Tuesday, 28th August, 2018

What is cognitive behavioural therapy (CBT)?

The trials and tribulations of modern life can often make us feel down or anxious. But for many people, their mood seems to dictate everything they do. Old habits die hard, and these habits certainly extend to our thoughts, feelings and emotions.

Thankfully, there are many alternative treatments to antidepressants that can help us better regulate our mood. CBT is one such treatment.

While you have probably heard of CBT in one way or another, you may not fully understand what it is or how it works. This guide will help put any lingering doubts aside and give you the full rundown on this increasingly accessible and popular therapy, which is now available on the NHS.

What is CBT?


CBT, or cognitive behavioural therapy, combines cognitive therapy (examining the things you think) with behavioural therapy (examining the things you do).

It is most commonly used to treat depression and anxiety, though it can also be useful in treating a range of mental and physical health problems.

CBT focuses on how we think about what has happened to us in our lives. Basically, it’s a way of talking about:

  • how you think about yourself, other people and the world around you
  • how your actions affect your thoughts and feelings, and vice versa.

As a form of practical talking therapy, the aim of CBT is to help you change how you think (‘cognitive’) and act (‘behaviour’). Applied correctly, these changes can markedly improve how you feel. In fact, CBT is one of the few empirically valid talking therapies proven in clinical trials to effectively treat depression and anxiety.

The theory behind CBT

The fundamental tenets of CBT can be traced back to ancient philosophical traditions such as Stoicism, which believed that how we think can directly affect how we feel and behave. Unlike classic psychiatry, which focuses on a person’s past, CBT very much centres on problems and difficulties in the ‘here and now’.

CBT as a clinical treatment for mental health problems is based on the ideas of psychiatrist Aaron T. Beck and psychologist Albert Ellis. Their therapeutic methods combined aspects of behavioural and cognitive therapies.

How does CBT work?

The treatment works by looking at seemingly huge and overwhelming problems in a person’s life and breaking them down into smaller, more digestible parts/stages. This starts with:

  • Looking at a particular situation - a problem, an event or a difficult moment.

The situation can then be split into the following areas:

  • Thoughts
  • Emotions
  • Physical feelings
  • Actions/behaviour

All of these areas are interconnected. A thought, for example, can completely affect how you feel both physically and emotionally - subsequently affecting your actions or behaviour. And by acting on these thoughts and feelings, you are likely to trigger more negative thoughts.

Let’s take an example situation: you can’t seem to get along with a co-worker, despite your best efforts to establish friendly terms.

For most people, this would merely be an inconvenience - after all, we can’t get along with everyone! If you are feeling anxious, however, this problem has the potential to rule every aspect of your life. Anxiety tends to create a self-replicating cycle of feelings. Before you know it, your negative pattern of thoughts, feelings, and behaviour may be spiralling out of control:


By making it easier for you to identify the factors that might trigger or perpetuate your problems, CBT aims to provide you with the tools to actively change your negative habits and break this vicious cycle. Through a proper series of sessions, this can allow you to:

✔ change negative thinking

✔ distinguish rational and irrational thoughts

✔ challenge your underlying assumptions

✔ stop catastrophising or thinking the worst

✔ enhance awareness of your mood

✔ stop taking things personally and taking blame

✔ gradually expose yourself to situations that you fear

✔ see situations from different perspectives

✔ focus on how things are rather than how you feel they should be

✔ describe, accept, and understand a situation rather than judge.

Does CBT work with antidepressants?

Although talking therapy is often considered an alternative to medication, in many instances CBT works well alongside antidepressants.

If you are already taking antidepressants, there’s a good chance your GP will recommend attending CBT sessions too. This very much depends on the nature of your particular condition, as every individual case is different.

What can CBT treat?

Quite a lot, actually.

CBT has been shown to be an effective method in treating a number of various mental health conditions. As well as helping people with anxiety and/or depression, it can also be used to treat:

  • post-traumatic stress disorder (PTSD)
  • obsessive-compulsive disorder (OCD)
  • bipolar disorder
  • schizophrenia and psychosis
  • panic disorder
  • phobias
  • eating disorders such as anorexia or bulimia
  • sleep problems such as insomnia
  • problems related to alcohol abuse
  • behavioural difficulties in children and adolescents

CBT can also be employed to treat people with long-term health problems such as:

  • chronic fatigue syndrome (CFS)
  • irritable bowel syndrome (IBS)
  • chronic pain
  • physical symptoms that have not been medically diagnosed

While CBT cannot cure the physical problems of these conditions, it can leave people better equipped to cope with their symptoms.

When and where does CBT take place?

CBT can be offered either individually or as part of a group, and the number of sessions you require usually depends on the severity of the problems you need help with. Most sessions generally run for 30 minutes to an hour, and commonly occur on a weekly or fortnightly basis.

The therapy can take place in a number of locations, including a clinic or hospital. If you suffer from agoraphobia or a related condition, CBT sessions can also take place at home.

Your therapist will be a healthcare professional who has been specially trained in CBT's therapeutic approaches - such as a GP, psychiatrist, psychologist or mental health nurse.

What happens during CBT sessions?


Documenting your progress in a behavioural diary is often recommended by therapists

1. During a session, the therapist will encourage you to approach your difficulties by separating a particular problem into thoughts, emotions, physical feelings and actions.

2. You will then apply this framework to specific difficulties that you are facing and together you will set goals around how to face them. Through analysing these problems together, your therapist will help you figure out how to change unhelpful or unhealthy thoughts and behaviours.

3. As time passes, your therapist will tailor sessions according to the progress you have made or the particular problem you are addressing. Keeping a behavioural diary is often recommended as a way to measure progress - and also to help you practice CBT methods in everyday life.

4. It’s definitely worth noting that CBT is not a quick fix: it requires hard work on your part to work with your therapist and actively seek positive solutions to your problems. The ultimate goal of CBT sessions is to provide you with the skills needed to apply what you have learned to everyday situations, and this process takes time and patience. CBT techniques should also help you to manage these situations after a course of sessions is completed.

If you are attending CBT sessions while taking antidepressants and you feel like you want to lower your dosage, talk to both your therapist and your GP.

Where can I find a CBT therapist?

The first step is to talk to your GP. They can help you figure out what the problems are and suggest if they think CBT is the right course of action to take. CBT is also accessible via IAPT (Improving Access to Psychological Therapies) or CMHT (community mental health teams).

CBT is available on the NHS through referral and is free of charge, although you may have to wait. Private therapy is also widely available, with sessions costing roughly between £40 and £100.  If you are considering private CBT sessions, you should ask your GP to recommend the best therapists in your local area. Check out the NHS website for expert help and advice on CBT.

Electronic self-help cognitive behavioural therapy options are also available. The NHS has approved two computer-based programmes: Fear Fighter for people with phobia or panic attacks, and Beating the Blues for people with mild to moderate depression. Both of these programmes provide 24-hour access to their resources and offer online courses that you can participate in from the comfort of your living room.

Clinically reviewed by Alistair Murray MRPharmS: 21/2/18