What is CBT?

CBT is a talking therapy which is the most popular therapy currently advocated by the NHS for people suffering with anxiety, depression and other mental health concerns. CBT is a tool to help manage mental health problems and some physical conditions by changing the way people think and behave.

The principles of CBT are more easily understood than some of the other more complicated treatment theories, and CBT is therefore pretty accessible for most people. Because the concept is easy to learn, progress can be demonstrably swift and this encourages the person seeking help. The accessibility and easy comprehension of the therapy also empowers them to take control and feel they can make changes for the better.

CBT is one of the most available talking therapies because there has been a big increase in the number of therapists in the last 20 years. In 2007, the UK government put aside £173m to train an extra 3,600 therapists. There is also a growing trend of health insurance providers who offer cover for talking therapies as part of their policy coverage.

What does CBT mean?

CBT stands for Cognitive Behaviour Therapy and is classified as a talking therapy which focuses on current issues or problems in someone’s life rather than things which have happened in the past.

What is CBT?

CBT is based on the premise that everyone’s thoughts, feelings, physical health and their actions are all connected. This is why negative thoughts and feelings can constantly spiral round, trapping that person in a vicious circle of emotions and behaviour that they cannot break free from.

The idea behind CBT is to break down this seemingly impenetrable jungle of thoughts, emotions and actions by, in the first instance, deconstructing them down into smaller parts. A therapist or counsellor can show someone the way to change these negative patterns to improve how they feel.

What does CBT involve?

Theoretically, anyone is a potential candidate for CBT although it is best to have an evaluation from a GP or other healthcare professional as there may be a better option or a different talking therapy that is more appropriate in individual circumstances; CBT is not the right choice for everyone. For instance, CBT only works on current issues in someone’s life; if difficulties or trauma are being experienced from past or childhood events, then a different therapy may be more helpful.

CBT takes an educational approach directed from the therapist to the recipient or patient. The therapist educates the person in techniques which can be used to combat negative thinking, and which need practice and repetition to be effective, all done with the support of the therapist.

Techniques may include:

• Measuring the gains clients make in concrete terms by asking them to rate the intensity and frequency of thoughts and occurrences on a scale of 1 to 10 and regularly re-assessing the scores by thinking about the same past events and situations and re-evaluating how they feel about them.
• Making a log or diary of feelings and emotions.
• Setting homework exercises so the patient or client learns to become self-sufficient.

The therapist will help that person break down their problems into separate parts such as feelings, actions and thoughts. The therapist and the client collaborate to work out if these are unhelpful or unrealistic and try to determine the effect they have on that person. The therapist will help work out what changes can be made to unhelpful and negative thoughts and behaviours and then ask the client to implement these and practise them, with a review taking place at the next therapy session.

Sessions are usually once a week or once a fortnight and the average course of CBT lasts for between five and twenty sessions. An average session lasts from half an hour up to an hour.

The idea is that the therapist kickstarts the process and rather than fixing the problem teaches the client to fix themselves through education and empowerment. Becoming self-reliant will reduce the need to resort to a therapist in the future.

CBT is a therapy which can be self-administered to a degree without a therapist’s support, although most people start with professional help and become more independent and self-reliant later on. CBT follows a very structured approach which lends itself to different formats such as books and self-help apps so there is access to CBT for those who don’t want to see a therapist. MIND, the mental health charity, has plenty of information on different online tools.

CBT is also a technique which can be used to help support young people, teaching them skills and techniques early on in life which will help positive development and equip them for the big challenges that lie ahead. There has been particular focus on youth mental health after the lockdowns imposed by the Covid-19 pandemic; young people particularly suffered with isolation during a crucial stage of their development and growing up, and this has raised awareness about the importance of mental health in young people.

It is essential to have a proper evaluation from a dedicated and skilled medical professional rather than assuming CBT is the most appropriate form of help; CBT cannot take the place of antidepressant medication for those people suffering with severe depression.

When was CBT introduced?

Cognitive Behavioural Therapy is a combination of two different therapies: behavioural therapy and cognitive therapy.

In the early 1900s, Austrian psychotherapist Alfred Adler was one of the earliest therapists to understand the concept of basic mistakes and their link to unpleasant emotions – this was called cognition in psychotherapy.

Then in the 1950s, some half a century later, the American psychologist Aaron T. Beck picked up Adler’s baton and developed rational emotive cognitive psychotherapy. This centred on the idea that a person’s emotional distress arises from their reaction or thoughts about an event rather than the actual event or incident itself.

Beck understood the link between thoughts and feelings and how important it is and developed the term ‘automatic thoughts’ to describe the emotional thoughts that can just pop into someone’s head. Beck worked on the lines of uncovering and challenging these negative thoughts to bring about positive change; people literally stepped outside of these thoughts and looked at them objectively, testing them out.

In the 1960s, there were a number of studies into how cognition affects behaviour and emotions; this was known as the cognitive revolution. It highlighted the role that conscious thinking plays in psychotherapy and is widely referred to as ‘the second wave’ of CBT.

Does CBT work?

