Royal College of Psychiatrists >
Mental Health Info >
Treatments >
CBT
Aims
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, 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 focussing
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. It
can also alter what you do about it. There are helpful and
unhelpful ways of reacting to most situations, depending on how you
think about them.
For example:
| 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. |
| |
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 |
| 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:
- a number of uncomfortable feelings
- an unhelpful behaviour.
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 don't, you won't have the chance to correct any
misunderstandings about what they think of you - and you will
probably feel worse. This is a simplified way of looking at what
happens. The whole sequence, and parts of it, can also feedback
like this:
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.
"Five areas" assessment
This is another way of connecting all the 5 areas mentioned above.
It builds in our relationships with other people and helps us to
see how these can make us feel better or worse. Other issues such
as debt, job and housing difficulties are also important. If you
improve one area, you are likely to improve other parts of your
life as well.
"5 areas" diagram.
What does CBT involve?
The sessions
CBT can be done individually or with a group of people. It can also
be done from 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 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
What other treatments are there and how do they
compare?
CBT is used in many conditions, so it isn't possible to list
them all in this leaflet. We will look at alternatives to the most
common problems - anxiety and depression.
- CBT isn't for everyone and another type of talking treatment
may work better for you.
- CBT is as effective as antidepressants for many forms of
depression. It may be slightly more effective than antidepressants
in treating anxiety.
- For severe depression, CBT should be used with antidepressant
medication. When you are very low you may find it hard to change
the way you think until antidepressants have started to make you
feel better.
- Tranquillisers should not be used as a long term treatment for
anxiety. CBT is a better option.
Problems with CBT
- CBT is not a quick fix. A therapist is like a personal trainer
that advises and encourages - but cannot 'do' it for you.
- If you are feeling low, it can be difficult to concentrate and
get motivated.
- To overcome anxiety, you need to confront it. This may lead you
to feel more anxious for a short time.
- A good therapist will pace your sessions. You decide what you
do together, so you stay in control.
How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on
the type of problem and how it is working for you. The availability
of CBT varies between different areas and there may be a waiting
list for treatment.
What if the symptoms come back?
There is always a risk that the anxiety or depression will
return. If they do, your CBT skills should make it easier for you
to control them. So, it is important to keep practising your CBT
skills, even after you are feeling better. There is some research
that suggests CBT may be better than antidepressants at preventing
depression coming back. If necessary, you can have a "refresher"
course.
So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously
affect your ability to work and enjoy life. CBT can help you to
control the symptoms. It is unlikely to have a negative effect on
your life, apart from the time you need to give up to do it.
How can I get CBT?
- Speak to your GP. They may refer you to someone trained in CBT
- for example, a psychologist, nurse, social worker or
psychiatrist.
- The British Association for Behavioural and
Cognitive Psychotherapies keeps a register of accredited
therapists.
- You can try 'self-help' - using a book, internet programme or
computerised CBT. This is more likely to work if you also receive
support from a professional.
What will happen if I don't have CBT?
You could discuss alternatives with your doctor. You could
also:
- Read more about the treatment and its alternatives.
- If you want to "try before you buy", get hold of a self-help
book or CD-Rom and see if it makes sense to you.
- Wait to see if you get better anyway - you can always ask for
CBT later if you change your mind.
CHANGE VIEW: 10 key facts about
CBT
|
|
|
|
Change: your thoughts and actions
Homework: practice makes perfect
Action: don't just talk, do!
Need: pinpoint the problem
Goals: move towards them
Evidence: shows CBT can work
|
View: events from another angle
I can do it: self-help approach
Experience: test out your beliefs
Write it down: to remember progress
|
Useful CBT web links
Further reading
A large series of self-help books which use the
theories and concepts of CBT to help people overcome many
common problems. Titles include: overcoming social anxiety and
shyness, overcoming depression and overcoming low
self-esteem.
Free online CBT resources:
- Mood Gym: moodgym.anu.edu.au Information,
quizzes, games and skills training to help prevent depression
- Living Life to the Full: www.livinglifetothefull.com
Free online life skills course for people feeling distressed and
their carers. Helps you understand why you feel as you do and
make changes in your thinking, activities, sleep and
relationships.
- Fear Fighter: www.fearfighter.com (free
access can only be prescribed by your doctor in England and
Wales)
References
For further information contact:
Information, support and understanding for people who suffer
with depression, and for relatives who want to help. Self-help
groups, information, and raising awareness for
depression.
Produced by the RCPsych Public Education Editorial Board.
Editor: Dr Philip Timms.
Main author: Dr Paul Blenkiron
Updated: August 2009
Due for review: August 2001
© 2005 Royal College of Psychiatrists. This leaflet may
be downloaded, printed out, photocopied and distributed free of
charge as long as the Royal College of Psychiatrists is properly
credited and no profit is gained from its use. Permission to
reproduce it in any other way must be obtained from the
Head of Publications. The College
does not allow reposting of its leaflets on other sites, but
allows them to be linked to directly.
For a catalogue of public education materials or copies of our
leaflets contact:
Leaflets
Department, The Royal College of Psychiatrists, 17
Belgrave Square, London SW1X 8PG.
Charity registration number (England and Wales) 228636
and in Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to dhart@rcpsych.ac.uk
On each line, click on the mark which most closely reflects how you feel about
the statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
every item.
Did you look at this leaflet because you are a (maximum of 2 categories
please):
Age group (please tick correct box)