What is Cognitive Behavioural Therapy?

Cognitive behavioural therapy (CBT) aims to help you to change the way that you think, feel and behave. It is used as a treatment for various mental health and physical problems.

Cognitive Therapy

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 psychological problems (e.g. anxiety, depression, phobias, etc). The therapist helps you to understand your current thought patterns. In particular, to identify any unhelpful thoughts that you have that can trigger your psychological difficulty, or make it worse. The aim is then to change your ways of thinking and the way you deal with unhelpful thoughts.

Behavioural Therapy

This aims to change any behaviours that are unhelpful. 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 tolerate anxiety and to cope when you face up to the feared situations.

Cognitive Behavioural Therapy

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.

What conditions can be helped by cognitive behavioural therapy?

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
• Depression
• Eating disorders
• OCD
• Body dysmorphic disorder
• Anger
• Post-traumatic stress disorder
• Sexual and relationship problems
• Drug or alcohol abuse
• Chronic fatigue syndrome
• 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 that 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.

Frequently Asked Questions

What is likely to happen during a course of cognitive behavioural therapy?

The first session of therapy will 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 lasts about 50-60 minutes. Typically, a session of therapy is done once a week. Most courses of CBT last for several weeks. It is common to have 10-15 sessions, but a course of CBT can be longer or shorter, depending on the nature and severity of the condition.

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 that occur when you become anxious before a social event. Later on you may be given homework for trying out ways of coping that you have learned during therapy.

What is the difference between cognitive behavioural therapy and other talking treatments?

CBT is one type of psychotherapy (talking treatment). Unlike other types of psychotherapy, CBT tends to deal with the here and now – how your current thoughts and behaviours are affecting you now. It recognises that events in your past have shaped the way that you currently think and behave; in particular, thought patterns and behaviours learned in childhood, However, CBT does not dwell on the past, but aims to find solutions to how to change your current thoughts and behaviours so that you can function better now and in the future.

CBT is also different to counselling, which is meant to be non-directive, empathetic and supportive. Although the CBT therapist will offer support and empathy, the therapy has a structure, is problem-focused and practical.

How well does cognitive behavioural therapy work?

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 are longer-term benefits of CBT over medication, as the techniques to combat these problems can be used for the rest of your life.

What are the limitations of cognitive behavioural therapy?

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 difficulties with the help of the therapist. It can be hard work. The homework may be challenging. You may be taken ‘out of your comfort zone’ when tackling situations that cause anxiety or distress. However, many people have greatly benefited from a course of CBT.