CBT (Cognitive Behaviour Therapy)

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.

NHS choices say:

It is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

CBT cannot remove your problems, but it can help you deal with them in a more positive way. It is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.

CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller parts and showing you how to change these negative patterns to improve the way you feel.

Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.

How cognitive behavioural therapy works 

Cognitive behavioural therapy (CBT) can help you make sense of overwhelming problems by breaking them down into smaller parts.

In CBT, problems are broken down into five main areas:

• situations

• thoughts

• emotions

• physical feelings

• actions

CBT is based on the concept of these five areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.

Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.

For example, if your marriage has ended in divorce, you might think you have failed and that you are not capable of having another meaningful relationship.

This could lead to you feeling hopeless, 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.

But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.

This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.

This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.

CBT sessions

CBT can be carried out with a therapist in one-to-one sessions or in groups with other people in a similar situation to you.

If you have CBT on an individual basis, you will usually meet with a CBT therapist for between 6 and 12 weekly or fortnightly sessions, with each session lasting 60 minutes. Sometimes CBT can last longer in some cases.  

First sessions

The first few sessions will be spent making sure CBT is the right therapy for you, and that you are comfortable with the process. The therapist will ask questions about your life and background. Three sessions of assessment can reveal so much that work can progress very quickly.

If you are anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They will also ask about events that may be related to your problems, treatments you have had, and what you would like to achieve through therapy. CBT is effective for so many issues, please ask us if it is suitable for what you are experiencing.

If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it is not appropriate, or you do not feel comfortable with it, they can recommend alternative treatments. Some therapist are counsellors too so can integrate CBT into the sessions.   

Further sessions

After the initial assessment period, you will start working with your therapist to break down problems into their separate parts – the situation, thoughts, emotions, physical feelings and actions. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.

You and your therapist will analyse your thoughts, feelings and behaviours to work out if they are unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours. Irrational thoughts can cause upset for you and those around you.   

After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve questioning upsetting thoughts and replacing them with more helpful ones, or recognising when you are going to do something that will make you feel worse and instead doing something more helpful. You may be asked to do some 'homework' between sessions to help with this process.

At each session, you will discuss with your therapist how you have got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.

Confronting fears and anxieties can be very difficult. Your therapist will not ask you to do things you do not want to do and will only work at a pace you are comfortable with. During your sessions, your therapist will check you are comfortable with the progress you are making.

One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return. You can become your own counsellor once the thought processes have changed.

Helen is a Counsellor and offers working in a CBT way.  

CBT is a very structured way of working, it requires the therapist to plan sessions and review the work and also set homework for the client.