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 http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/cbt.aspx

Cognitive Behavioural Therapy

This leaflet is for anyone who wants to know more about Cognitive Behavioural Therapy (CBT). t

!iscusses how it works" why it is use!" its effects" its si!e#effects" an! alternative treatments. f youcan$t fin! what you want here" there are sources of further information at the en! of this leaflet. 

What is CBT?

It is a way of talking about:

how you think about yourself" the worl! an! other people

how what you !o affects your thoughts an! feelings.

CBT can help you to change how you think ($Cognitive$) an! what you !o ($Behaviour$). Thesechanges can help you to feel better. %nlike some of the other talking treatments" it focuses on the$here an! now$ problems an! !ifficulties. nstea! of focusing on the causes of your !istress orsymptoms in the past" it looks for ways to improve your state of min! now. 

When does CBT help?

CBT has been shown to help with many !ifferent types of problems. These inclu!e: anxiety"!epression" panic" phobias (inclu!ing agoraphobia an! social phobia)" stress" bulimia" obsessivecompulsive !isor!er" post#traumatic stress !isor!er" bipolar !isor!er an! psychosis. CBT may alsohelp if you have !ifficulties with anger" a low opinion of yourself or physical health problems" like painor fatigue.

 

How does it work?

CBT can help you to make sense of overwhelming problems by breaking them !own into smallerparts. This makes it easier to see how they are connecte! an! how they affect you. These parts are: 

A Situation # a problem" event or !ifficult situation. &rom this can follow:

Thoughts

!otions

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"hysi#al feelings

A#tions

'ach of these areas can affect the others. ow you think about a problem can affect how you feelphysically an! emotionally.  ll these areas of life can connect like this: * reas +hat happens in one of these areas can affect all the others. There are helpful an! unhelpful ways of reacting to most situations" !epen!ing on how you thinkabout it. The way you think can be helpful # or unhelpful. An e$a!ple:

The Situation

 ,ou$ve ha! a ba! !ay" feel fe! up" so go out shopping. s you walk !own the roa!" someone youknow walks by an!" apparently" ignores you. This starts a casca!e of: 

%nhelpful Helpful

Thoughts: e/she ignore! me # they !on$tlike me

e/she looks a bit wrappe! up inthemselves # won!er if there$ssomething wrong-

!otional:&eelings

ow" sa! an! reecte! Concerne! for the other person"positive

"hysi#al: 0tomach cramps" low energy"feel sick 1one # feel comfortable

 

A#tion: 2o home an! avoi! them 2et in touch to make sure they$re34

 The same situation has le! to two very !ifferent results" !epen!ing on how you thought about thesituation. ow you think has affecte! how you felt an! what you did. n the example in the left han! column"you$ve umpe! to a conclusion without very much evi!ence for it # an! this matters" because it$s le! to: 

having a number of uncomfortable feelings

behaving in a way that makes you feel worse.

f you go home feeling !epresse!" you$ll probably broo! on what has happene! an! feel worse. f youget in touch with the other person" there$s a goo! chance you$ll feel better about yourself. f you avoi! the other person" you won$t be able to correct any misun!erstan!ings about what theythink of you # an! you will probably feel worse. This $vicious circle$ can make you feel worse. t can even create new situations that make you feel

worse. ,ou can start to believe 5uite unrealistic (an! unpleasant) things about yourself. This happens

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because" when we are !istresse!" we are more likely to ump to conclusions an! to interpret things inextreme an! unhelpful ways. CBT can help you to break this vicious circle of altere! thinking" feelings an! behaviour. +hen yousee the parts of the se5uence clearly" you can change them # an! so change the way you feel. CBTaims to get you to a point where you can $!o it yourself$" an! work out your own ways of tackling these

problems. 

What does CBT involve?

The sessions,ou can !o CBT in!ivi!ually or with a group of people" or even a self#help book or computerprogramme. n 'nglan! an! +ales" two computer#base! programmes have been approve! for use by the10. &ear &ighter  is for people with phobias or panic attacks6 Beating the Blues is for people withmil! to mo!erate !epression.

f you have in!ivi!ual therapy:

,ou will usually meet with a therapist for between * an! 78" weekly" or fortnightly sessions.

