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In the years 2020-21 in the UK, 1.02 million people accessed talking therapies, also referred to as psychotherapies. People access these services for a range of conditions including depression, anxiety, agoraphobia and obsessive-compulsive disorder (OCD).
Popular treatments for these types of issues include counselling, peer support and Cognitive Behavioural Therapy (CBT).
If you choose to try CBT to help you to overcome problems or cope with a mental or physical condition, you will want to find a qualified and experienced therapist who you feel comfortable talking to.
Understanding CBT
Cognitive behavioural therapy (CBT) is a type of talking therapy that aims to change and reframe the way we think and approach our problems.
It can be used to treat common mental health conditions such as anxiety and depression.
The aim of CBT is to reframe the way we think and approach problems, often trying to break them down into smaller, more manageable parts:
- Situation
- Thoughts
- Emotions
- Physical feelings
- Actions
At the core of CBT teachings is the idea that the above five areas are interconnected and that they affect one another. This means that your thoughts affect your feelings (emotional and physical) as well as how you respond to them. When we feel bad, we can get caught in a cycle of negative thoughts and negative emotions. The aim of CBT is to change how we view our problems and thus how we feel about them and react to them.
Why seek a CBT therapist?
If you need help with negative or sad thoughts, overcoming obstacles, learning to be a more effective problem solver and want to feel more empowered, CBT may be a useful method for you. It may also help with more serious mental health conditions and even some physical problems.
CBT is considered an effective way to treat various mental health conditions in addition to anxiety and depression, including:
- Bipolar disorder
- Eating disorders
- Phobias
- Post-traumatic stress disorder (PTSD)
- Panic disorders
- Sleep problems (such as insomnia)
- Obsessive-compulsive disorder (OCD)
- Alcohol or substance misuse problems
CBT can also be used to help manage symptoms of certain long-term, physical health conditions, such as chronic pain.
Cognitive behavioural therapy can also help people to deal with emotional upheaval and stresses in life, such as:
- Grief
- Emotional trauma
- Relationship breakdown
You may decide on your own that you want to try CBT or you may be directed to try it by a doctor or other therapist.
Why choose CBT?
- Goal oriented
- Can be used in combination with other therapies
- Non-invasive
- Can be effective in addition to medication or when medication is not working or is not an option
- Helpful for people who get stuck in negative thought cycles or feel that they lack agency
Sessions can be delivered one on one or in a group setting.
Qualifications of a CBT therapist
Before choosing a CBT therapist, you should go online to check their credentials. It is important that you find an experienced and qualified therapist in order to get the best service possible.
Before seeing a psychotherapist, you should:
- Check their qualifications
- Check their certifications and licences
- Consider if you need a therapist who has a specialism in a particular field
- Look up reviews online from other patients
You will also want to think about accessibility. Your sessions may be done in person or online. If you have to attend a building for your CBT sessions you may want to choose somewhere that is easy to travel to and whether the building is appropriate if you have any access needs.
A CBT therapist can be any kind of healthcare professional who has been specially trained in the field. This includes psychiatrists, psychologists, GPs and mental health nurses. To become a qualified CBT therapist, you usually require a degree in a subject that relates to health and social care (such as psychology, mental health nursing or counselling) and are then required to complete an accredited postgraduate course in Cognitive Behavioural Therapy.
Finding a qualified and skilled therapist is important but it is equally important to find someone that you trust and feel comfortable around. This may be difficult to assess from looking at a website, therefore you may want to do some research into how others have found the therapist to be and whether they would recommend them.
Recommendations and referrals
You may be able to access CBT and other talking therapies on the NHS. You can self-refer or ask for your GP to refer you to an appropriate service. You may also be able to ask your GP for a list of qualified, local therapists that they recommend.
Mental health services are overwhelmed at the moment and NHS waiting lists are long. If you can afford to pay, you will get seen significantly more quickly if you are able to pay for private treatment.
You can find a register of accredited therapists in the UK on the British Association for Behavioural and Cognitive Therapists (BANCP) website.
You may also ask for recommendations from your trusted circle of friends, family or co-workers, or within any support groups that you attend.
You can easily check reviews and recommendations for therapists online using Google reviews or on social media.
Ideally, you will want to find a qualified CBT therapist who is able to:
- Listen without judgement
- Plan, organise and set goals for you
- Conduct themselves in a friendly, professional and relatable way
- Put you at ease and encourage you to open up
- Assist you in achieving your goals and improving your quality of life
- Provide a realistic framework for your sessions and adjust them as needed
Initial consultation
At your initial consultation your therapist will need to get to know a bit about you and what specific issues you want to work on.
It will also give you a chance to get a feel for whether the therapist is a good fit for you or not. You should think about the suitability of:
- The therapist’s approach and demeanour
- The therapy itself
- How long the sessions will last and how many you may need
- The goals of your treatment
You may also need to consider how realistic the goals are and whether the treatment plan is affordable if you are not able to access free sessions.
