CBT: how cognitive behaviour therapy works

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Everything you need to know about CBT, a talking therapy based on changing unhelpful behaviours to improve how you feel.

By Navit Schechter – PGDip, BABCP (Accred), BSc (Hons)

Cognitive Behaviour Therapy (or CBT) is a type of talking therapy most commonly used to treat symptoms of anxiety and depression, although it can help with many other types of problems too.

Navit Schechter, a qualified CBT Therapist with more than 12 years experience, explains the principles of CBT including how it works, who it’s for and where to get help:

What is CBT?

CBT helps you to understand how your beliefs about yourself, other people and the world affect how you feel and the things that you do. These beliefs can create a vicious cycle that can keep you stuck in patterns of negative feelings. CBT helps you to recognise and break out of these vicious cycles. It focuses on the problems that you are experiencing in the present moment, in the ‘here and now’ and helps you to identify and achieve your goals to feel better.

How does CBT work?

CBT is based on the understanding that our thoughts, feelings, physical symptoms and behaviours are all interrelated and making a change in any one of these areas will affect what is going on in the others.

CBT recognises that negative feelings such as anxiety and depression commonly arise, not as a result of the situation that we’re in, but from the biased or unrealistic thoughts that we have as a result of it. These can lead us to do things that may help us to feel better in the short-term but exacerbate or maintain our negative feelings in the long-term.

CBT is based on the understanding that our thoughts, feelings, physical symptoms and behaviours are all interrelated.

Imagine a man was bitten by a dog and as a result developed a belief that all dogs would attack him. Every time he saw a dog, he would be reminded of this thought and would feel intensely anxious and short of breath as a result. In an attempt to avoid being attacked, he would go out of his way to avoid dogs and by doing so would not get the opportunity to see that this was unlikely to happen.

His biased and unrealistic thoughts would therefore remain, along with the anxiety caused by them every time he saw a dog. This is a very simplified example, but shows the inevitable link between our thoughts, feelings, physical symptoms and behaviours.

CBT works by helping you to recognise the unhelpful thoughts and beliefs that you have and the things that you do that may be contributing to the way that you are feeling and helps you to change these in order to improve how you feel.

How does CBT differ to other therapies?

CBT differs from other talking therapies in a number of ways:

  • A key feature of CBT is that it is collaborative, which means that you and your therapist will be working together as a team in your sessions to help you to identify the problems you’re experiencing, the goals you would like to achieve and how to achieve them.
  • Compared to many other types of talking therapy, CBT is a relatively short-term treatment, usually lasting for between five and 20 sessions. These are usually hour long weekly sessions, but may be more or less frequent, or slightly longer or shorter, depending on what you need.
  • As it is a short-term treatment, CBT is a focused treatment and sessions will centre around helping you to move from the problems you are experiencing to the goals that you want to achieve.
  • At the end of each session, you and your therapist will identify how you can continue your improvement over the following week with out-of-session tasks (sometimes known as homework). This is key component of CBT therapy and it has been found that the more attention clients pay to their therapy outside of the therapy session, the more likely they are to relieve their symptoms.
  • During your course of therapy your therapistwill help you to develop an understanding of how emotional problems develop and are maintained as well as a toolkit of strategies that you can use to overcome them so that in the future you are able to become ‘your own best therapist’.
  • Towards the end of a course of therapy, you and your therapist will develop a blueprint which is a summary of everything that you have learnt in therapy and a record of the strategies that have helped you which you can look back on, should you face similar difficulties in the future.

What can CBT help with?

CBT will give you a safe and non-judgmental space to talk about your fears, negative thoughts, difficulties and concerns which can bring a sense of relief and release, especially if you have been holding them in for many years.

It will help you to clearly understand yourself and the difficulties you’re experiencing and learn how emotional and mental issues develop and the things that we do to reinforce them.

CBT will give you a safe and non-judgmental space to talk about your fears and negative thoughts.

CBT will help you to become clear on what you want and how you need things to be in your life to maintain a healthy mind as well as the steps that you need to take to achieve this and will give you the skills you need to feel yourself again and reclaim your life, enabling you to be more confident in yourself and your ability to deal with future problems when they arise.

What does CBT treat?

CBT is most commonly used to treat common mental health problems such as:

  • Depression
  • Anxiety
  • Social phobia
  • Panic disorder
  • Obsessive compulsive disorder
  • Generalised anxiety disorder
  • Phobias
  • Health anxiety
  • Post-traumatic stress disorder

CBT is also used in the treatment of bipolar disorder, borderline personality disorder, eating disorders, schizophrenia and psychosis, insomnia and alcohol misuse.

More recently, CBT has also been found effective in supporting people who are experiencing long-term health conditions such as chronic fatigue syndrome, chronic pain, irritable bowel syndrome and fibromyalgia.

How effective is CBT?

CBT refers to a number of different treatments which are centred around the interaction between thoughts, feelings, physical symptoms and behaviours and using this to help clients make the changes they need.

All treatments that are included under the umbrella term of CBT are evidence-based which means that they have been proven, in scientific studies, to be effective. The National Institute for Health and Clinical Excellence (NICE) therefore recommends CBT as the talking therapy of choice in the treatment of anxiety and depression and many other problems as there is now so much research available demonstrating it’s effectiveness.

What happens during a CBT session?

You will usually start a CBT therapy session by setting an agenda. This allows you and your therapist to plan how you will spend the session time so that you can make the best use of it and ensure that the session is as relevant and helpful for you as possible.

At the beginning of a course of therapy, the majority of the session will be focused on helping you to understand why you are experiencing the problems you are experiencing and how to recognise the factors that are contributing to these problems. Later on in the course of therapy, most of the session will be focused on supporting you to make the changes that you need to make in order to feel better.

The pros and cons of CBT

CBT is not a quick fix or a ‘magic pill’. To get the most benefit from it, you need to be an active participant in your recovery, attending regular appointments and putting what you’ve learnt from therapy into practise between sessions. This can be time-consuming and some people find that they feel worse before they feel better as they start to pay more attention to their problems and how they are affecting them.

CBT is not a quick fix and to get the most benefit you need to be an active participant in your recovery.

However CBT can help you completely overcome your anxiety and depression, giving you long-lasting results and knowledge and skills that you can use in the future. It can be helpful in treating some mental health conditions when medication has not worked or is not wanted and is a relatively short-term treatment compared to some other talking therapies, that focuses on helping you to make changes, achieve your goals and create the life that you want.

Where to get CBT

If you think you would benefit from a course of CBT, to access CBT therapists online or in your area, try one of the following resources:

  • Contact your GP

If you think you would benefit from a course of CBT therapy, your GP can refer you to your local psychological therapy service. CBT therapy is available on the NHS to adults aged 18 and over who are registered with a GP and sessions are now commonly delivered online either via video or instant messaging.

  • Local psychological service

If you aren’t able to contact your GP, you may be able to refer yourself directly to your local psychological service which you can find here:

  • Private CBT therapist

You can also have therapy with a private CBT therapist. The benefits of seeing a private therapist are that you should not have to wait long to start treatment and there is no limit on the number of sessions available to you. To find a qualified and accredited therapist visit the British Association of Behavioural and Cognitive Psychotherapies (BABCP).

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