Cognitive Behavioural Therapy (CBT)
What is CBT?
It is a way of talking about:
CBT can help you to change how you think ("Cognitive") and what you do ("Behaviour)". These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the "here and now" problems and difficulties. Instead of focussing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
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.
How does it work?
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:
A Situation - a problem, event or difficult situation
From this can follow:
Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them.
What does CBT involve?
You will usually meet with a therapist for between 5 and 20, weekly, sessions. Each session will last 50 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
- how they affect each other, and you.
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 more helpful (and more realistic) one that you have developed in CBT.
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
What other treatments are there and how do they compare?
CBT isn't for everyone and another type of talking treatment may work better for you.
CBT is as effective as antidepressants for many forms of depression. It may be slightly more effective than antidepressants in treating anxiety.
For severe depression, CBT should be used with antidepressant medication. When you are very low you may find it hard to change the way you think until antidepressants have started to make you feel better.
Tranquillisers should not be used as a long term treatment for anxiety. CBT is a better option.
Problems with CBT
CBT is not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for you.
If you are feeling low, it can be difficult to concentrate and get motivated.
To overcome anxiety, you need to confront it. This may lead you to feel more anxious for a short time.
How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment.
What if the symptoms come back?
There is always a risk that the anxiety or depression will return. If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practising your CBT skills, even after you are feeling better. There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a "refresher" course.
So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.
CHANGE VIEW: 10 key facts about CBT
Change: your thoughts and actions
Homework: practice makes perfect
Action: don't just talk, do!
Need: pinpoint the problem
Goals: move towards them
Evidence: shows CBT can work
View: events from another angle
I can do it: self-help approach
Experience: test out your beliefs
Write it down: to remember progress
Useful CBT web links
Mood Gym: moodgym.anu.edu.au Information, quizzes, games and skills training to help prevent depression
Living Life to the Full: www.livinglifetothefull.com Free online life skills course for people feeling distressed and their carers. Helps you understand why you feel as you do and make changes in your thinking, activities, sleep and relationships.
Fear Fighter: www.fearfighter.com (free access can only be prescribed by your doctor in England and Wales)