Cognitive Behavioural Therapy (CBT)

What is CBT?

CBT helps you to learn more helpful ways of thinking and reacting in everyday situations. Changing the way you think, and what you do, can help you to feel better.

Unlike some other talking therapies, CBT focuses on your current challenges rather than on your past experiences. It aims to improve your state of mind by teaching you to spot the links between your thoughts, actions and feelings.

When doing CBT, you will work with your therapist to find new ways of dealing with problems, and set goals for what you want to change. When CBT is successful it can help you to feel more in control of your life.

Who can CBT help?

CBT has been shown to help with many different mental health conditions. These include:

• depression
• anxiety, panic and phobias – including agoraphobia (fear of being in situations where you can’t escape or get help), social anxiety (fear of social situations) and health anxiety (fear of being ill or becoming ill)
• eating disorders
• obsessive compulsive disorder (OCD)
• post-traumatic stress disorder (PTSD)
• bipolar disorder, and
• psychosis (including schizophrenia).

CBT can also help with other problems, including:

• sleep difficulties
• stress
• anger
• low self-esteem, and
• physical health problems, like pain and extreme tiredness.

CBT can work for people of any age, including children.

You can take medication for your mental health at the same time as having CBT. This will depend on the problem, what your doctor advises and personal choice.

If you have alcohol or drug dependency issues, it is best to get help to deal with these before starting CBT for another problem. This is because using high levels of alcohol or drugs can make it difficult to learn and remember more helpful ways of managing your mental health.

CBT has not been shown to be effective in people with severe memory problems, including dementia. Learning new skills is an important part of CBT and this is likely to be difficult if you cannot remember or practice new ways of coping.

How does CBT work?

C stands for ‘cognitive’ (what you think) – In CBT, you learn to notice when you are thinking negatively. You work to challenge negative or unhelpful thoughts, for example:

• ‘I’m useless’ or
• ‘It’s all going to go wrong’.

Instead, you work to develop more useful, realistic thoughts, for example:

• ‘What’s the evidence this is true?’
• ‘What’s another way to think about this?’ or
• ‘What advice would I give a friend in my situation?’

B stands for ‘behaviour’ (what you do) – Your behaviour is what you do and how you act. CBT can help you to deal with things you have been avoiding or have fears around. When doing CBT, you might keep a daily diary of activities, and set goals to try things that you are afraid of doing. Writing down your goals and actions can give you a sense of achievement and help you to mark your progress.

T stands for ‘therapy’ (what you learn) – Through CBT you learn new skills that you can then practise as ‘homework’. After you have finished receiving CBT you can continue to practise these skills, which can give you the tools to stay well in the future.

CBT in more detail:

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 – for example, an activity, or something that happens to you that you find difficult

From this can follow:

• Thoughts
• Emotions
• Physical feelings
• Actions

This diagram shows how the way we think about and react to situations can affect our behaviour and emotions:

Here is an example of how the way you think in a situation can have an impact on your emotions, feelings and actions.

Example:

The situation

You've had a bad day and feel fed up, so you go out shopping. As you walk down the road, someone you know walks by and seems to ignore you. You can react to this situation with helpful or unhelpful thoughts. Depending on how you react, the following things might happen:

In this example, the same situation has led to two very different results.

When we are feeling sad or distressed, we might be more likely to interpret things in extreme and unhelpful ways.

CBT helps you to understand the ways your thoughts, feelings and actions work together. This can help you learn to:

• let go of unhelpful thinking habits (jumping to conclusions)
• let go of unhelpful actions (avoiding situations)
• adopt helpful thinking habits (seeing the potential for something positive) and
• adopt helpful actions (in this example, reaching out to a friend).