Cognitive Behavioural Therapy (CBT)
CBT helps you to:
- Reconsider how you think about yourself, the world and other people.
- Understand how what you do affects your thoughts and feelings.
An effective course of CBT can help you to change how you think (the "Cognitive" part) and what you do (the "Behavioural” bit). When put into practice these changes can help you to feel better. CBT is one of several “talking treatments”, but unlike some of the other methods, it focuses on the problems or difficulties that are affecting you now. Rather than focussing on the causes of your distress or symptoms from the past, CBT teaches you ways to improve your state of mind now and in the future.
Psychologists and therapists have found CBT to be effective in the treatment of:
- Agoraphobia and other phobias
- Obsessive compulsive disorder
- Post traumatic stress disorder
- Social phobia
Research continues to find other conditions for which CBT can be effective.
How does CBT work?
The objective of CBT is to help you to make sense of problems that you feel are overwhelming you, by categorising your response to them, and by understanding how you react. This enables you to see how all the parts are connected and how they affect you. These parts are:
The Event - a problem, or difficult situation
From this can follow:
- Physical feelings
Each one of these areas can have an effect the others How you think about a problem can affect; how you feel both physically and emotionally. It can also alter what you do about it.
When you are depressed or anxious the interaction between thoughts, actions, feelings and situations can become a vicious cycle which can make you feel worse. Cognitive Behavioural Therapy explores the relationship between your unhelpful thoughts, actions, and feelings and shows you ways that can help you to break this vicious cycle.
A full course of CBT has traditionally been delivered by a therapist on a one-to-one basis or with a group of people. In many parts of the country there is a long waiting list for CBT and there is now a good evidence base supporting accessing CBT on a computer (computerised CBT).There are also books that some people find useful
However it is delivered for CBT to be successful, you must be prepared to put in some effort between each session so that you can apply what you learn to your day to day life. CBT is much more successful if you complete these tasks and projects
What happens in face to face CBT?
- You will usually meet with a therapist for between 5 and 20 weekly, or perhaps fortnightly, sessions. A session typically lasts between 30 and 60 minutes.
- During the first 2-4 sessions, your therapist will check that this sort of treatment is right for you and you will make sure that you are comfortable with it.
- Your 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 each day.
For any CBT to be successful you must be prepared to put in some effort between each session. With your therapist you identify each of your problems and then look at your Thoughts, Feelings and Behaviours to work out:
- If they are unrealistic or unhelpful.
- How they affect each other, and you.
Your therapist will then help you to work out ways to change your unhelpful thoughts and behaviours.. When you have identified what you can change, your therapist will recommend "homework" - you practice these changes in your day-to-day life
At each meeting you discuss how you've got on since the last session. Your therapist can help if any of the tasks seem too hard or don't seem to be helping. Your therapist 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 practice and develop your skills after the sessions have finished. This makes it less likely that your symptoms or problems will return.
Is CBT effective?
- One of the most effective treatments for conditions where anxiety or depression is the main problem
- The most effective psychological treatment for moderate and severe depression
- As effective as antidepressants for many types of depression
CBT is not, however, suitable for everyone and another type of talking treatment may work better for you. CBT is as effective as antidepressants for many forms of depression, and 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 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.
Will I be cured?
There is always a risk that the anxiety or depression will return, depending on your circumstances and the factors causing your problems. If they do, the new skills you have learned through CBT should make it easier for you to recover. So, it is important to keep practicing your CBT skills, even after you are feeling better. There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a "refresher" course.
CBT techniques can also be very useful for people who are simply experiencing low mood, mild depression, or worries because of something that is happening at work or at home. Self help material that teaches the concepts and skills of CBT can be very helpful in these cases.
Other useful websites are listed on our useful links page.