Cognitive Behavioral Therapy (CBT)

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What is cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy (CBT) is a type of talking therapy used to help people with mental health conditions and other disorders. It has been shown to be helpful in treating anxiety, depression, obsessive-compulsive disorder (OCD), body dysmorphia, and many other mental health problems.1

As the name suggests, CBT focuses on our thoughts (cognition) and actions (behavior).

CBT is based on the principle that our thoughts, feelings, and behavior are linked. The way that these three parts are connected is described as “the cognitive triangle”.

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CBT and The Cognitive Triangle

Everything  that humans do is related to thoughts, feelings and actions, the three parts of the cognitive triangle.

The Cognitive Triangle used in CBT

To show an example of how this works, let’s imagine an example of an ideal, healthy cycle of thoughts, feelings, and behavior.

Healthy (positive) cycle

You think about going to a party with your friends and how you will have a good time. This positive thought creates a feeling of happiness which makes you want to go to the party. 

You have a positive experience at the first party, so next time you get invited to a party, you think about how you will have a good time again. 

This positive thought makes you feel happy, so you go to the second party and you have a good time. And so the cycle continues. 

You may not be aware of this cycle going on in your brain, because it usually happens automatically. Ideally, these cycles create positive behavior, helpful thoughts and pleasant feelings.

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A problem occurs when the cycle involves irrationally negative thoughts, feelings or behaviors. 

Everybody has unhelpful or negative thoughts sometimes, but in mental health conditions such as anxiety or depression, the person may have unhelpful or irrational negative thoughts more often. 

These negative thoughts can lead to unpleasant feelings, which can cause the person to act in a way they might not necessarily want to act, or in a way that has negative results.

Unhealthy (negative) cycle

As an example, let’s look at the party scenario again. 

You get invited to a party, but you have negative thoughts about going. You may imagine that there will be no one to talk to, or that you may not fit in. 

These negative thoughts cause you to feel anxious and worried about going. You may even experience physical symptoms, such as a pounding in your chest or an uneasy stomach. 

These unpleasant feelings may lead to you avoiding the party, or going but shying away from people. 

These actions may cause further negative thoughts, such as the thought that no one wants to talk to you, or that you don’t fit in. 

When you get invited to a second party, these thoughts may make you feel anxious and worried, so you avoid going to the party. 

This cycle then becomes a habit which leads to negative consequences, such as low self-esteem, or loneliness. The more the cycle goes on, the more it strengthens itself and creates negative thoughts, feelings, and actions.

unhealthy (negative) cycle example using the cognitive triangle

CBT focuses on the relationships between thoughts, feelings, and actions to try and break negative cycles, and create healthier ones. It aims to change the way you think, and the way you act.

Healthy cycle vs. unhealthy cycle

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unhealthy (negative) cycle example using the cognitive triangle

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How does cognitive behavioral therapy (CBT) work?

CBT is a goal-based therapy. This means that the CBT therapist will encourage you to consider what you want to change about your life and will help you set goals to work towards in therapy.

During CBT, the therapist will help you explore any negative patterns of behavior in your life and work with you to help break them. 

The aim of CBT is to allow you to see negative patterns and understand how to  change them. This way you will build the skills to stop negative cycles on your own.

To break the cycles, the therapist will discuss the  thoughts you have during certain situations, and whether or not you think they are reasonable. 

Some questions they may ask are:

  • Where do these thoughts come from?
  • How do these thoughts make you feel?
  • If these thoughts cause negative feelings, are they perhaps unhelpful?
  • How can you challenge these thoughts?
Young arab man in a Cognitive behavioural therapy (CBT) therapy session with a psychologist

How is CBT used to break the unhealthy (negative) cycle?

The therapist will discuss ways that you can challenge these thoughts or feelings, and stop them from negatively influencing your actions. 

To continue with the previous party example, your therapist may suggest that when you next get invited to a party, you challenge your usual negative thoughts, perhaps by reminding yourself that they are your friends, and they invited you because they want you there. 

These positive thoughts may improve how you feel about going to the party, and encourage you to go. Ideally you go to the party and have a good time, therefore breaking the negative cycle. 

