Cognitive behavioural therapy (CBT)

CBT is one of several types of talking therapy used to help children and young people with mental health problems.

Talking therapies (also known as psychotherapies) are offered to people who are experiencing things like:

• stress and anxiety
• emotional problems
• relationship problems
• troublesome habits
• other problems, such as hearing voices.

Talking therapies are usually given by a therapist who is trained to treat people with certain problems using the therapy that will work best for them.

CBT stands for cognitive behavioural therapy.

• cognitive is to do with our thoughts. If you have difficult thoughts, CBT can help you to work to challenge these and develop more useful, realistic thoughts.
• behaviour is about the things we do. If you are avoiding things or have fears around them, CBT can help you to challenge these behaviours and develop more useful ones.

CBT helps you work on your thoughts and behaviours together. Understanding the links between the way that you think (your thoughts, beliefs and assumptions), how you feel (your emotions) and what you do (your behaviour) is a really effective way to help with hard to manage thoughts and feelings.

CBT will help you learn how to overcome:

• negative thoughts (e.g. she doesn’t like me)
• unhelpful behaviours (e.g. not going to that party)
• difficult emotions (e.g. feeling sad)

CBT has been found to help young people with a wide range of problems, including:

• low self-esteem
• depression
• anxiety problems
• obsessive-compulsive disorder (OCD)
• post–traumatic stress disorder (PTSD)

There is increasing evidence that CBT can work well for other problems like sleep disorders. CBT may help manage symptoms, improve functioning and reduce the distress associated with having a chronic illness.

CBT is available on the NHS. You should speak to your GP if you are experiencing challenges with your mental health. They might refer you for CBT if they feel your problem would benefit from the treatment.

CBT may be given by trained CBT therapists who usually work in mental health services like Child and Adolescent Mental Health Services (CAMHS) and Children’s Improving Access to Psychological Therapies (IAPT services).

Some CBT therapists work independently, in schools, colleges or in voluntary and community organisations.

Some young people might be given online CBT for specific things like anxiety or low mood.

Self-help CBT manuals or online CBT can help if you’re motivated and your problems are not too severe. Some of these resources might be helpful if you live in an area where you have to wait for a long time to access treatment.

What we think and do affects how we feel. Here is an example of how swapping unhelpful thoughts for helpful thoughts can lead to positive actions:

Situation: your friend doesn't ring you

Sometimes we fall into patterns of unhelpful thinking and behaving that can make us feel worse. The goal of CBT is to help you learn a more balanced way of thinking and to change any unhelpful patterns of thinking and behaving.

CBT helps you understand the link between your thoughts, feelings and behaviours. It can help you to learn new skills, like how to:

• understand the individual challenges you’re facing
• understand what is keeping the problem going
• approach situations in a more balanced way.

These skills will hopefully make you more effective in solving your problems and help you to feel more in control of your life.

Your therapist should explain to you that you are having CBT, what it means and the plans they have for your treatment. If you were referred for CBT by a mental health team, you might also need to check in with them occasionally about how you are finding it.

If you and your doctor agree CBT is the right therapy for you, you’ll be expected to meet with your therapist regularly and to practise some of the skills you learn in CBT in your spare time. Your parents or carers might be involved with your therapy if it is felt that it will help you.

To help your therapist to understand your specific challenges, you will be asked to complete some questionnaires or worksheets. You might have to do this a few times throughout your treatment so that your therapist can see how you’re doing.

Your views and feelings are very important, so your therapist should work with you regularly to understand how you’re progressing and how you feel about the treatment.

After your sessions you will be given ‘homework’ so that you can practise some of the skills you have learnt. You may be given worksheets to help remind you of what you need to do.

Unfortunately, you can’t learn to ride a bike by reading a book, and CBT is no different. It’s important for you to practice the things you learn in CBT so that when you stop having sessions you are able to do them on your own.

Practising the skills you are taught in CBT can also help you to:

• be sure that you understand them
• know how to use them when you need to (e.g. when you are feeling upset about something)
• identify any problems you might be having using these skills so that you can work on them with your therapist.

It’s not always easy to learn new skills, so if you feel comfortable you should ask for help from your friends, family or carers.

If you have to wait for therapy, don’t want it or can’t access it for whatever reason, there are things that you can do to help yourself with the problems you’re facing.

• Talk about it – Try speaking to someone you trust about how you are feeling. This could be a close friend, your GP, a teacher, religious leader, or anyone who you feel comfortable asking for support. Tell them how you’ve been feeling, and if your challenges have been caused by something happening in your life they might be able to offer you advice on how you can get help.
• Self-help tools – There are lots of self-help tools that you can use to improve your mental health. These include things like meditation or mindfulness apps, as well as books or apps that allow you to practice CBT on your own. You can find out more about these in the further information section of this resource.
• Self-help groups – Ask your GP about self-help and peer support groups, where you will be able to meet and talk with people who have similar problems. Ask your GP what kind of group might be helpful for you depending on the issues you’re facing.

You might also be able to find a self-help group, or peer support through a charity. For example, the mental health charity Mind have local services that run different groups depending on who you are and what help you need.

Information for families and carers

It is very important that you are actively involved in your child’s therapy. You will be encouraged to be a ‘co-therapist’, a role that might include:

• having a shared understanding of the problem
• establishing shared goals
• supporting with trying new things during treatment
• helping to monitor progress.
  

It’s also important that you understand confidentiality and the privacy of your child’s sessions.

Information for young people

Websites

• Young Minds – The UK’s leading charity fighting for children and young people's mental health.
• Youth Access – This website provides information, advice, counselling and support services for young people and also has useful links for parents.
• Get Self Help – Free CBT self-help information, resources and therapy worksheets.

Books

• Getting through it with CBT: a young person’s guide – Claire Holdaway
  This guide is written for young people who want to understand more about how therapy works and what to expect from it. It can support and help you through your process of therapy and can be used alongside therapy.
• Getting through depression with CBT: a young person’s guide – Louise Dalton
  This guide is written for young people who want to understand more about depression and how therapy could help them with this problem.
• Getting through Anxiety with CBT: A young person’s guide – Ben Gurney-Smith
  This guide has been written for young people who want to understand more about anxiety and how CBT could help them with this problem.
• Breaking free from OCD: a CBT guide for young people and their families – Jo Derisley
  This guide is written for young people with OCD and their families, and is to be used in home treatment or as a self-help book.

Online CBT resources

• Beating the Blues – Self-help CBT course for depression and anxiety. Free access can be prescribed by your doctor.
• Living Life to the Full – Free online life skills course for people who are feeling distressed, depressed or anxious.
• Headspace – Mindfulness app with free introductory exercises.

This information was produced by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Kirsty Woodhead, Dr Virginia Davies and Dr Vasu Balaguru

Full references for this resource are available on request.