What is Cognitive Behavioral Therapy (CBT)?
It is a way of talking about:
- how you think about yourself, the world and other people
- how what you do affects your thoughts and feelings.
When does CBT help?
How does it work?
- A Situation – a problem, event or difficult situation
From this can follow:
- Physical feelings
|Situation : You’ve had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you.|
|Thoughts:||He/she ignored me – they don’t like me||He/she looks a bit wrapped up in themselves – I wonder if there’s something wrong?|
|Low, sad and rejected||Concerned for the other person|
|Physical:||Stomach cramps, low energy, feel sick||None – feel comfortable|
|Action:||Go home and avoid them||Get in touch to make sure they’re OK|
- a number of uncomfortable feelings
- an unhelpful behaviour.
What does CBT involve?
CBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme. In England and Wales, two computer-based programmes have been approved for use by the NHS. Fear Fighter is for people with phobias or panic attacks; Beating the Blues is for people with mild to moderate depression.
If you have individual therapy:
- 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
- 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 a 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 is used in many conditions, so it isn’t possible to list them all in this leaflet. We will look at alternatives to the most common problems – anxiety and depression.
- 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 the 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.
- A good therapist will pace your sessions. You decide what you do together, so you stay in control.
How long will the treatment last?
What if the symptoms come back?
So what impact would CBT have on my life?
How can I get CBT?
- Speak to your GP. They may refer you to someone trained in CBT – for example, a psychologist, nurse, social worker or psychiatrist.
- The British Association for Behavioural and Cognitive Psychotherapies keeps a register of accredited therapists.
- You can try ‘self-help’ – using a book, internet programme or computerised CBT. This is more likely to work if you also receive support from a professional.
What will happen if I don’t have CBT?
- Read more about the treatment and its alternatives.
- If you want to “try before you buy”, get hold of a self-help book or CD-Rom and see if it makes sense to you.
- Wait to see if you get better anyway – you can always ask for CBT later if you change your mind.
|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
: Royal College of Psychiatrist