Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

CBT encourages you to talk about:

• how you think about yourself, the world and other people
• how what you do affects your thoughts and feelings

By talking about these things, CBT can help you to change how you think (‘cognitive’) and what you do (‘behaviour’), which can help you feel better about life.

Who can use it

CBT is particularly helpful in tacking problems such as anxiety, depression, post-traumatic stress disorder, eating disorders and drug misuse.

Unlike other talking treatments, such as psychotherapy, CBT focuses on the problems and difficulties you have now, rather than issues from your past. It looks for practical ways you can improve your state of mind on a daily basis.

Number of sessions

CBT usually involves weekly or fortnightly sessions with a therapist. The number of sessions required varies greatly depending on your problems and objectives, with treatment usually lasting from six weeks to six months.

Outlook

CBT can help you see how your thoughts and behaviour relate to the way you feel, and how this might contribute to problems in your life.

Your therapist will help you find ways to change your thought patterns and behaviour so you can cope with your problems and anxieties better (see box, left).

CBT cannot remove your problems, but can help you to manage them in a more positive way.

CBT is thought to be one of the most effective treatments for anxiety and depression.

Cognitive behavioural therapy (CBT) can be used to treat a number of different mental health conditions, including:

• obsessive compulsive disorder
• phobias and panic disorder
• post-traumatic stress disorder
• depression
• eating disorders (for example, anorexia and bulimia)

CBT can also help:

• anger problems
• habits (such as facial tics)
• drug and alcohol abuse
• relationship problems
• sleep problems

CBT is also used to treat people with chronic health conditions, such as arthritis or irritable bowel syndrome. Although CBT cannot cure any physical symptoms, it can help people who have long-term conditions to cope better with their symptoms.

Where to find a CBT therapist

CBT is available on the NHS for the treatment of many conditions including anxiety, phobias, eating disorders, depression and schizophrenia. If you feel that CBT may be of benefit to you, discuss it as a possible treatment option with your GP. They can refer you to someone trained in CBT, such as a psychologist, nurse, social worker or psychiatrist.

Alternatively, you can get CBT privately. The British Association for Behavioural and Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK. The cost of private therapy sessions varies, but is usually £40-£100.

CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts.

Following from the problem, event or difficult situation are your:

• thoughts
• feelings
• physical sensations
• actions

Each of these areas can affect the others. For example, your thoughts about a problem can affect how you feel physically and emotionally, and how you act upon it.

An example

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

• If your marriage has just ended in divorce, you could think that you have failed as a partner and are not capable of having another meaningful relationship.
• This could lead you to feel hopeless and 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 this thought pattern, after your divorce you could:

• Accept that many marriages end, learn from your mistakes and move on, feeling optimistic about the future.
• Feeling energetic, you may then become more socially active, start evening classes and find a new circle of friends.

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

CBT helps to stop negative cycles such as these. By breaking down the things that are making you feel bad, anxious or scared, CBT makes them more manageable. CBT can show you ways to change your negative patterns and improve the way you feel.

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

What CBT involves

CBT is usually done individually, but can also be offered:

• as group therapy, with others who wish to tackle a similar problem
• as a self-help book, where you carry out exercises from the book
• as a computer programme (known as computerised CBT; see below)

The sessions

Individual work will usually involve meeting with a CBT therapist for 5 to 20 weekly or fortnightly sessions, with each session lasting 30-60 minutes.

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

Homework

• With your therapist, you break down a problem into its separate parts: situation, thoughts, emotions, physical feelings and actions. To help with this, you may be asked to keep a diary or write down your thought and behaviour patterns.
• With your therapist, you will look at your thoughts, feelings and behaviours to work out if they are unrealistic or unhelpful and how they affect each other and you.
• Your therapist will help you to work out how to change unhelpful thoughts and behaviours.
• After you have worked out what you can change, your therapist will recommend homework, so you can practise these changes in your daily life. This may involve questioning upsetting thoughts and replacing them with more helpful ones, 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 your homework, and what it felt like. Your therapist can 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 should continue to check you are comfortable with the progress you are making.

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

Computerised CBT

A number of interactive software programmes are now available that replicate some of the functions of a CBT therapist. Two examples of programmes approved for use by the NHS are:

• Beating the blues, which has been approved for the treatment of depression, anxiety and phobias
• Fear fighter, which has been approved for use in people with phobias and panic attacks

However, NICE states in its latest (2009) guidelines on depression in adults that other computerised CBT packages (both internet and web-based) may be similarly effective to Beating the Blues.

Some people find they prefer using a computer rather than talking to a therapist about their private feelings, or they use the software as an introduction to CBT.

Evidence suggests that the delivery of CBT via a computer can help with anxiety and depressive disorders, especially when a patient also sees a therapist.

Advantages

• Research has shown that cognitive behavioural therapy (CBT) can be as successful as medicine in treating many types of depression and other mental health disorders
• CBT can be completed in a relatively short time compared with other talking therapies.
• Because it is highly structured, CBT can be provided in a number of different formats such as through computer programmes, groups and self-help books.
• The skills learnt in CBT are useful, practical and helpful strategies that can be incorporated into an individual’s life to help them cope better with future stresses and difficulties.

Disadvantages

• 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.
• Because of the structured nature of CBT, it may not be suitable for people who have more complex mental health needs or learning difficulties.
• Some critics of CBT argue that because the therapy only addresses current problems and focuses on very 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 to manage problems, such as anxiety and depression, so they are less likely to have a negative impact on your life. There is always a risk that the bad feelings you associate with your problem 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 to practise your CBT skills. Some research suggests that CBT may be better than antidepressants at preventing the return of depression. ‘Refresher’ CBT courses are available if you feel you need to go through the skills you have learnt again. 

Carol Cattley, 73, 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 re-live 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."