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Cognitive behavioural therapy (CBT)


What is cognitive behavioural therapy?

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

CBT cannot remove your problems, but can help you manage them in a more positive way. It encourages you to examine how your actions can affect how you think and feel.

Talking and changing your behaviour can change how you think (cognitive) and what you do (behaviour). This can make you feel better about life.

When is CBT used?

CBT has been shown to be particularly helpful at tackling problems such as anxiety, depression, post-traumatic stress disorder (PTSD), eating disorders and [drug misuse].

Unlike other types of talking treatments, such as psychotherapy, 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.

CBT can also be used to treat people with long-term health conditions, such as arthritis and irritable bowel syndrome (IBS). CBT cannot cure the physical symptoms of these health conditions, but can help people cope better with them.

Read more about when CBT is used.

How CBT works

CBT works by helping you make sense of overwhelming problems by breaking them down into smaller parts.

Your thoughts, feelings, physical sensations and actions are interconnected, often trapping you in a negative spiral.

CBT helps you stop these negative cycles. It aims to break down factors that are making you feel bad, anxious or scared so that they are more manageable. It can show you how to change these negative patterns to improve the way you feel.

Read more about how CBT works.

CBT sessions

If CBT is recommended, you will usually have a session with a therapist once a week or once every two weeks.

Some problems may require more intensive intervention and a therapist may spend several hours at your home to encourage you to face your fears.

Overall, the number of sessions you need will depend on your individual problems and objectives. Treatment usually lasts six weeks to six months.

Pros and cons of CBT

There are a number of advantages and disadvantages associated with CBT.

Research has shown that CBT can be as effective as medicine in treating depression and other mental health problems. Compared with other talking therapies, CBT can also be completed over a relatively short period of time.

However, to benefit from CBT, you need to commit yourself to the process. A therapist can help and advise you, but they cannot make your problems go away without your full co-operation.

Also, due to the structured nature of CBT it may not be suitable for people with more complex mental health needs or learning difficulties.

Read more about the pros and cons of CBT.

What is CBT used for?

Cognitive behavioural therapy (CBT) has been shown to be an effective way of treating a number of different mental health conditions.

These include:

CBT can also be useful in helping people with:

  • anger management problems
  • habits (such as facial tics)
  • drug misuse and alcohol misuse problems
  • relationship problems
  • sleep problems, such as insomnia

CBT is sometimes used to treat people with long-term health conditions, such as arthritis and irritable bowel syndrome (IBS). CBT cannot cure the physical symptoms of these health conditions, but can help people cope better with their symptoms.

How does CBT work?

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

Your thoughts, feelings, physical sensations and actions are interconnected – each one can affect the others.

For example, your thoughts about a problem can often affect how you feel both physically and emotionally, as well as how you act on the problem.

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 have failed and that you are 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.

However, instead of accepting this thought pattern, after your divorce you could accept that many marriages end, learn from your mistakes and move on and feel optimistic about the future.

Feeling energetic may 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 disorders (OCDs).

In such cases, talking about the situation is unhelpful and you need to learn to face your fears in a methodical and structured way.

Treatment 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 will find your anxiety does not climb as high and does not last as long.

You will then be ready to move to a more difficult item. 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 will need to regularly practice the exercises as prescribed to overcome your problems.

CBT sessions

If you have CBT on an individual basis, you will 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 will usually last longer to ensure your anxiety comes down during the session. The therapy may take place in a clinic, outside (if you have specific fears there) or in your own home (particularly if you have agoraphobia or OCD involving a specific fear of items at home).

The first session will be spent making sure CBT is the right therapy for you, and that you are comfortable with the process. The therapist will ask questions about your life and background. You will decide what you want to deal with in the short, medium and long-term.

With the help of your therapist, you will break down a problem into its separate parts the situation, thoughts, emotions, physical feelings and actions. 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 look at your thoughts, feelings and behaviours to work out if they are 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, or recognising when you are going to do something that will make you feel worse and instead doing something more helpful.

At each session, you will discuss with your therapist how you have 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 will not ask you to do things you do not want to do and will only work at a pace you are comfortable with. During your sessions, your therapist will check you are comfortable with the progress you are 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 replicate some functions of a CBT therapist. Two programs approved for use by the NHS are:

However, the National Institute for Health and Clinical Excellence (NICE) states in its guidance about depression in adults (PDF, 2.6Mb) that other, similar computerised CBT (CCBT) packages may also be effective.

Some people prefer using a computer rather than talking to a therapist about their private feelings. The software can also be used as an introduction to CBT.

Evidence suggests that using computerised CBT packages can help treat anxiety and depressive disorders, particularly when used in conjunction with a therapist.

Carol's story

Carol Cattley had cognitive behavioural therapy (CBT) after 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."

What are the advantages of CBT?

Research has shown cognitive behavioural therapy (CBT) can be as effective as medicine in treating depression and other mental health problems.

However, for CBT to be successful, a committed approach is required, and it may not be suitable for everyone.

Some advantages and disadvantages of CBT are listed below.

Advantages of CBT

  • Research has shown CBT can be as effective as medicine in treating many types of depression and other mental health disorders.
  • CBT can be completed in a relatively short period of time compared with other types of 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.
  • Skills you learn in CBT are useful, practical and helpful strategies that can be incorporated into everyday life to help you cope better with future stresses and difficulties.

Disadvantages of CBT

  • To benefit from CBT, you need to commit yourself to the process. A therapist can help and advise you, but cannot make your problems go away without your co-operation.
  • Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties.
  • Some critics argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
  • CBT focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviours), and does not address wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing.

How effective is CBT?

CBT can help you manage problems, such as anxiety and depression and make them less likely to have a negative impact on your life.

There is always a risk that bad feelings you associate with your problem will return, but with your CBT skills it should be easier for you to control them.

Even after you are feeling better and your sessions have finished, it is important you practise your CBT skills. Some research suggests CBT may be better than antidepressants at preventing the return of depression.

‘Refresher’ CBT courses are also available if you feel you need to go through skills you have learnt again.

Content supplied byNHS Logonhs.uk

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Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.

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