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CBT Content Supplied by NHS Choices
Introduction

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.

It's most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

This topic covers:

How it works

Uses

What happens during a session

Pros and cons

Finding a therapist

How CBT works

CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.

CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You're shown how to change these negative patterns to improve the way you feel.

Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.

Read more about how CBT works.

Uses for CBT

CBT has been shown to be an effective way of treating a number of different mental health conditions.

In addition to depression or anxiety disorders, CBT can also help people with:

CBT is also sometimes used to treat people with long-term health conditions, such as:

Although CBT can't cure the physical symptoms of these conditions, it can help people cope better with their symptoms.

What happens during CBT sessions

If CBT is recommended, you'll usually have a session with a therapist once a week or once every two weeks. The course of treatment usually lasts for between five and 20 sessions, with each session lasting 30-60 minutes.

During the sessions, you'll work with your therapist to break down your problems into their separate parts - such as your thoughts, physical feelings and actions.

You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.

After working out what you can change, your therapist will ask you to practise these changes in your daily life and you'll discuss how you got on during the next session.

The eventual aim of therapy is to teach you to apply the skills you've learnt during treatment to your daily life.

This should help you manage your problems and stop them having a negative impact on your life - even after your course of treatment finishes.

Pros and cons of CBT

Cognitive behavioural therapy (CBT) can be as effective as medication in treating some mental health problems, but it may not be successful or suitable for everyone.

Some of the advantages of CBT include:

  • it may be helpful in cases where medication alone hasn't worked
  • it can be completed in a relatively short period of time compared to other talking therapies
  • the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programs
  • it teaches you useful and practical strategies that can be used in everyday life - even after the treatment has finished

Some of the disadvantages of CBT to consider include:

  • you need to commit yourself to the process to get the most from it - a therapist can help and advise you, but they need your co-operation
  • attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
  • it may not be suitable for people with more complex mental health needs or learning difficulties - as it requires structured sessions
  • it involves confronting your emotions and anxieties - you may experience initial periods where you're anxious or emotionally uncomfortable
  • it focuses on the individual's capacity to change themselves (their thoughts, feelings and behaviours) - which doesn't address any wider problems in systems or families that often have a significant impact on an individual's health and wellbeing

Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn't address the possible underlying causes of mental health conditions, such as an unhappy childhood.

Finding a CBT therapist

If you think you have a problem that may benefit from treatment with CBT, the first step is usually to speak to your GP.

Your GP may be able to refer you for CBT that's free on the NHS, although you may have to wait.

Find psychological therapy services.

If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies, but it's usually 40-100 per session.

If you're considering having CBT privately, ask your GP if they can suggest a local therapist.

The British Association for Behavioural & Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK and The British Psychological Society (BPS) has a directory of chartered psychologists, some of whom specialise in CBT.


'It can be agonising in many ways'

Carol Cattley had cognitive behavioural therapy (CBT) following the death of her husband. She found it to be a painful experience at times, but it gave her the confidence to continue helping herself.

"I had CBT in the millennium year, a couple of years after my husband died. My husband's death hit me really badly, because we had been together for so long. I had suffered from depression as a teenager and was feeling extremely down again.

"One of the things about CBT is that it's a very emotional experience, because as you work through it, you relive painful experiences. It can be agonising in many ways.

"I had eight or so treatments by the time I finished the course, and I had definitely shaken a lot of things out of myself. It's given me the confidence to be able to help myself.

"The CBT worked for me because I understood what was happening. It was a clearly defined exercise that was obviously leading somewhere, and the truth is that deliberately raking everything up achieved something.

"The psychiatrist gave me a book called Mind over Mood with exercises that you can do on your own. It's a very good book for depression.

"I think CBT is a vital treatment as an alternative to antidepressants.

"It's such a different experience. You feel as if you're in control of your destiny. It's a sensible, rational thing you can do to help yourself."

How-does-it-work

Cognitive behavioural therapy (CBT) can help you make sense of overwhelming problems by breaking them down into smaller parts.

In CBT, problems are broken down into five main areas:

  • situations
  • thoughts
  • emotions
  • physical feelings
  • actions

CBT is based on the concept of these five areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.

How CBT is different

CBT differs from many other psychotherapies because it's:

  • pragmatic - it helps identify specific problems and tries to solve them
  • highly structured - rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
  • focused on current problems - it's mainly concerned with how you think and act now rather than attempting to resolve past issues
  • collaborative - your therapist won't tell you what to do; they'll work with you to find solutions to your current difficulties

Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.

For example, if your marriage has ended in divorce, you might think you've failed and that you're not capable of having another meaningful relationship.

This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.

But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.

This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.

This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.

Exposure therapy

Exposure therapy is a form of CBT particularly useful for people with phobias or obsessive compulsive disorder (OCD).

In such cases, talking about the situation isn't as helpful and you may need to learn to face your fears in a methodical and structured way through exposure therapy.

Exposure therapy involves starting with items and situations that cause anxiety, but anxiety that you feel able to tolerate. You need to stay in this situation for one to two hours or until the anxiety reduces for a prolonged period by a half.

Your therapist will ask you to repeat this exposure exercise three times a day. After the first few times, you'll find your anxiety doesn't climb as high and doesn't last as long.

You'll then be ready to move to a more difficult situation. This process should be continued until you have tackled all the items and situations you want to conquer.

Exposure therapy may involve spending six to 15 hours with the therapist, or can be carried out using self-help books or computer programs. You'll need to regularly practice the exercises as prescribed to overcome your problems.

CBT sessions

CBT can be carried out with a therapist in one-to-one sessions or in groups with other people in a similar situation to you.

If you have CBT on an individual basis, you'll usually meet with a CBT therapist for between five and 20 weekly or fortnightly sessions, with each session lasting 30-60 minutes.

Exposure therapy sessions usually last longer to ensure your anxiety reduces during the session. The therapy may take place:

  • in a clinic
  • outside - if you have specific fears there
  • in your own home - particularly if you have agoraphobia or OCD involving a specific fear of items at home

Your CBT therapist can be any healthcare professional who has been specially trained in CBT, such as a psychiatrist, psychologist, mental health nurse or GP.

First sessions

The first few sessions will be spent making sure CBT is the right therapy for you, and that you're comfortable with the process. The therapist will ask questions about your life and background.

If you're anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They'll also ask about events that may be related to your problems, treatments you've had, and what you would like to achieve through therapy.

If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it's not appropriate, or you don't feel comfortable with it, they can recommend alternative treatments.

Further sessions

After the initial assessment period, you'll start working with your therapist to break down problems into their separate parts. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.

You and your therapist will analyse your thoughts, feelings and behaviours to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours.

After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:

  • questioning upsetting thoughts and replacing them with more helpful ones
  • recognising when you're going to do something that will make you feel worse and instead doing something more helpful

You may be asked to do some "homework" between sessions to help with this process.

At each session, you'll discuss with your therapist how you've got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.

Confronting fears and anxieties can be very difficult. Your therapist won't ask you to do things you don't want to do and will only work at a pace you're comfortable with. During your sessions, your therapist will check you're comfortable with the progress you're making.

One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return.

Computerised CBT

A number of interactive software programs are now available that allow you to benefit from CBT with minimal or no contact with a therapist.

The main program currently approved for use by the NHS is Beating the Blues, which is approved for treating mild to moderate depression.

However, there are many similar computerised CBT (CCBT) packages that may also be effective.

Some people prefer using a computer rather than talking to a therapist about their private feelings. However, you may still benefit from occasional meetings or phone calls with a therapist to guide you and monitor your progress.

Read more about self-help therapies.


 
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