COGNITIVE BEHAVIOURAL THERAPY (CBT)
Cognitive Behavioural Therapy (CBT) how it works, why it is used, its effects, side-effects, and alternative treatments.
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.
It Has Been Found To Be Helpful In:
Anxiety
Depression
Panic
Agoraphobia and other phobias
Social phobia
Bulimia
Obsessive compulsive disorder
Post traumatic stress disorder
Schizophrenia
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.
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.
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.p>
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 a positive (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
If you are feeling low and are having difficulty concentrating, it can be hard, at first, to get the hang of CBT - or, indeed, any psychotherapy
This may make you feel disappointed or overwhelmed. A good therapist will pace your sessions so you can cope with the work you are trying to do.
It can sometimes be difficult to talk about feelings of depression, anxiety, shame or anger.
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.
