Cognitive Behavioural Therapy

This leaflet is for anyone who wants to know more about Cognitive Behavioural Therapy (CBT). It discusses how it works, why it is used, its effects, its side-effects, and alternative treatments. If you can't find what you want here, there are sources of further information at the end of this leaflet.

What is CBT?

It is a way of talking about:

• how you think about yourself, the world and other people
• how what you do affects your thoughts and feelings.

CBT can help you to change how you think ('Cognitive') and what you do ('Behaviour'). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

When does CBT help?

CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue.

How does it work?

CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:

• A Situation - a problem, event or difficult situation. From this can follow:
• Thoughts
• Emotions
• Physical feelings
• Actions

Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally.

All these areas of life can connect like this: 5 Areas

What happens in one of these areas can affect all the others.

There are helpful and unhelpful ways of reacting to most situations, depending on how you think about it. The way you think can be helpful - or unhelpful.

An example:

The Situation

You've had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you. This starts a cascade of:

	Unhelpful	Helpful
Thoughts:	He/she ignored me - they don't like me	He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?
Emotional: Feelings	Low, sad and rejected	Concerned for the other person, positive
Physical:	Stomach cramps, low energy, feel sick	None - feel comfortable
Action:	Go home and avoid them	Get in touch to make sure they're OK

The same situation has led to two very different results, depending on how you thought about the situation.

How you think has affected how you felt and what you did. In the example in the left hand column, you've jumped to a conclusion without very much evidence for it - and this matters, because it's led to:

• having a number of uncomfortable feelings
• behaving in a way that makes you feel worse.

If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself.

If you avoid the other person, you won't be able to correct any misunderstandings about what they think of you - and you will probably feel worse.

This 'vicious circle' can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.

CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can 'do it yourself', and work out your own ways of tackling these problems.

What does CBT involve?

The sessions
You can do CBT individually or with a group of people, or even a self-help book or computer programme.

In England and Wales, two computer-based programmes have been approved for use by the NHS. Fear Fighter is for people with phobias or panic attacks; Beating the Blues is for people with mild to moderate depression.

If you have individual therapy:

• You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes.
• In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.
• The 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 that day.

The work

• With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
• Together you will look at your thoughts, feelings and behaviours to work out:
• if they are unrealistic or unhelpful
•  how they affect each other, and you.
• The therapist will then help you to work out how to change unhelpful thoughts and behaviours.
• It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend 'homework' - you practise these changes in your everyday life. Depending on the situation, you might start to:

• question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT

• recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.

• At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping.
• They 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 practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.

How effective is CBT?

• It is one of the most effective treatments for conditions where anxiety or depression is the main problem.
• It is the most effective psychological treatment for moderate and severe depression.
• It is as effective as antidepressants for many types of depression.