During the initial sessions you may need to answer a few questions about your life and background to help your therapist make their assessment. However, as CBT techniques focus on the present, after your initial consultations, the focus will likely shift to:
- How your problems are affecting you, your life, your loved ones or your career
- How you think and feel about your issues
- Whether you can break these issues and thoughts down into smaller parts
- Recognising unhelpful thoughts and replacing them with thoughts that are more useful, more practical and less toxic
- How well you are implementing strategies learned during your sessions into your daily life
- What improvements you are seeing and what subsequent changes you need to make to reach your goals
Treatment plan
CBT has a more structured approach in comparison to other types of therapy. It is goal oriented and requires significant engagement and commitment from patients.
As discussed previously, your treatment plan will usually consist of the following framework:
- Identifying problems or issues to overcome
- Discussing your thoughts and attitudes to your problems
- Breaking them down into five key areas
- Identifying negative and unhelpful thoughts
- Suggesting ways to reframe and reshape thoughts to break negative thought patterns
If your issues relate to a specific trigger (such as a phobia) you may be recommended ‘exposure therapy’. This involves being gradually exposed to a situation or object that causes you anxiety. After a few exposure sessions, ideally, your anxiety should be reduced when exposed to the trigger.
The goal is to reduce anxiety to a minimal or tolerable level by the end of the sessions when faced with your specific trigger. Exposure therapy usually involves 6-15 hours with a therapist. It may also involve some computer work or self-help.
Collaborative approach
Cognitive behavioural therapy requires significant engagement from patients. You will be expected to complete homework assignments, practise techniques outside of your sessions and provide honest feedback.
CBT differs from other types of psychotherapy because:
- It focuses on finding practical, pragmatic solutions to problems that are identified during sessions.
- It has a specific structure and focus on discussing specific problems and finding solutions.
- Rather than going over issues from the past, CBT focuses more on the here and now.
- Collaboration is key for CBT to work. Your therapist will guide you but not direct you on specifically what to do; they try to work alongside patients to identify problems and find ways to change thoughts and behaviour.
Duration and frequency
CBT sessions might take place in a clinic, your own home, outdoors (usually this is when your goal is to overcome phobias) or even online.
If you are meeting for one-to-one therapy, NHS guidelines suggest that you should see your therapist once every two weeks for CBT, for 6-20 sessions (although this can vary between patients and settings). CBT sessions typically last for half an hour to an hour.
One of the most useful aspects of CBT is that it teaches tools and techniques that can be implemented long after the sessions have concluded.
Measuring progress
CBT sessions are structured and you will usually have a treatment plan which agrees on how often you will meet with your therapist. For the process to be effective, patients should keep to their appointment schedules and partake in any activities as far as possible.
Progress might be discussed in terms of how a patient is feeling, how their thoughts have altered and whether they are meeting their goals.
As discussed, a key goal of CBT is to reframe negative thoughts to improve outcomes for patients – below is an example of how this may look in practice:
- A person has a very difficult and tumultuous break-up after a long relationship.
- As a result, they have lost hope in finding love and feel lonely and sad.
- These feelings have left the person stuck in a cycle of sadness and loneliness; they do not go out and socialise because they feel down and they are unlikely to meet a new partner because they rarely leave the house.
- Rather than getting lost in these negative feelings, a CBT therapist may suggest a mindset shift. Many relationships end and it can be seen as a fresh start and a chance for change and growth.
- The therapist may set their patient small tasks to complete, with the end goal being for them to go out and start socialising again with a more open mind.
This is a very simple explanation and many psychological issues are far more nuanced and complex, but it provides a brief overview of how reframing our thought processes may look.
To measure progress in your CBT sessions, it is important to regularly evaluate how the treatment plan is working and make any adjustments needed to make it more effective:
- Is the patient attending?
- Is the patient engaging and doing necessary work outside of sessions?
- Does the patient notice a change in their thoughts and feelings?
- Is the patient putting into practice what is discussed in sessions?
- Is the therapist listening to and acting on patient feedback?
Your progress at the end of your CBT sessions can be benchmarked against how far you have come since you began the programme and to what extent you have achieved your goals, developed appropriate coping mechanisms and changed your mindset.
Ethical considerations
Patients often come to see their psychotherapists in a vulnerable state. It is therefore vital that therapists understand their legal and ethical responsibilities and uphold their code of conduct.
Your CBT therapist is responsible for:
- Maintaining confidentiality (except in extreme cases such as when you pose a serious threat to yourself or others)
- Keeping a professional distance from patients (not getting involved with them on a personal level)
- Providing a safe, clean and supportive environment for treatment
- Referring patients to alternative services if it is clear CBT is ineffective or inappropriate
- Being open and honest about their skills, experience, qualifications and accreditations
Conclusion
Cognitive behavioural therapy (CBT) has been proven to be useful to treat a range of conditions. To get the most out of your sessions, patients need to engage fully and be open to the guidance and advice of their therapist.
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