CAT looks at the way your past has affected your current actions and helps you create a new way forward.

Over 20% of adults in the United States live with a mental health condition ― and roughly 47% of those adults have received mental health treatment over the past year. Treatment for mental health conditions can include a variety of approaches, from talk therapy to medication and beyond.

Cognitive analytic therapy (CAT) is a type of talk therapy that focuses on helping people recognize and change the way that they behave and interact with others.

Below, we’ll share an overview of what cognitive analytic therapy is, including what to expect during sessions and what science says about the effectiveness of CAT for treating mental health conditions.

Cognitive analytic therapy (CAT) is a type of talk therapy that focuses on how a person’s relationships ― both with themselves and others ― can influence their behaviors and emotions. It can be an effective approach for a variety of mental health conditions, including depression, anxiety, personality disorders, and other mental health symptoms that can accompany big life changes.

One of the main focal points of CAT is exploring how someone’s life experiences have shaped the way that they interact with themselves and the people around them. According to CAT, the impact of these past experiences generally causes three specific types of behavioral patterns, also called “procedures”:

  • Traps happen when dysfunctional behaviors and negative thought patterns feed on each other, almost in a type of “cycle.” When people aren’t able to recognize these spirals, it keeps them stuck in the trap of these behaviors and thoughts.
  • Dilemmas happen when people remain in situations or continue to engage in behaviors in order to avoid a potentially worse alternative. Oftentimes, dilemmas are the result of “either/or” and “if/then” thinking.
  • Snags happen when the anticipation of future consequences prevents someone from being able to make choices or engage in behaviors that they want. Sometimes a snag can come from within ― other times, it can come from those around us.

With the help and guidance of a cognitive analytic therapist, a person can learn more about their own history, recognize if they’re engaging in these behaviors, and work to change them.


Cognitive behavioral therapy (CBT) is a type of talk therapy that teaches people how to recognize and change their own thoughts, feelings, and behaviors. Research has shown that CBT is one of the most effective approaches for treating a wide variety of mental health conditions, including both depression and anxiety.

CBT and CAT are both intended to be short-term approaches that teach you the skills you need to improve your mental health. However, CBT tends to focus more on your present thoughts, emotions, and behaviors, while CAT focuses more on how the experiences of your past affect your current behaviors and beliefs.

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Cognitive analytic therapy is a type of short-term talk therapy that runs for anywhere from 16–24 weeks, depending on your own personal needs and progress. As a general rule of thumb, sessions are 50 minutes long and take place once a week.

As with any new type of therapy, the first session allows you to introduce yourself and get to know your therapist a little better. During this first session, you’ll review your mental health history, establish the goals for your treatment, and learn more about what CAT is and how it can help you.

After your initial session, your therapist will ask you to fill out a tool known as the psychotherapy file, which is a tool unique to cognitive analytic therapy. Your psychotherapy file will help paint a picture of your unique circumstances, including your symptoms, moods, thoughts, behaviors, and patterns.

As therapy progresses, your therapist will walk you through a series of phases to help you address and work through your problems:

  • Reformulation: Using all of the information and history you’ve provided up until now, your therapist will write you a reformulation letter, which pinpoints areas of focus for your sessions. Working together, you and your therapist will use this information to create diagrams or maps that will outline the changes you’re going to make.
  • Recognition and revision: Both the recognition and revision stages happen during therapy as you work through your recovery diagram. Once you recognize the problematic patterns you’ve engaged in, you can revise the way that you approach or tackle these patterns to improve the relationship you have with yourself and those around you.

As you near the end of your CAT treatment, you’ll receive a goodbye letter from your therapist, which outlines everything you’ve accomplished over the course of your therapy sessions. You’ll also be scheduled for a 3-month follow-up with your therapist to check in and see how you’ve improved.

Research on cognitive analytic therapy is lacking, with very few large studies available. However, current research suggests that CAT is effective for a variety of conditions, including depression, anxiety, personality disorders, and even chronic pain.

In one meta-analysis from 2020, researchers analyzed 28 different studies to discover the effectiveness, durability, and acceptability of CAT. According to the results of the analysis, CAT was effective at helping reduce not only overall mental health symptoms but also interpersonal difficulties and depression.

Another study from 2020 explored the effectiveness of a 12-week group CAT approach for people with depression and anxiety. Although only a little over 50% of the study participants completed the entire 12-week course, results showed that group CAT was effective at reducing symptoms of stress, anxiety, and depression.

And in an earlier study from 2019, researchers investigated the role of CAT as a part of pain management services for people with chronic pain. According to the results, as little as eight sessions of CAT improved both well-being and self-efficacy, as well as reduced pain-related appointments, in study participants.

Who created cognitive analytic therapy?

Dr. Anthony Ryle, a general practitioner in London, developed cognitive analytic therapy in the late 1970s and mid-1980s.

Although it was initially introduced to patients at Guy’s and St Thomas’ Hospitals in the 1980s, it wasn’t until 1984 that CAT was considered a distinct form of talk therapy. Historically, cognitive analytic therapy has been used to treat many different mental health conditions, from mood disorders to complex personality disorders, and more.

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If you’re interested in trying out cognitive analytic therapy, it’s important to find a therapist who is trained in the technique. Here are a few resources to get you started on your search:

As a note, this type of therapy is more popular in the UK and Europe but is gaining new ground in the United States. If you can’t find any therapists that specialize in it, you can talk with your therapist about incorporating some of these techniques into your treatment.

Cognitive analytic therapy is just one of the many talk therapy approaches used for treating mental health conditions like anxiety, depression, and personality disorders.

CAT places a strong emphasis on the way that personal experiences and relationships influence thoughts, emotions, and behaviors. Treatment with CAT can allow people to not only recognize their interactions with themselves and others but also change their behaviors to improve their mental health.