Who can work as a therapist in CBT?
Cognitive behavioural therapy (CBT) can be carried out with a therapist in one-to-one sessions or in groups with other people in a similar situation to you. Your CBT therapist is usually a healthcare professional who has been specially trained in CBT, such as a psychiatrist, psychologist, mental health nurse or family doctor. You can also do CBT without a therapist (see below).
What happens during CBT treatment?
If you have one-to-one cognitive behavioural therapy (CBT) with a therapist, you'll usually have between five and 20 weekly or fortnightly sessions, with each session lasting 30-60 minutes. Exposure therapy sessions usually last longer to make sure your anxiety reduces during the session. The therapy may take place in a clinic or in another place, such as your own home if you have agoraphobia or obsessive compulsive disorder (OCD) involving a specific fear when at home.
The first few sessions will be spent making sure CBT is the right therapy for you, and that you're comfortable with the process. The therapist will ask questions about your life and background. After the initial assessment period, you'll start working with your therapist to break down problems into their separate parts, including your thoughts, physical feelings and actions. To help with this, your therapist may ask you to keep a diary or write down your thoughts and behaviour patterns.
You and your therapist will analyse your thoughts, feelings and behaviours to work out if they're unrealistic or unhelpful and to determine the effect they have on you. Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.
How do I make progress?
After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:
- Questioning upsetting thoughts and replacing them with more helpful ones.
- Recognising when you're going to do something that will make you feel worse and to be able to do something more helpful instead.
At each session, you'll discuss with your therapist how you've got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.
Confronting fears and anxieties can be very difficult. Your therapist won't ask you to do things you don't want to do and will only work at a pace you're comfortable with.
Further reading and references
Computerised cognitive behaviour therapy for depression and anxiety; NICE Technology Appraisal Guidance, February 2006 (last updated May 2013)
Gartlehner G, Gaynes BN, Amick HR, et al; Comparative Benefits and Harms of Antidepressant, Psychological, Complementary, and Exercise Treatments for Major Depression: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016 Mar 1164(5):331-41. doi: 10.7326/M15-1813. Epub 2015 Dec 8.
Pompoli A, Furukawa TA, Imai H, et al; Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database Syst Rev. 2016 Apr 134:CD011004. doi: 10.1002/14651858.CD011004.pub2.
James AC, James G, Cowdrey FA, et al; Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2015 Feb 182:CD004690. doi: 10.1002/14651858.CD004690.pub4.
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