CBT teaches self-sufficiency and techniques which not only work for the current entrenched status quo but can be used in the future to combat other situations, meaning that new problems can be solved and usually without resorting back to the therapist.

CBT is not a ‘quick fix’ although it can produce results earlier than some other therapies, but it does require effort and commitment on behalf of the individual. This can become the ‘chicken and egg’ cycle where a person feels too low to make that effort or finds it just too difficult to confront negative thinking patterns and anxieties which have been entrenched over many years and deliberately suppressed or blocked out.

Facing some of these difficulties can cause a short-term increase in anxiety or low self-esteem, which for some people is simply too hard to overcome. For those that don’t have the resources to make this effort, it can be easy to point the finger at CBT and proclaim that it doesn’t work. Sometimes, antidepressants can be used to kickstart the process and help induce an upward spiral which can then be supported by CBT once that person is starting to feel better and has the resources to make an input into the process.

The National Service framework used by the NHS has classified and assessed the quality of evidence into CBT which is used in support of its effectiveness. Research into CBT has been classified as ‘level 1’ evidence which, under the criteria of the framework, mean that at least one good systematic review and one randomised controlled trial have taken place with positive findings.

In theory, CBT should work for everyone but the reality is that some people find this therapy more effective than others. Much depends upon the mental status and background of each individual – those with dependency or substance abuse problems, PTSD or childhood traumas, may find that other therapies are more helpful or use CBT in conjunction with other treatments.

There was a detailed study in 2005 conducted by Roth & Fonagy called “What Works For Whom?” and this provided a sound body of evidence and research studies which showed a strong case for CBT being helpful in treating a range of different conditions and disorders.

Who would benefit from CBT?

CBT can be helpful in treating the following disorders and problems:

• Major depressive disorders.
• Social phobias.
• Generalised anxiety disorders.
• Bipolar disorder.
• Obsessive compulsive disorder.
• Panic attacks and panic disorder.
• PTSD – Post Traumatic Stress Disorder.
• Bulimia.
• Sleep problems and insomnia.
• Anorexia nervosa.
• Substance abuse, usually cocaine abuse.
• Sexual problems.
• Some conditions common in autistic children.

There are also some physical illnesses and conditions which CBT is used for:

• IBS or Irritable Bowel Syndrome.
• CFS – Chronic Fatigue Syndrome.
• Fibromyalgia.

CBT cannot remove the physical issues attached to these conditions but it can help people respond and cope better with the symptoms they experience daily.

There are many people who can benefit from CBT sessions without a diagnosis of one of the disorders or conditions listed above. CBT can be a very powerful tool for people who are just finding life overwhelming or who are going through a bad patch.

The National Institute for Clinical Excellence (NICE) recommends that CBT should be the first approach for mild and moderate depression, with drug intervention only recommended if CBT does not prove effective or is not effective enough. CBT is a great starting point for people who don’t want to resort to oral medication as an intervention.

How much is CBT?

CBT is available on the NHS; people can refer directly to an NHS psychological therapy service (IAPT) without GP referral or the GP may refer a patient who will benefit from CBT. There can be a wait to see a therapist which is why many people opt to pay for sessions.

CBT can produce positive results relatively quickly so it is known as a time-limited therapy and this also puts it within the reach of many more people who may have modest budgets.

The cost of CBT will vary depending on where you live, who is conducting the appointment and, sometimes, the time of the session, with a higher fee charged for evenings and weekends. Clients should expect to pay anywhere from £50 to £150 per session.

If you have health insurance then your insurer may cover the costs of a defined course of CBT sessions. The Association of British Insurers has been working hard to recognise the place of mental health support throughout the insurance sector and promote greater access to insurance and protection for people suffering with mental health problems.

In any given year, 1 in 4 people will have a mental health problem, and of this figure around four million people will struggle with their financial situation as a consequence. The ABI report that in 2017, mental health was the most common reason cited for a claim on income protection policies.

Finding a therapist is straightforward without a direct referral from a GP. The British Association for Behavioural & Cognitive Psychotherapies (BABCP) maintains a register of all UK accredited therapists. People can also consult the British Psychology Society (BPS) who keep a directory of chartered psychologists, some of whom offer CBT.

Different types of CBT

Over the years, CBT has developed and been modified and new forms of therapy have appeared as a consequence. These are DBT – Dialectical Behaviour Therapy – and ACCT which is Acceptance and Commitment Therapy, both of which are recognised offshoots of CBT.

Dialectical Behaviour Therapy (DBT)

This variation of and development of CBT was introduced to help those with suicidal thoughts and actions. It uses mindfulness so works to accept current problems whilst simultaneously taking steps to address them. Sessions are both 1:1 and a group session which teaches reality acceptance skills, emotional regulation, interpersonal effectiveness and mindfulness.

Acceptance and commitment therapy (ACT)

This type of therapy is aimed at the acceptance of thoughts and emotions without any form of judgement, changing the perception of self. ACT is similar to DBT but the techniques and exercises used during the therapy sessions are different.

CBT is a recognised and accessible form of mental health support, suitable for a wide variety of people with usually fairly quick results or improvement and is easy to convert into online tools for wider self-help for all ages.