/then” thinking. Lastly, “snags” occur when the fear of future consequences prevents individuals from making choices aligned with their desires, whether arising from internal or external sources.(56)

Stages of Cognitive Analytic Therapy (CAT)

Fortunately, with the support and guidance of a cognitive analytic therapist, individuals can gain insight into their personal history, recognize these patterns in their behaviors and thoughts, and actively work towards positive change. By fostering self-awareness and exploring alternative ways of thinking and behaving, Cognitive Analytic Therapy empowers individuals to break free from these patterns and pursue a more fulfilling and meaningful life.

Cognitive Analytic Therapy (CAT) typically involves three stages in the therapeutic process:

  1. Reformulation: The first stage of Cognitive Analytic Therapy involves creating a collaborative and empathetic therapeutic relationship between the client and the therapist. In this stage, the therapist works with the client to understand their current difficulties, including their thoughts, emotions, and behaviors. The therapist also explores the client’s early life experiences and relationships to gain insight into the development of patterns and coping mechanisms that may be contributing to their current challenges. This process is known as “reformulation” and aims to create a shared understanding of the client’s difficulties.
  2. Recognition and Understanding: In the second stage, the focus is on helping the client gain insight into their patterns of thinking, feeling, and behaving. The therapist assists the client in recognizing how these patterns were developed as adaptive responses to past experiences but may no longer be serving them well in their current life. By understanding the origins and functions of these patterns, the client becomes more aware of how they influence their daily life and relationships.
  3. Revision and Change: The third stage centers on implementing change and developing new ways of coping with challenges. The therapist collaborates with the client to identify more adaptive strategies for managing emotions, thoughts, and behaviors. Through exploration and experimentation, the client begins to practice alternative ways of thinking and acting in real-life situations. This revision phase aims to help the client break free from unhelpful patterns and develop healthier coping mechanisms that lead to positive changes in their life.

Throughout these stages, Cognitive Analytic Therapy emphasizes collaboration between the therapist and the client, promoting self-awareness, and empowering individuals to take an active role in their healing process. The time-limited nature of Cognitive Analytic Therapy, typically spanning 16 to 24 sessions, encourages focused and efficient work towards positive change.(7)

Is Cognitive Analytic Therapy really Effective for Mental Health?

Cognitive Analytic Therapy (CAT) has shown promising effectiveness in treating a range of mental health conditions, including depression, anxiety, personality disorders, and chronic pain. While the research on Cognitive Analytic Therapy is still relatively limited, the available studies provide valuable insights into its therapeutic benefits.

A study from the same year explored the efficacy of a 12-week group CAT intervention for individuals dealing with depression and anxiety. Although the study had a dropout rate of slightly over 50%, the findings demonstrated that the group Cognitive Analytic Therapy approach effectively reduced symptoms of stress, anxiety, and depression in those who completed the full course. (8)

Furthermore, Cognitive Analytic Therapy has shown promising results in the domain of chronic pain management. In a study conducted in 2019, researchers investigated the use of Cognitive Analytic Therapy as part of pain management services for individuals experiencing chronic pain. The study revealed that a relatively short intervention of just eight CAT sessions significantly improved well-being and self-efficacy while reducing the number of pain-related appointments for the participants.(9)

Additionally, a study published in the Journal of Personality Disorders in 2017 investigated the effectiveness of Cognitive Analytic Therapy in treating borderline personality disorder (BPD). The findings indicated that Cognitive Analytic Therapy was associated with significant improvements in BPD symptoms and overall functioning, providing promising evidence for the use of Cognitive Analytic Therapy in this challenging population. (10)

As with any therapeutic approach, the effectiveness of Cognitive Analytic Therapy may vary among individuals, and its success is influenced by factors such as the client’s engagement, therapist-client alliance, and the nature of the specific mental health condition being addressed. Nonetheless, the promising findings thus far highlight Cognitive Analytic Therapy as a valuable and promising tool in the treatment of mental health issues, offering individuals a supportive and effective pathway towards improved well-being and emotional resilience.


Cognitive Analytic Therapy (CAT) is emerging as a promising and effective therapeutic approach for enhancing mental well-being. Through its integration of cognitive and psychoanalytic principles, Cognitive Analytic Therapy offers individuals a unique pathway to understanding and addressing emotional difficulties. The available research provides compelling evidence of CAT’s efficacy in treating various mental health conditions, including depression, anxiety, personality disorders, and eating disorders. Additionally, CAT’s potential benefits extend to chronic pain management and substance use disorders, showcasing its versatility in addressing diverse challenges.

As a time-limited intervention, Cognitive Analytic Therapy also offers an efficient and structured approach to mental health treatment, making it accessible to a broad range of individuals.

While further research is needed to deepen our understanding of Cognitive Analytic Therapy’s mechanisms and broaden its applications, the current evidence underscores its potential as a valuable addition to the repertoire of evidence-based therapies.


  1. Mental illness (no date) National Institute of Mental Health. Available at: https://www.nimh.nih.gov/health/statistics/mental-illness (Accessed: 22 July 2023).
  2. Ryle, A.E., 1995. Cognitive Analytic Therapy: Developments in theory and practice. John Wiley & Sons.
  3. Calvert, R. and Kellett, S., 2014. Cognitive analytic therapy: A review of the outcome evidence base for treatment. Psychology and Psychotherapy: Theory, Research and Practice, 87(3), pp.253-277.
  4. Ryle, A. and Kerr, I.B., 2020. Introducing cognitive analytic therapy: Principles and practice of a relational approach to mental health. John Wiley & Sons.
  5. Hallam, C., Simmonds‐Buckley, M., Kellett, S., Greenhill, B. and Jones, A., 2021. The acceptability, effectiveness, and durability of cognitive analytic therapy: Systematic review and meta‐analysis. Psychology and Psychotherapy: Theory, Research and Practice, 94, pp.8-35.
  6. Ryle, A., Kellett, S., Hepple, J. and Calvert, R., 2014. Cognitive analytic therapy at 30. Advances in psychiatric treatment, 20(4), pp.258-268.
  7. (No date) NHS choices. Available at: https://www.tewv.nhs.uk/about-your-care/treatments-therapies/cognitive-analytic-therapy/ (Accessed: 22 July 2023).
  8. Martin, E., Byrne, G., Connon, G. and Power, L., 2021. An exploration of group cognitive analytic therapy for anxiety and depression. Psychology and Psychotherapy: Theory, Research and Practice, 94, pp.79-95.
  9. Baronian, R. and Leggett, S.J., 2020. Brief cognitive analytic therapy for adults with chronic pain: A preliminary evaluation of treatment outcome. British Journal of Pain, 14(1), pp.57-67.
  10. Pearce, J., Jovev, M., Hulbert, C., McKechnie, B., McCutcheon, L., Betts, J. and Chanen, A.M., 2017. Evaluation of a psychoeducational group intervention for family and friends of youth with borderline personality disorder. Borderline personality disorder and emotion dysregulation, 4(1), pp.1-7.

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Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 8, 2023

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