'ach session will last between 98 an! 8 minutes.

n the first 7#; sessions" the therapist will check that you can use this sort of treatment an!

you will check that you feel comfortable with it.

The therapist will also ask you 5uestions about your past life an! backgroun!. lthough CBT

concentrates on the here an! now" at times you may nee! to talk about the past toun!erstan! how it is affecting you now.

,ou !eci!e what you want to !eal with in the short" me!ium an! long term.

,ou an! the therapist will usually start by agreeing on what to !iscuss that !ay.

The work

+ith the therapist" you break each problem !own into its separate parts" as in the example

above. To help this process" your therapist may ask you to keep a !iary. This will help you toi!entify your in!ivi!ual patterns of thoughts" emotions" bo!ily feelings an! actions.

Together you will look at your thoughts" feelings an! behaviours to work out:

if they are unrealistic or unhelpful

 how they affect each other" an! you.

The therapist will then help you to work out how to change unhelpful thoughts an!

behaviours.

t$s easy to talk about !oing something" much har!er to actually !o it. 0o" after you have

i!entifie! what you can change" your therapist will recommen! $homework$ # you practisethese changes in your every!ay life. <epen!ing on the situation" you might start to:

5uestion a self#critical or upsetting thought an! replace it with a more helpful (an! morerealistic) one that you have !evelope! in CBT

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recognise that you are about to !o something that will make you feel worse an!" instea!"

!o something more helpful.

 t each meeting you !iscuss how you$ve got on since the last session. ,our therapist can

help with suggestions if any of the tasks seem too har! or !on$t seem to be helping.

They will not ask you to !o things you !on$t want to !o # you !eci!e the pace of the treatment

an! what you will an! won$t try. The strength of CBT is that you can continue to practise an!!evelop your skills even after the sessions have finishe!. This makes it less likely that yoursymptoms or problems will return.

How effe#tive is CBT?

t is one of the most effective treatments for con!itions where anxiety or !epression is the

main problem.

t is the most effective psychological treatment for mo!erate an! severe !epression.

t is as effective as anti!epressants for many types of !epression.

What other treat!ents are there and how do they #o!pare?

CBT is use! in many con!itions" so it isn$t possible to list them all in this leaflet. +e will look atalternatives to the most common problems # anxiety an! !epression.

CBT isn$t for everyone. nother type of talking treatment may work better for you.

CBT works as well as antidepressants for many forms of !epression. t may be

slightly better than anti!epressants in helping anxiety.

&or severe !epression" CBT shoul! be use! with anti!epressant me!ication. +hen you are

very low" you may fin! it har! to change the way you think until the anti!epressants havestarte! to make you feel better.

Tran5uillisers shoul! not be use! as a long term treatment for anxiety. CBT is a better option.

"roble!s with CBT

CBT is not a 5uick fix. therapist is like a personal trainer that a!vises an! encourages # but

cannot $!o$ it for you.

f you are feeling low" it can be !ifficult to concentrate an! get motivate!.

To overcome anxiety" you nee! to confront it. This may lea! you to feel more anxious for a

short time.

  goo! therapist will pace your sessions. ,ou !eci!e what you !o together" so you stay in

control.

How long will it last?

  course may be from weeks to months. t will !epen! on the type of problem an! how it isworking for you. The availability of CBT varies between !ifferent areas an! there may be a waiting list

for treatment. 

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What if the sy!pto!s #o!e ba#k?

There is always a risk that the anxiety or !epression will return. f they !o" your CBT skills shoul!make it easier for you to control them. 0o" it is important to keep practising your CBT skills" even afteryou are feeling better. There is some research that suggests CBT may be better than anti!epressantsat preventing !epression coming back. f necessary" you can have a =refresher= course.

 

So what i!pa#t would CBT have on !y life?

<epression an! anxiety are unpleasant. They can seriously affect your ability to work an! enoy life.CBT can help you to control the symptoms. t is unlikely to have a negative effect on your life" apartfrom the time you nee! to give up to !o it. 

How #an I get CBT?

0peak to your 2>. They may refer you to someone traine! in CBT # for example" a

psychologist" nurse" social worker or psychiatrist.

The British ssociation for Behavioural an! Cognitive >sychotherapies keeps a register of

accre!ite! therapists.

,ou can try $self#help$ # using a book" internet programme or computerise! CBT. This is more

likely to work if you also receive support from a professional.

