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Cognitive behavioural therapy (CBT) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviours and cognitions through a goal-oriented, systematic procedure. It is based on a combination of basic behavioural and cognitive research.
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.
Our cognitive processes are our thoughts which include our ideas, mental images, beliefs and attitudes. Cognitive therapy is based on the principle that certain ways of thinking can trigger, or fuel, certain health problems. For example, anxiety, depression, phobias, etc, but there are others, including physical problems. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or thoughts which you have that can trigger your health problem, or make it worse. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful.
This aims to change any behaviours that are harmful or not helpful. Various techniques are used. For example, a common unhelpful behaviour is to avoid situations that can make you anxious. In some people with phobias the avoidance can become extreme and affect day-to-day life. In this situation a type of behavioural therapy called exposure therapy may be used. This is where you are gradually exposed more and more to feared situations. The therapist teaches you how to control anxiety and to cope when you face up to the feared situations. For example, by using deep breathing and other techniques.
Cognitive behavioural therapy (CBT)
This is a mixture of cognitive and behavioural therapies. They are often combined because how we behave often reflects how we think about certain things or situations. The emphasis on cognitive or behavioural aspects of therapy can vary, depending on the condition being treated. For example, there is often more emphasis on behavioural therapy when treating obsessive-compulsive disorder (OCD) - where repetitive compulsive actions are a main problem. In contrast, the emphasis may be on cognitive therapy when treating depression.
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:
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.
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.
CBT has been shown to help people with various conditions - both mental health conditions and physical conditions. For example:
Certain anxiety disorders, including phobias, panic attacks and panic disorder
Obsessive Compulsive Disorder (OCD)
Body dysmorphic disorder
Post-traumatic stress disorder
Sexual and relationship problems
Habits such as facial tics
Drug or alcohol abuse
Some sleep problems
Chronic fatigue syndrome (CFS) / Myalgic encephalomyelitis (ME)
Chronic (persistent) pain
As a rule, the more specific the problem, the more likely CBT may help. This is because it is a practical therapy which focuses on particular problems and aims to overcome them. CBT is sometimes used alone, and sometimes used in addition to medication, depending on the type and severity of the condition being treated.
The first session of therapy will usually include time for the therapist and you to develop a shared understanding of the problem. This is usually to identify how your thoughts, ideas, feelings, attitudes, and behaviours affect your day-to-day life.
You should then agree a treatment plan and goals to achieve, and the number of sessions likely to be needed. Each session typically lasts between 50 to 60 minutes. Typically, a session of therapy is done once a week. Most courses of CBT last for several weeks. It is common to have 10 to 15 sessions, but a course of CBT can be longer or shorter, depending on the nature and severity of the condition. In some situations CBT sessions can be done by telephone.
You have to take an active part, and are given homework between sessions. For example, if you have social phobia, early in the course of therapy you may be asked to keep a diary of your thoughts which occur when you become anxious before a social event. Later on you may be given homework of trying out ways of coping which you have learned during therapy.
CBT has been shown in clinical trials to help ease symptoms of various health problems. For example, research studies have shown that a course of CBT is just as likely to be effective as medication in treating depression and certain anxiety disorders. There may be long-term benefits of CBT, as the techniques to combat these problems can be used for the rest of your life to help to keep symptoms away. So, for example, depression or anxiety are less likely to recur in the future. There is good research evidence too to show that CBT can help to improve symptoms of some physical conditions such as rheumatoid arthritis.
CBT does not suit everyone and it is not helpful for all conditions. You need to be committed and persistent in tackling and improving your health problem with the help of the therapist. It can be hard work. The homework may be difficult and challenging. You may be taken out of your ‘comfort zone’ when tackling situations which cause anxiety or distress. However, many people have greatly benefited from a course of CBT.
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.
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.
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. You can also get CBT privately. The British Association for Behavioural and Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK.