What is Cognitive Behavioural Therapy?

Cognitive behavioural therapy (CBT) can help you make sense of overwhelming problems by breaking them down into smaller parts.

In CBT, problems are broken down into 5 main areas:

  • situations
  • thoughts
  • emotions
  • physical feelings
  • actions

CBT is based on the concept of these 5 areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.

What distinguishes CBT from other therapies?

CBT theorises that early life experiences are relevant in the development of a person’s thoughts about themselves, the world, and other people. These templates result in ‘core beliefs’ which influence how a person reacts to current situations or triggers. As such, life experiences and relationships are discussed. However, CBT differs from other psychotherapies because it is: –

  • pragmatic – it helps identify specific problems and tries to solve them
  • structured – rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
  • focused on current problems – it’s mainly concerned with how you think and act now rather than attempting to resolve past issues
  • collaborative – your therapist will not tell you what to do; they will work with you to find solutions to your current difficulties.
  • there is a focus on conscious thoughts and changing relationship with these thoughts to impact on mood.

Alongside traditional CBT, there are also third wave cognitive and behavioural therapies. These also have a focus on the relationship a person has with their thoughts but include additional elements and focuses. For example, Acceptance and Commitment Therapy (ACT) is a behavioural therapy which focus on valued based living and developing skills to accept and live with distress.

Mindfulness based cognitive therapy (MCBT) facilitates and enhances mindfulness in relationship to negative or distressing thoughts. It applies mindfulness to help a person develop some distance from experiences and the ability to observe rather than be purely immersed the distressing thoughts, feelings, and sensation.

You will usually meet with a CBT therapist for between 5 and 20 weekly sessions, with each session lasting 50 minutes.If engaged in exposure work, sessions may last longer to ensure your anxiety reduces during the session. The therapy will usually take place in a clinic, but if engaging behavioural experiments, they may take place outside.

The first session will be an opportunity to outline current difficulties and impact of these and discuss CBT approach. The therapist will also ask questions about your life and background to enable understanding.

Your therapist will ask how difficulties interfere with your family, work, and social life. They will also ask about events that may be related to your problems, treatments you’ve had, and what you would like to achieve through therapy. Questionnaires will also be used to establish current level of functioning.

After the initial assessment period, you will start working with your therapist to break down problems into their separate parts. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.

You and your therapist will analyse your thoughts, feelings and behaviours 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 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. This may involve:

  • questioning upsetting thoughts and replacing them with more helpful ones
  • recognising when you’re going to do something that will make you feel worse and instead doing something more helpful

You will be asked to do some “homework” between sessions to help with this process.

At each session, you’ll discuss with your therapist how you’ve got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.

Confronting fears and anxieties can be very difficult. Your therapist will not ask you to do things you do not want to do and will only work at a pace you’re comfortable with. During your sessions, your therapist will check you are comfortable with the progress you are making.

One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return.

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

  • anxiety disorders such as social anxiety, panic disorder, generalised anxiety disorder, phobias, obsessive compulsive disorder (OCD), health anxiety, post-traumatic stress disorder (PTSD)
  • Depression
  • Low self-esteem
  • sleep problems – such as insomnia
  • Poor impulse control (including over-eating; alcohol; substance misuse)

CBT is also used in the treatment of long-term physical health conditions, to help better manage symptoms, including chronic pain and irritable bowel syndrome.

  • CBT acknowledges the past but also looks towards the future, meaning that whilst your old ways of thinking will be reviewed and examined, you will be doing so to facilitate positive change in the present
  • Cognitive behavioural therapy involves the use of homework, so you can expect to do the ‘work’ of CBT outside your therapy sessions, applying the insight that you have gained in your daily life. It will also encourage you to engage in practices which will help move away from unhelpful cycles, such as Mindfulness.
  • By interrupting patterns of negative thinking with CBT, you will be able to alter the behaviours and feelings associated with those thoughts, resulting in a greater capacity for coping with stress and making healthy choices in the future
  • By addressing and confronting self-defeating beliefs, you will gain healthier levels of self-awareness and self-esteem that will assist you in building a fulfilling and rewarding life.

Schema Therapy is an integrative psychotherapy for problems such as long-lasting anxiety and depression, relationship issues, and personality difficulties. It integrates Cognitive Behavioural Therapy (CBT), Object Relations, and Attachment Theory. It is particularly effective when working with issues that have not always respond well to other treatments

In Schema Therapy, the therapist works with the client to identify and understand the client’s schemas, which are sometimes called early maladaptive schemas.

These are essentially unhelpful patterns that some people develop due to their emotional needs not being met as a child, such as need to be protected and loved. These schemas can affect the individual throughout their life and contribute to problematic coping methods and behaviours if they are not addressed. The aim of therapy is to help the client reach a place where their emotional needs are met in a healthy way, enabling improved functioning and a better relationship with themselves and others.

Cognitive Behavioural Therapy is an effective treatment for addictions, as it enables the client to focus on and move away from some of the negative beliefs they hold about themselves and identifies healthier coping strategies for managing distressing feelings and improving mood.

The CBT for addictions model also provides approaches for the client to help with impulse control, such as recognising circumstances which lead to using illicit drugs and/or alcohol and over-eating and develops strategies to minimise contact with trigger situations, and identifying tools to switch attention when experiencing cravings.

Acceptance and Commitment Therapy (ACT) is a form of therapy that combines mindfulness skills with the practice of acceptance.

ACT is a behavioural therapy in that it encourages and supports people to live a life that they want, driven by their values, whilst at the same time helping people to tolerate and accept distress that is part of the human condition.

Research evidence suggests that ACT is helpful for many mental health difficulties, including anxiety disorders, depression, addiction problems and adjustment to complex health conditions such as chronic pain. 

Mindfulness-based cognitive therapy is an approach which combines cognitive behavioural techniques with mindfulness strategies to help individuals better understand and manage their thoughts and emotions.  The aim of therapy is to improve distress tolerance, and enhance self-efficacy, and is helpful for a wide range of mental health issues including depression and anxiety. 

Conditions Treated by Psychotherapy

Our team of highly specialised clinicians offer patients a wide range of treatment options for the conditions listed below.