Cognitive Behavioural Therapy (Cbt)

Adapted from the Royal College of Psychiatrists website:
www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/cbt.aspx

What is CBT?

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 ‘here and now’ problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now. It helps you to make sense of overwhelming problems by breaking them down in the following way:

• SITUATION: Define the problem, experience or difficult situation.
• THOUGHTS: How were you thinking at the time and what are your thoughts now?
• FEELINGS: How did you feel. What emotions did this experience bring up for you?
• PHYSICAL: What physical symptoms (if any) did you experience?
• ACTION: How do you act following this experience?

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. Here is an example:

SITUATION	You’ve had a bad day, feel fed up, and so go 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 him/herself – I wonder if there’s something wrong?
FEELINGS	Low, sad and rejected.	Concerned for the other person.
PHYSICAL	Stomach cramps, low energy, feel sick.	Feel comfortable.
ACTION	Go home and avoid them.	Decide to forget about it or 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 any evidence for it – and this matters, because it’s led to:

• A number of uncomfortable feelings
• An unhelpful behaviour

These patterns can lead to a vicious circle because when you are feeling low, sad and rejected you are much more likely to over-react to a similar or some other type of situation. The alternative (helpful) way of choosing to see the situation leads to what we might call a virtuous circle because you are more likely to view other events in a positive (helpful) way.

What does CBT therapy involve?

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 the NHS has approved two computer-based programmes.
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.
• 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 actions to decide if they are unrealistic or unhelpful.
• 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.
• You will learn to question self-critical or upsetting thoughts and replace them with  helpful (and more realistic) ones that you have developed in your CBT session.
• You will recognise that you are about to do a certain action that will make you feel worse and, instead, do something more helpful.
• At each meeting you will discuss how you’ve got on since the last session. Your therapist can help with suggestions where you are still having difficulty.
• Your therapist 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.

What conditions does it help?

• It is one of the most effective treatments for conditions where anxiety or depression is the main problem.
• It is an effective psychological treatment for moderate and severe depression.
• It is as effective as antidepressants for many forms of depression.
• It may be slightly more effective than antidepressants in treating anxiety.

Is CBT safe?

• For severe depression, CBT would normally be used with antidepressant medication. When you are very low you may find it hard to change the way you think until the 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.