Cognitive behavioural therapy (CBT) 

Introduction 

CBT expert

Professor David Clark explains how cognitive behavioural therapy (CBT) works and who could benefit from it.

Media last reviewed: 24/04/2013

Next review due: 24/04/2015

Types of CBT

CBT can be carried out in several different forms, including:

  • individual therapy – one-to-one sessions with a therapist
  • group therapy – with others who wish to tackle a similar problem
  • a self-help book – where you carry out exercises from the book
  • a computer program – known as computerised CBT (CCBT)

Mental health services

Find out what mental health services exist and how to access them

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.

It is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

CBT cannot remove your problems, but it can help you deal with them in a more positive way. It is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.

CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller parts and showing you how to change these negative patterns to improve the way you feel.

Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.

Read more about how CBT works.

When is CBT used?

CBT has been shown to be an effective way of treating a number of different mental health conditions.

In addition to depression or anxiety disorders, CBT can also help people with:

CBT is sometimes used to treat people with long-term health conditions, such as irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). CBT cannot cure the physical symptoms of these health conditions, but it can help people cope better with their symptoms.

Finding a CBT therapist

If you think you have a problem that may benefit from treatment with CBT, the first step is usually to speak to your GP. 

Your GP may be able to refer you for CBT that is free on the NHS, although this is not available in all areas and the waiting list can be long.

If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies, but it is usually £40-£100 per session.

If you are considering having CBT privately, ask your GP if they can suggest a local therapist. The British Association for Behavioural & Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK and The British Psychological Society has a directory of chartered psychologists, some of whom specialise in CBT.

You can also use this website to search for CBT services near you.

What happens during CBT sessions?

If CBT is recommended, you will usually have a session with a therapist once a week or once every two weeks. The course of treatment will usually last for between five and 20 sessions, with each session lasting 30-60 minutes.

During the sessions, you will work with your therapist to break down your problems into their separate parts – such as your thoughts, physical feelings and actions.

You and your therapist will analyse these areas to work out if they are unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.

After working out what you can change, your therapist will ask you to practise these changes in your daily life and you will discuss how you got on during the next session.

The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life. This should help you manage your problems and stop them having a negative impact on your life – even after your course of treatment finishes.

Pros and cons of CBT

There are a number of advantages and disadvantages of CBT.

Research has shown that CBT can be as effective as medication in treating some mental health problems. Compared to other talking therapies, CBT can also be completed over a relatively short period of time.

However, to benefit from CBT, you need to commit yourself to the process. A therapist can help and advise you, but they cannot make your problems go away without your full co-operation.

Also, due to the structured nature of CBT it may not be suitable for people with more complex mental health needs or learning difficulties.

Read more about the pros and cons of CBT.




Page last reviewed: 04/07/2014

Next review due: 04/07/2016

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Comments

The 16 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Ade10 said on 06 September 2014


My partner approached the group cbt sessions with an open mind and has found them very good. More through desperation really.

She has battled with the darkness for many years and the course has really helped with understanding of her feelings and methods of managing how she feels. I have noticed a big difference in that she may have dificult days rather than longer periods of several days.

You are able to quietly learn from the therapist or speak within the group if you feel you can, you are not expected to braodcast your issues to strangers.

What have you got to loose ?

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LaaLauraaaa said on 07 August 2014

I think that everyone needs to understand and accept that there is no cure for mental health problems. No Psychiatrist, Therapist or Counselor has ever 'cured' depression, anxiety ect. The purpose of CBT is to provide you with the tools to manage your problems, which will eventually ease the symptoms, it's not a quick-fix and it will take time.

I have had CBT for an Eating Disorder, i'm now thinking of seeking it for anxiety and my experience with NHS funded CBT is brilliant. If you feel like you're not getting along with your therapist do not be afraid to ask to change, as I agree that feeling comfortable is important. I found that asking for someone similar in age and of the same gender helped greatly. Go into CBT with an open mind: (it is a talking therapy so you should expect to do just that) bringing old memories and feelings back to the surface may be distressing, but leaving a session thinking 'that really upset me, so i'm not going back' will get you nowhere. Persevere for a bit longer and if you still don't get along with it, at least you know that CBT is not for you and you can seek another style of treatment. You WILL find something that works for you, just persevere and pester your Doctor until you get what you want.

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LouiseNewmark said on 05 August 2014

I am stunned by some of the comments below. I have struggled with severe stress and anxiety brought about by eating problems for some times and I have to say, having tried both voluntary services and NHS services, the treatment I have received on the NHS is super.

I believe the principle behind CBT is that those with severe depression find some liufe events too difficult to talk about. It is more supportive to help someone out of a nasty circle than to talk for hours about, surely?

Therapy can't fix your life, it is meant to help those with unmanageable feelings of self doubt.

