Cognitive behavioural therapy (CBT)

Published by Bupa's Health Information Team, April 2011.

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

CBT is a short-term psychological treatment. It helps to challenge negative thoughts, feelings and behaviours. CBT is most commonly used as a treatment for anxiety and depression.

The availability and exact details of this therapy may vary from country to country. Ask your doctor or therapist for advice.

About CBT
What happens during CBT?
Where can I find a CBT practitioner?
Is CBT effective?
Deciding on CBT treatment

About CBT

CBT is a type of talking therapy. It's a combination of cognitive therapy, which helps with your thinking processes, and behavioural therapy, which focuses on your behaviour in response to those thoughts.

Common CBT techniques include:

• challenging negative beliefs and replacing them with alternative ones
• problem solving
• developing coping skills

CBT is a short-term treatment that usually lasts between six weeks and six months. It consists of individual treatment sessions, which you will usually attend every week. Occasionally, group sessions are available as well. The number of sessions you have will depend on your condition and commitment to the treatment. Each session usually lasts for about an hour.

CBT is most often used to treat anxiety disorders or depression. However, it can also be used to treat:

• panic disorders
• eating disorders
• obsessive-compulsive disorder (OCD)
• bipolar disorder
• phobias
• stress
• post-traumatic stress disorder
• schizophrenia
• anger issues
• sleep problems
• body dysmorphic disorder
• persistent pain
• sexual or relationship issues

CBT is sometimes given together with medication for anxiety disorders, moderate to severe depression and attention deficit hyperactivity disorder (ADHD).

What happens during CBT?

To start with, your CBT practitioner will usually ask about your background and how you are currently feeling. He or she will work with you to identify problem areas and you will decide which areas you would like to deal with.

You will learn to make sense of your problems by breaking them down into smaller areas so that you can see how they are connected and how they affect you.

Using structured techniques, your CBT practitioner will try to identify how you are thinking and how this can cause problematic feelings and behaviours. You will learn to challenge negative ways of thinking, and how to react more positively. This can lead to behavioural changes that may make you feel better.

You may 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.

Your CBT practitioner may also set you homework assignments. This can include reading material, tasks where you can test and practise the techniques you learn, or gradually exposing yourself to situations you're afraid of. Your CBT practitioner may ask you to practise replacing negative thoughts with positive ones during everyday events. This isn't always easy, but by using CBT techniques you can try out different behavioural approaches in real situations, which can help you to make 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 what you have learnt and continue on your own.

Where can I find a CBT practitioner?

If you think you may benefit from CBT, speak to a doctor. He or she may be able to refer you to someone who is trained in this type of therapy.

A number of different health professionals are trained to use CBT, including clinical psychologists, psychiatrists (doctors who specialise in mental health conditions), mental health nurses and social workers.

Some mental health services and doctor's surgeries may have access to interactive 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. Most people are more likely to benefit from CBT with a well-qualified therapist.

Is CBT effective?

CBT only helps people with certain conditions and it isn't for everyone. Research suggests that CBT is effective at reducing the symptoms of anxiety disorders and mild to moderate depression. It may also help to reduce your risk of getting these conditions again (relapse).

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. The success of CBT depends on your active participation and commitment to the process.