What will happen if I don't have CBT?

t !epen!s very much on the problem. ,ou coul!:

+ait to see if you get better anyway # you can always ask for CBT later if you change yourmin!.

Talk over some alternatives with your !octor.

?ea! more about CBT an! its alternatives. (see below).

f you want to =try before you buy=" get hol! of a self#help book or C<#?om an! see if it makes

sense to you.

CHA() *IW: +, key fa#ts about CBT

 

Change: your thoughts an! actions

Homework: practice makes perfect

Action: !on$t ust talk" !o@

(ee!: pinpoint the problem

)oals: move towar!s them

vi!ence: shows CBT can work

*iew: events from another angle

I can !o it: self#help approach

xperience: test out your beliefs

Write it !own: to remember progress

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%seful CBT web links

British Asso#iation for Behavioural and Cognitive "sy#hotherapies

Beating the Blues

&urther reading

-eading Well Agen#y: Books on "res#ription?ea!ing +ell Books on >rescription helps you manage your well#being using self#help rea!ing. Thescheme is en!orse! by health professionals" inclu!ing the ?oyal College of >sychiatrists" an! issupporte! by public libraries. The '.ver#o!ing' series/ Constable and Robinson

0elf#help books which use the theories an! concepts of CBT to help people overcome many commonproblems. Titles inclu!e: overcoming social anxiety an! shyness" overcoming !epression an!

overcoming low self#esteem. 

&ree online CBT resour#es

0ood)10: nformation" 5uiAAes" games an! skills training to help prevent !epression

2iving 2ife to the &ull: &ree online life skills course for people feeling !istresse! an! their

carers. elps you un!erstan! why you feel as you !o an! make changes in your thinking"activities" sleep an! relationships.

&ear&ighter : free access can only be prescribe! by your !octor in 'nglan! an! +ales.

-eferen#es

Williams CJ (2009) Overcoming depression and low mood: a five areas approach. 3rd edition odder:

!ondon

<epartment of ealth (788). mproving access to psychological therapies (>T)

programme: computerise! cognitive behavioural therapy (cCBT) implementation gui!e.

1C' (788) C277: nxiety: management of anxiety (panic !isor!er" with or without

agoraphobia" an! generalise! anxiety !isor!er) in a!ults in primary" secon!ary an!community care. 

1C' (78): C279: Common mental health !isor!ers: !entification an! pathways to care .

1C' technology appraisal T D (788E): Computerise! Cognitive Behaviour Therapy for

!epression an! anxiety.

&or further infor!ation #onta#t:

An$iety %3 4for!erly (ational "hobi#s So#iety5Fon!ay to &ri!ay: D.* am to D.88 pm: tel: 8E;;; * ;6 8 77 DEDE6 email:infoGanxietyuk.org.uk  national registere! charity forme! 98 years ago by a sufferer of agoraphobia for those affecte! by

anxiety !isor!ers. 

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6epression Allian#eelpline: 8E;* 79 79 786 informationG!epressionalliance.orgnformation" support an! un!erstan!ing for people who suffer with !epression" an! for relatives whowant to help. 0elf#help groups" information" an! raising awareness for !epression.

>ro!uce! by the ?C>sych >ublic '!ucation '!itorial Boar!. '!itor: <r >hilip Timms.

Fain author: <r >aul Blenkiron

llustration by o Cole: www.locole.co.uk

This leaflet reflects the best available evi!ence at the time of writing.

 

H %p!ate!: Iuly 7896 !ue for review: Iuly 78*. ?oyal College of >sychiatrists. This leaflet may be!ownloa!e!" printe! out" photocopie! an! !istribute! free of charge as long as the ?oyal College of>sychiatrists is properly cre!ite! an! no profit is gaine! from its use. >ermission to repro!uce it in anyother way must be obtaine! from permissionsGrcpsych.ac.uk. The College !oes not allow repostingof its leaflets on other sites" but allows them to be linke! to !irectly.

 &or a catalogue of public e!ucation materials or copies of our leaflets contact: eaflets<epartment" The ?oyal College of >sychiatrists" 7 >rescot 0treet" on!on 'EBB. Telephone: 878 98 7**7.

Charity registration number ('nglan! an! +ales) 77E9 an! in 0cotlan! 0C89E9D.