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What is CBT? The basics of Cognitive Behavioural Therapy, explained

Cognitive behavioural therapy (CBT) is one of the most commonly prescribed (and effective) types of therapy out there. We asked a psychotherapist to explain everything we need to know, from what mental health conditions it can treat, to how it actually works.

The idea of therapy can sound pretty scary: sitting in a room with a stranger and exploring the deepest, darkest depths of your mind? Argh.

As someone who has gone through therapy – and regularly sings its praises to anyone who will listen – I’m here to tell you that, despite all those initial fears and worries, having cognitive behavioural therapy (CBT) to help me with my OCD was one of the best things I’ve ever done for my mental health. Of course, speaking openly and honestly about the inner-workings of your brain isn’t the easiest thing you’ll ever do, but it’s 100% worth it.

There are plenty of different kinds of therapy out there, and depending on what you’re dealing with, your GP or another medical professional will be able to advise you which type of therapy will suit you best. Out of these types, one of the most commonly prescribed and effective styles of therapy is CBT, which is used to treat a range of mental health conditions including bipolar disorder, anxiety, depression, sleep problems (such as insomnia) and OCD. CBT can also be prescribed to help people cope with the symptoms of long-term health conditions such as chronic fatigue syndrome and fibromyalgia. 

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With this in mind, it makes sense that more and more of us are becoming curious about the potential benefits of this kind of therapy. Whether you want to know more about what CBT actually is or want some advice on finding a CBT-qualified therapist, we asked Dr Meg Arroll, chartered psychologist at Healthspan, about everything you need to know when it comes to CBT. 

What is CBT?

For many people, the anxiety which comes with seeking CBT for the first time originates from a fear of the unknown. Knowing what CBT actually is – and how it helps us to deal with mental health conditions – is a great first step in seeking help.

“CBT works by examining your thoughts and feelings through a series of structured exercises such as behavioural experiments, to show how your ‘cognitions’ influence your behaviour, which in turn affects how you may feel and think about situations and events,” Dr Arroll explains. “It may at first seem odd that thoughts influence our behaviours, but it really is easy to become caught in negative-thought patterns which impact on our lived experience.

A therapy session illustration
“CBT works by examining your thoughts and feelings through a series of structured exercises such as behavioural experiments, to show how your ‘cognitions’ influence your behaviour.”

“Over-thinking and ruminating on events, the future and even bodily sensations can impact on our hypothalamus-pituitary-adrenal axis (HPA), triggering a state of chronic stress which has a physiological effect on our bodies and minds.”

CBT works to address the negative thought patterns we may have established as a result of a mental health condition, and aims to build healthier thought systems which will help us to deal with the things that trigger us. You can almost think of it as a “rewiring” of the brain – as a form of therapy, CBT works to provide us with ways to understand and evaluate our experiences so we respond in a way which isn’t detrimental to our mental health.

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“This type of psychological treatment is very structured with a solution-focused approach, in comparison to other well-known therapies such as psychotherapy, which tends to be more exploratory,” Dr Arroll says. 

What happens during a CBT session, and how long do they last?

There are actually lots of different ways to take part in CBT, so the make-up of a session will vary depending on your condition and whether the session is face-to-face or online.

“CBT is most commonly delivered by a trained and qualified therapist, although there are now many online courses, apps and self-help books on the technique,” Dr Arroll explains.

However, she also warns that the less-conventional CBT methods (such as via a self-help book or online) are not backed by the same scientific research as a face-to-face session with a qualified therapist in a clinical setting.

CBT sessions typically last between 30-60 minutes, and a course of therapy will last anywhere from five to 20 sessions.

A therapy session illustration
“CBT is most commonly delivered by a trained and qualified therapist, although there are now many online courses, apps and self-help books on the technique.”

According to the NHS, during CBT sessions you’ll “work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.”

You’ll then spend the session analysing this information and working out how you can change these unhelpful thoughts and behaviours.

What is CBT used for?

CBT can treat a range of different mental health conditions, as well as help people dealing with long-term health conditions to handle their symptoms.

“CBT aims to challenge and alter unhelpful thought patterns which may be inhabiting health outcomes,” Dr Arroll explains. 

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“The most extensive research has been conducted in people with mental health issues such as anxiety and depression but a wide range of conditions have been show to benefit from CBT, including the psychological symptoms of the menopause, sleep disturbance and insomnia (known as CBT-I: the Sleepio app is based on this treatment), and gastrointestinal disorders such as irritable bowel syndrome, among many others.”

To find out whether CBT could help you and your mental health, always seek the advice of your GP or a mental health professional. 

How effective is CBT?

As a mental health treatment, CBT can be highly effective. While sometimes it is prescribed in conjunction with other treatments such as medication, other times it is used on its own.

As Dr Arroll points out: “CBT is very effective, in some cases it has been show to be more effective than medication.”

However, she says, it’s important to remember that CBT is not a passive treatment – you’ll have to put in the work to ensure it’s effective.

A woman unravelling her thoughts
“In a typical CBT session, a therapist will work though a number of structured and standardised exercises that challenge your thoughts and beliefs.”

“CBT requires quite a bit of work on the part of the patient. You’ll be asked to record your thoughts, feelings and behaviours (as well as your symptoms if you experience a particular condition) to see where there are links between them. Hence, in a typical CBT session, a therapist will work though a number of structured and standardised exercises that challenge your thoughts and beliefs.

“You will most likely be given some ‘homework’ to do between sessions as well as it can take time and practice to change the way we think.”

Can you get CBT on the NHS?

Yes, you can, and the way you go about getting it depends on the area of the country you live in.

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“In many areas of the country you don’t even need to see your GP as you can self-refer via the IAPT (Improving Access to Psychological Therapies) services,” Dr Arroll explains.

Click here to see if you can access IAPT in your area (if not, you’ll need to make an appointment with your GP). 

How much does CBT cost?

If you decide to skip the NHS and seek CBT privately, the price ranges depending on a number of different factors.

“The average cost per session ranges from £40-£100,” Dr Arroll says, “depending on location, specialty and experience of the therapist.”

How to find a CBT therapist

According to Dr Arroll, the best place to find a qualified CBT therapist is via The British Psychological Society (BPS), which is the governing body for psychologists in the UK, and has a directory which can be searched by area and by technique.

“Additionally, you can search for practitioners who specialise in certain types of problems under the ‘What are the issues?’ section to narrow down the search,” she says. 

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