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Cognitive behavioural therapy

Published by Bupa's health information team, July 2009.

This factsheet is for people who are considering having cognitive behavioural therapy, or who would like information about it.

Cognitive behavioural therapy (CBT) is a short-term psychological treatment. CBT helps to challenge negative thoughts, feelings and behaviour, and is particularly suitable for specific problems such as phobias, panic attacks, eating disorders and depression. It can also help people who have more severe psychiatric disorders.

About CBT
Where can I find a therapist?
About a CBT treatment session
Is CBT effective?
Deciding on CBT treatment
Questions and answers
Related topics
Further information
Sources

About CBT

CBT is a combination of cognitive therapy that helps with thinking processes, such as unwanted thoughts, attitudes, and beliefs (called cognitive processes) and behavioural therapy that focuses on behaviour in response to those thoughts.

CBT is based on the belief that people learn most of their unhealthy ways of thinking and behaving over a long period of time. Using a set of structured techniques, a CBT practitioner aims to identify how you are thinking and how this can cause problematic feelings and behaviour. You will learn to challenge negative ways of thinking, which helps you to react more positively. This can lead to behavioural changes and then to improved self-esteem.

For example, negative thoughts usually lead to upsetting or angry feelings which can affect your mood and your behaviour. If you're unable to balance such thoughts with a more positive view, a negative spiral starts and your perceptions of a situation become distorted. CBT encourages you to challenge the way you react to events, your beliefs about yourself and your abilities, so that you achieve a more realistic view of a situation.

How does CBT work?

You will learn to make sense of problems by breaking them down into smaller areas so that you can see how they are connected and how they can affect you. This includes looking at your thoughts, emotions, physical feelings and actions in reaction to a situation.

You will probably be asked to keep a diary so that you can identify how you react to certain events. This will help you to identify patterns of thoughts, emotions, physical feelings and actions, and see if they are unrealistic or unhelpful.

You and your therapist then work together to make changes. Once you've learnt to identify negative patterns, you'll be asked to practise replacing negative thoughts with positive ones during everyday events. This isn't always easy but using CBT techniques you can try out different behavioural approaches in real situations, which can help to bring about changes. You won't be asked to do anything that you don't feel comfortable with.

CBT aims to provide you with the insight and skills to improve your quality of life. Once therapy has finished, you will be able to practise and develop on your own what you have already learnt.

What problems can CBT help?

CBT can help people who have:

anger issues
anxiety and panic attacks
chronic fatigue syndrome
depression
drug or alcohol problems
eating disorders
obsessive-compulsive disorder
persistent pain
phobias
post-traumatic stress
schizophrenia
sleep problems
sexual or relationship issues

Where can I find a therapist?

A number of health professionals use CBT in their treatment, including clinical psychologists, psychiatrists, nurses and social workers. Your GP can give you information about accessing services.

Practitioners vary in skill, training and experience. The British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the UK Council for Psychotherapy (UKCP) hold registers of accredited practitioners. You can contact the BABCP or search their website for a list of therapists in your area.

Some mental health teams and GP surgeries will have access to computer-based CBT programmes, some of which are available for free online. These are thought to be helpful but there is a lack of evidence to show how effective they really are. Lots of people start using them but drop out before the end of the programme.

The programmes may help you decide if you would like to see a therapist. You can also try working through CBT books or computer programmes on your own. Ask your GP for more information. Your local library may have CBT programmes available to borrow.

About a CBT treatment session

At a consultation

The success of CBT depends on your active participation in the whole process, so you will have an initial consultation to help you decide whether you want to go ahead with the therapy. It also enables the therapist to talk to you and decide if this sort of therapy will be useful.

At this session, you and your therapist will work together to identify the problem areas. You and your therapist will then plan a structured way forward with agreed practical objectives. This helps you to plan future sessions, including the treatment aims and tasks. In further sessions you will review your progress, set targets and undertake tasks that aim to reach your goal of recovery.

A key part of the treatment is the homework assignments you agree with your therapist. These may include reading material, or tasks where you can test and practise the techniques you learn, or exposing yourself gradually to situations you're afraid of.

Common CBT techniques include:

challenging irrational beliefs and replacing them with alternative ones
stopping unhelpful thoughts
gradual exposure to situations
assertiveness training
social skills training

How many sessions will I need?

CBT is a short-term treatment which typically lasts for 10 to 15 individual, weekly sessions. The number of sessions depends on the type of problem and your commitment. Each session usually lasts for about an hour.

Is CBT effective?

CBT isn't for everyone and only helps people with certain conditions, especially if anxiety and depression are the main problems. Clinical trials suggest that CBT is as effective as medicines for short-term treatment of many non-severe depressive and anxiety disorders.

Studies have shown that two years after therapy has ended, CBT patients do better than those using other treatments. They also suggest that CBT brings about a real change in how people feel about themselves and protects them from getting ill again. People who use medicines may be at greater risk of relapse when they stop taking them compared with people who have undertaken CBT, which can lead to lasting change.

Deciding on CBT treatment

Treatment can be challenging and you must want to actively change your thoughts and behaviour for it to be successful. You will need to be open, persistent and brave when undergoing CBT and you may have to deal with difficult emotions such as anger, guilt and shame.