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 it can help you deal with them in a more positive way. It 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 crack this cycle by breaking down overwhelming problems into smaller parts and showing you 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.
When is CBT used?
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:
- obsessive compulsive disorder (OCD)
- panic disorder
- post-traumatic stress disorder (PTSD)
- eating disorders, such as anorexia and bulimia
- sleep problems, such as insomnia
- problems related to alcohol misuse
CBT is sometimes used to treat people with long-term health conditions, such as irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). CBT cannot cure the physical symptoms of these health conditions, but it can help people cope better with their symptoms.
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 is free on the NHS, although you may have to wait. Find psychological therapy services (IAPT).
If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies, but it is usually £40-100 per session.
If you are 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.
What happens during CBT sessions?
If CBT is recommended, you will usually have a session with a therapist once a week or once every two weeks. The course of treatment will usually last for between 5 and 20 sessions, with each session lasting 30-60 minutes.
During the sessions, you will 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 are 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 will 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
There are a number of advantages and disadvantages of CBT.
Research has shown that CBT can be as effective as medication in treating some mental health problems. Compared to 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.
How cognitive behavioural therapy works
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:
- physical feelings
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.
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.
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.
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 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 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 programmes. You will need to regularly practice the exercises as prescribed to overcome your problems.
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 will usually meet with a CBT therapist for between 5 and 20 weekly or fortnightly sessions, with each session lasting 30-60 minutes.
Exposure therapy sessions will 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) or 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.
The first few sessions 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.
If you are anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They will also ask about events that may be related to your problems, treatments you have 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 is not appropriate, or you do not feel comfortable with it, they can recommend alternative treatments.
After the initial assessment period, you will start working with your therapist to break down problems into their 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 analyse 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. You may be asked to do some ‘homework’ between sessions to help with this process.
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.
A number of interactive software programmes are now available that allow you to benefit from CBT with minimal or no contact with a therapist.
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, although 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.
Things to consider
Research has shown that cognitive behavioural therapy (CBT) can be as effective as medication in treating some mental health problems.
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. This is why it is important to continue practising your CBT skills even after you are feeling better and your sessions have finished. “Refresher” CBT courses are also available if you feel you need to go through skills you have learnt again.
Nevertheless, CBT may not be successful or suitable for everyone. Some advantages and disadvantages of the approach are listed below.
Advantages of CBT
- Can be as effective as medication in treating some mental health disorders and may be helpful in cases where medication alone has not worked.
- 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 programmes.
- 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, even after the treatment has finished.
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.
- Attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time.
- Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties.
- As CBT can involve confronting your emotions and anxieties, you may experience initial periods where you are more anxious or emotionally uncomfortable.
- 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.
‘It can be agonising in many ways’
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.”