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annabellabeau said on 02 August 2014

I think that these people are preying on vulnerable people - untrained (yes I don't care if they have PhDs) people who have come into this job for money for old rope should not be left with vulnerable persons I was given mounds of paperwork to complete and the sessions did NOTHNG I felt worse. These people do not help in any shape or form The NHS are cutting corners and not allowing us to see highly qualified and experienced medical persons - only someone with a glorified BTEC level 4.

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Nicky Johnson said on 30 March 2014

In contrast to the negative responses below, I felt it necessary to add my positive experiences and advice for after the sessions finished.

I've dealt with depression for close to a decade, and used CBT 3 times. The first 2 times there was a fair wait, but the last time was pretty quick due to my severity. So yes, if you're referred, expect a wait depending on the waiting list in your area

It's important to distinguish between CBT and counselling. Counselling is more talking therapy; you go in, talk about your problems and life events, etc. CBT, in my opinion and experience, is doing therapy. You learn to identify problems and work on them, not talk heavily about them.

I was initially confused by the concept of the worksheets, but by the end of the sessions I figured out the point. Take the Negative Core Belief sheets, designed to help you identify your negative belief ('I'm a useless person') weigh up the evidence for and against, and come out with a more balanced belief. Eventually, I became able to do this without using a pen and paper, and that is ultimately the point.

As I said, I went back 3 times. The first block was coping with past mistakes and their effect on my self view. The second was a repeat of that. The third was dealing with my terrible experience in my job at the time. It's true, after a while, you might relapse and find it hard. What you have to realise though is that this is the nature of depression, and that even if you get pushed back, you've been shown and given the tools to rise again. The worksheets are readily available online, although not on here I don't think, and you can print them off and go through the process again.

Ultimately, CBT is not for everyone, much in the same way that Citalapram, or Sertraline, isn't ideal meds for everyone. However, as someone who benefited from it, if it is right for you and you put the work in, it can be a great help.

Good luck.

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HAA said on 15 March 2014

Patient requested treatment for PTSD – physio had pointed out some of the problem was caused by PTSD.
GP said it was a long wait, 6 months! Patient waited.

Finally an appointment, the Counsellor was at GP surgery and said treatment was only 8 appointments. Patient wondered why it was focused on childhood at each appointment which was irrelevant - at fifth appointment Counsellor then said they don’t do PTSD!

Patient went back to GP – turned out GP knew counsellor didn't do PTSD! what a waste of time, sending patient to wrong counsellor.

GP then said it was longer wait for PTSD counsellor – 18 months. Patient waited again.
Two years later, still no appointment, patient contacted GP again

Further 8 months, more than 3 years since attack, counselling started but did not deal with the problem – seemed as if too difficult for counsellor, or lack of interest. Just went round and round, and counsellor kept cancelling appointments. Finally counsellor reduced patient to tears and made it clear there was to be no assistance.

Patient again asked GP. GP gave patient forms to fill in. These were to be sent to same people as before! and were the same forms as previously filled in but excluding the PTSD form - so obviously not dealing with PTSD !

Complete waste of time over several years – effectively denied PTSD treatment.

So NO treatment, years wasted waiting for treatment & just given the run around then expected to start again and excluding PTSD! Obviously they were having a laugh at patient's expense.

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Jayde_97 said on 21 November 2013

I found that at first this did work but after I finished it I found I was going back into old habits with my OCD, depression and self harming. And it just seemed like I was just repeating my self every time I went there I wouldn't really recommend it for anyone, although I was 16 when I went it isn't really that good, and it took me 9 months to get my first appointment. For all they knew I could have been dead by then.

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curiouslyn said on 04 November 2013

My GP has been trying for the past 4 weeks to refer me for CBT. I had an appointment with her this morning, and she told me that they no longer have the funding for this!!! Instead, I have been asked to try a computer based form of therapy!!
Im not sure how this is going to work, but I have to attend a centre for 8 weeks, and use their computers for this! Im going to give it a go and see how it works.....or even if it does work!!
I just cant believe they have had the funding stopped for this!!

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Amazonopal said on 18 September 2013

I too have been referred to CBT by my gp after explaining the additional difficulties I am experiencing with my daily life following a brain injury.

I have been given two packs of paperwork to go through and a relaxation exercise cd. I think it's a cause for concern if they expect someone like me to go through this independently, fortunately I'm one of the 'lucky' ones with my injury so still have the ability to read, understand and write I doubt anyone else with my injury could cope with it. There has already been one comment here saying that the tasks given made no sense and had actually triggered anger. My first session had the same affect on me when I was asked if I would return to job I was doing when I had the injury which basically reignited bad memories.

