Cognitive behavioural therapy (CBT)

How CBT works

CBT 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 deal with overwhelming problems in a more positive way by breaking them down into smaller parts.

You're shown 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.

Uses for CBT

CBT has been shown to be an effective way of treating a number of different mental health conditions.

In addition to depression or anxiety disorders, CBT can also help people with:

• obsessive compulsive disorder (OCD) 
• panic disorder
• post-traumatic stress disorder (PTSD)
• phobias
• eating disorders – such as anorexia and bulimia
• sleep problems – such as insomnia
• problems related to alcohol misuse

CBT is also sometimes used to treat people with long-term health conditions, such as:

• irritable bowel syndrome (IBS)
• chronic fatigue syndrome (CFS)

Although CBT can't cure the physical symptoms of these conditions, it can help people cope better with their symptoms.

What happens during CBT sessions

If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks.

The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 60 minutes.

During the sessions, you'll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.

You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful, and to determine the effect they have on each other and on you.

Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.

After working out what you can change, your therapist will ask you to practise these changes in your daily life and you'll discuss how you got on during the next session.

The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.

This should help you manage your problems and stop them having a negative impact on your life, even after your course of treatment finishes.

Pros and cons of CBT

Cognitive behavioural therapy (CBT) can be as effective as medication in treating some mental health problems, but it may not be successful or suitable for everyone.

Some of the advantages of CBT include:

• it may be helpful in cases where medication alone hasn't worked
• it can be completed in a relatively short period of time compared with other talking therapies
• the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps (you can find mental health apps and tools in the NHS apps library)
• it teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished

Some of the disadvantages of CBT to consider include:

• you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
• attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
• it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions
• it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable
• it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviours) – this doesn't address any wider problems in systems or families that often have a significant impact on someone's health and wellbeing

Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn't address the possible underlying causes of mental health conditions, such as an unhappy childhood.

How to find a CBT therapist

You can get psychological therapies, including CBT, on the NHS.

You don't need a referral from your GP.

You can refer yourself directly to a psychological therapies service.