Overview-Cognitive behavioural therapy (CBT)
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.
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.
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:
- bipolar disorder
- borderline personality disorder
- eating disorders – such as anorexia and bulimia
- obsessive compulsive disorder (OCD)
- panic disorder
- phobias
- post-traumatic stress disorder (PTSD)
- psychosis
- schizophrenia
- sleep problems – such as insomnia
- problems related to alcohol misuse
CBT is also sometimes used to treat people with long-term health conditions, such as:
- irritable bowel syndrome (IBS)
- chronic fatigue syndrome (CFS)
- fibromyalgia
Although CBT cannot 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 2 weeks.
The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 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 have 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 medicine 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 medicine alone has not worked
- it can be completed in a relatively short period of time compared with other talking therapies
- the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps (you can find mental health apps and tools in the NHS apps library)
- 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 person's capacity to change themselves (their thoughts, feelings and behaviours) – this does not address any wider problems in systems or families that often have a significant impact on someone's health and wellbeing
Some critics also 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.
How to find a CBT therapist
You can get psychological therapies, including CBT, on the NHS.
You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.
Or your GP can refer you if you prefer.
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 to £100 per session.
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.
How it works-Cognitive behavioural therapy (CBT)
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 5 main areas:
- situations
- thoughts
- emotions
- physical feelings
- actions
CBT is based on the concept of these 5 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 will not 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 is not 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 1 to 2 hours or until the anxiety reduces for a prolonged period by a half.
Your therapist will ask you to repeat this exposure exercise 3 times a day. After the first few times, you'll find your anxiety does not climb as high and does not 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 6 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 1-to-1 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 5 and 20 weekly or fortnightly sessions, with each session lasting 30 to 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 do not 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 will not ask you to do things you do not 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.
Online CBT
A number of interactive online tools are now available that allow you to benefit from CBT with minimal or no contact with a therapist.
You can see a selection of mental health tools and apps in the NHS apps library.
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.