I actually hadn't thought about contacting NHS conditions until I arrived at the end of one of the packs with a list of useful organisations and helplines. I'm hoping to have some help from an organisation which has the understanding that my condition isn't comparable to standard situations.

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KayaSoul said on 28 May 2013

I saw my doctor a few weeks ago (after waiting a few weeks for an appointment) and was told that the NHS do not offer counselling! I was offered a 'group' CBT session that I did not fancy at all! I just want to talk to someone and each day I feeel my will to live diminishing! Don't even know why I'm writing this, maybe I just want to tell someone, even an anonymous website.

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flyonthewall said on 24 May 2013

There is an Unit , ran by NHS Lancashire Care FT, who are specialists in treating PTSD. Unfortunately, due to plain territorial factors it is extremely difficult to get a referral to them!
subsequently I'm using a local Primary Care Psychology Service to hopefully help me get over the blockage that stops me from savoring all life is offering me.
The initial consultation was very business like, but its v early days - he did make the mistake once of putting words in my mouth - it is a delicate art I guess - I will point it out to him next time I see him! If he doesn't warm up I will also ask him to address that - warmth balanced by detachment is important - again a balance.

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David R2012 said on 26 April 2013

Hurrah!! Common sense has prevailed at long last and I am be referred to a psychiatrist. Shame I had to sing and dance about it. CBT does not treat personality disorders.

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David R2012 said on 25 April 2013

Interesting. I have been on this twice. Both occasions failed. Yet the letter that went to my Dr said something quite different how well it had worked etc.....
I complained today to the local authority about why this had been put down as this was a blatant lie. Apparently they will reissue the letter to my Dr saying this was incorrect. CBT actually made my condition worse, brought up some unpleasant memories which when addressed with the family split it. And this is being done in the name of progress and supposed therapy.
The homework I was left with made no sense. The therapist was no help.
I have a £20 book still on the bookshelf unloved etc....
I see CBT as a way of cutting the psychiatrists waiting lists.
The question the CBT person always asks is "what do you want out of this??". Hey I am coming to you for a cry for help and you throw the it back at me the patient.
it also affected my work and my employer was not at all impressed with 12 weeks of sessions each week so I had to leave early.
I was also annoyed today when I had spoken to "primary care" I went through how I was feeling etc.... spent half an hour to be told we can only offer more CBT. I let rip at this point and complained higher up. It appears we are being fobbed off with this treatment with no follow up afterwards to see how we are getting on and no one takes responsibility for the mess it causes as well.
CBT is like taking placebo tablets. Some people it works some it doesn't.
However, CBT is no good if you have a personality disorder (which my therapist thought I had) as something inherently has gone awry in the brain either chemically, physical or emotional. That needs more complicated treatment. Trying to make the world conform to 2+2 = 4 will not work if in your world 2+2=5.
I now have to see what alternatives as I have lost my job over this quack therapy.

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Auntyhen said on 10 February 2013

Focussing on the therapist rather than yourself, may be counter productive. Their purpose as I have experienced it, is to enable you to talk freely and "hear yourself" without the pressure of any sort of caring relationship. My severe depression turned out to be due to how I saw things as a result of early experiences, not the circumstances and people I blamed at all. Might it be be a little manipulative to try to take control of the sessions by tricking/testing the therapist, rather than entering into the exploratory talking and reflecting.? Understandable when you are in pain, but not a positive step.

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robina87 said on 24 October 2012

iknow what you mean about feeling that you are just another person to them and that they dont really care. and how you told her about your hobby and she showed no interest. the thing is you'v got to get past that feeling of wanting you to care about you or you will never get any reall help. take whatever help you can get and use it to your advantage and just get used to the feeling that you are in fact just another person.

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Truth4all said on 17 October 2012

The presenter indeed seems like a nice man and one of empathy.
Let`s now get into the real world.
I am in great need of some kind of therapy for severe clinical depression.
Waited 2 weeks for consultation appointment, now told I need to wait 2-3 months to have CBT regular help.
I came away from the consultation happy that I talked things over but unhappy when I was wondering whether the therapist was just trained to do a job and I was one in the production line of patients, or indeed if the therapist was generally interested in me and others in a caring positive way. So to test this near the end of the session I stated that I had taken up a new hobby, only response was the the therapist continued writing notes and nodded. I then said it`s a hobby with a difference, exact same response. I was hoping the therapist would show a genuine interest by asking what hobby, but no. I then mentioned the hobby and no real genuine interest in facial expression as the therapist was apparently due another patient whom I passed on the stairs, not very professional. So I`m skeptical about the whole reason for people trained as therapists. Does not matter what amount of training and techniques used, if the patient feels that he or she is just another job to be assigned to, it will not work. In my view too many therapists put career first over genuinely wanting to help people. Thanks however for the video.

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