Cognitive Behavioural Therapy (CBT) is a way of treating problems by helping to change patterns of thinking and behaviour that may have become unhelpful. It is based on the fact that how you think and behave affects your emotions, and vice versa. CBT is a collaborative approach with clear goals that are agreed with you, and reviewed regularly. CBT aims to provide a set of tools that you can apply during and after the course of treatment. In effect, you learn how to be your own therapist.
CBT usually works in the here and now. However, psychological problems and emotional difficulties can arise at any stage of life, and therapy may require an understanding of the previous experiences that have shaped the way you think, feel and behave. A period of assessment will include talking about all aspects of your life.
When does CBT help?
CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue.
What does CBT involve?
- You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes.
- In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.
- The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.
- You decide what you want to deal with in the short, medium and long term.
- You and the therapist will usually start by agreeing on what to discuss that day.
With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out: if they are unrealistic or unhelpful. The therapist will then help you to work out how to change unhelpful thoughts and behaviours.
It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend 'homework' - you practise these changes in your everyday life. Depending on the situation, you might start to: question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT or recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping. They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.
How effective is CBT?
It is one of the most effective treatments for conditions where anxiety or depression is the main problem.
It is the most effective psychological treatment for moderate and severe depression.
It is as effective as antidepressants for many types of depression.