By turning this negative cycle into a more positive one, you improve an area of your life and reduce some of the negative feelings you may be having.

Some therapists may recommend using a journal or workbook to help you work on challenging these negative thoughts or feelings in between therapy sessions.

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Who can benefit from cognitive behavioral therapy (CBT)?

CBT may offer benefit to people with the following mental health conditions:

CBT also has its uses for certain physical conditions such as chronic pain or chronic fatigue syndrome. 

Additionally, some people choose to use CBT to help with weight loss to manage obesity.

Who is cognitive behavioral therapy (CBT) suitable for?

CBT requires commitment from the patient. The sessions require a lot of concentration and mental effort. 

Additionally, CBT involves doing tasks or “homework” in between sessions. Therefore CBT is best suited for individuals who feel they can commit a certain amount of time and energy to the therapy process. Some people may find this difficult, and may wish to consider other therapies.

CBT can be used in all age groups. It can be very helpful for children,1 although the way the therapy is delivered will differ, for example, play sessions may be used.

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Does cognitive behavioral therapy (CBT) work?

The evidence for CBT being an effective type of therapy is strong. It has been shown to be especially useful for people with:

More research needs to be done to help the medical community learn more about how well CBT works in other conditions.1 

It’s important to remember that there are many therapy options available. Therapy is a very personal choice. If you think other options may suit you better, chat to your medical team for advice.

What are the different types of cognitive behavioral therapy (CBT)?

Rational emotive behavior is a therapy that follows very similar principles to typical CBT, but focuses on accepting negative thoughts as being part of who you are, while also considering why they are not rational.

Dialectical behavior therapy is a subtype of CBT, although it is often regarded as a separate therapy. 

Dialectical behavior therapy is mostly used for patients with borderline personality disorder. It focuses on thoughts, feelings and behaviors, but with an emphasis on feelings and how to regulate them. It also focuses on managing relationships with others.

Exposure therapy is another subtype of CBT. It involves slowly confronting situations/objects that cause unpleasant feelings. Exposure therapy is particularly useful for phobias and Obsessive-Compulsive Disorder (OCD), but also has uses in other anxiety disorders.

Cognitive Processing Therapy is a subtype of CBT which is particularly useful for people who suffer from Post-Traumatic Stress Disorder (PTSD)

 

Cognitive Processing Therapy focuses on the trauma that caused PTSD, and on processing and challenging thoughts and feelings caused by that trauma.

Trauma focused-CBT is another subtype of CBT specifically adapted for people who have suffered traumatic events. It aims to help them cope with the negative thoughts, feelings and behaviors caused by the trauma.

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Do I need to take medication whilst doing cognitive behavioral therapy (CBT)?

You do not have to be on medication to take part in CBT. 

In some cases however, it may be the most effective option for you to take medication and participate in CBT. For example, in depression, research studies have found that taking medication while also doing CBT has a stronger effect on reducing depressive symptoms.1

Whether you need to take medication during CBT depends on your mental health condition, or your reasons for needing CBT.

Your medical team will be able to give you more information about this.

How many cognitive behavioral therapy (CBT) sessions do I need?

The number of sessions you need will depend on a variety of factors, such as:

  • Your condition
  • How severe your symptoms are
  • What pace you feel comfortable going at
  • And whether you can find time to do the necessary work in between sessions

People will typically have between 5 to 20 sessions. Sessions usually last up to an hour.

Group of people in a therapy session comforting one of the group members who is upset.

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Where can I get cognitive behavioral therapy (CBT)?

Your doctor can refer you to a CBT therapist or give you CBT resources, but in some cases you can also organise CBT without needing a referral from your doctor.

The cost of your therapy may be covered by your national health service, or by your insurance provider, depending on where you live and what insurance you have. 

Some people may choose to pay privately for CBT. 

Always make sure you check that your therapist has the appropriate experience and qualifications.

CBT can be done through:

  • Face-to-face sessions, either individually or in groups. 
  • Online CBT courses
  • Self-help workbooks

Online resources can often be a cheaper option. They may also suit people that struggle to find the time to attend face-to-face sessions, or that have mobility issues.

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  1. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1 (Access here)

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