Cognitive behavioural thearapy (CBT)

Explains what cognitive behavioural therapy (CBT) is, what it is for, what happens during therapy and how to find a therapist.

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What should I expect from a CBT session?

This page covers:

How is CBT delivered?

CBT is usually a short-term treatment, so you wouldn't be expected to continue with the treatment for a long time. For example, a course of CBT might be delivered in 12 hour-long weekly sessions, spread across 12 weeks. In some areas, you may be offered four sessions initially, with the opportunity for more if you need them. These sessions might be delivered:

Individually – one to one with a therapist (either face-to-face, over the phone or over a video call).
In a group – with other people who may have similar problems.
Through a self-help book – you might be asked to complete exercises from a book by yourself.
Through a computer (usually online) – you may be offered computerised CBT.

CBT should only be delivered by a trained healthcare professional. Refresher CBT programmes may be available if you have already completed a course of CBT (your GP may know more about options in your area).

Computerised CBT

Some research suggests that computerised CBT could be helpful for some people, although it's not yet known how well it works.

There are some online CBT programmes available, for example Beating the Blues for depression. If you want to use a programme like Beating the Blues for free, you will need a referral from your GP or other service-provider. Some online CBT programmes include phone or email contact with a therapist assigned to you.

It can be difficult to decide whether an online programme is right for you. It's best to try and use one that has been recommended by your GP or another professional. If you're finding it hard to stick to or complete a computerised CBT course, talk to your GP about other options.

How are sessions structured?

A typical structure of a CBT session may include the following:

At the beginning of the therapy, you and your therapist may explore the problems you want to work on.
When you have agreed which problems you want to focus on and what your goals are, you may start planning the content of sessions and talking about how you could deal with your problems.
During the session, you might work through exercises with your therapist to explore your thoughts, feelings and behaviours. This may be in the form of diagrams or worksheets.
With CBT you are often given work to do in your own time, so the end of each session you might agree on some exercises to work on afterwards.
At the beginning of your next session your therapist might start by going over the conclusions from your previous session, and discussing what progress you've made with any work you agreed to do.

"My therapist gives me goals that I must achieve before the next session. They are challenging, yet achievable."

What might I learn?

CBT teaches coping skills for dealing with different problems. You may learn ways of coping with different situations, thoughts, feelings and behaviours. For example:

If you feel anxious: you may learn that avoiding situations could actually increase fears. Confronting fears in a gradual and manageable way can give you faith in your own ability to cope.
If you feel depressed: you may be encouraged to record your thoughts and explore how you can look at them differently. This may help to break the downward spiral of your mood.
If you experience sleep problems: you may learn to recognise the thoughts which make falling to sleep more difficult and learn to challenge these.
If you have long-standing problems relating to other people: you may learn to check out your assumptions about other people's motivation for doing things, rather than often assuming the worst.

"It can be daunting when faced with a list of things you can't do, but CBT helped me to break up my goals into manageable chunks."

What's the therapeutic relationship like?

One to one CBT can bring you into a kind of relationship you may not have had before.

CBT favours an equal, non-judgemental relationship between you and your therapist. They should seek your views and reactions to your experiences, which then shape the way your therapy progresses. The collaborative style means that you are actively involved in the therapy.

This therapeutic relationship may help you feel able to open up and talk about things that are difficult or personal to you.

"I was encouraged to try [CBT] again with a different therapist and have just had my 3rd session. I like the therapist and am getting on much better.....the therapist makes a BIG difference!"

Can I do CBT by myself?

It is possible to do CBT by yourself, through a self-help book or online. You may find that it's helpful to try while you are waiting for further treatment – or to remind yourself of some of the techniques.

But research suggests that CBT is usually more effective if you're working with a therapist. And some specific kinds of CBT treatments aren't suitable to try on your own (for example exposure and response prevention for OCD) – in this case getting support from a therapist is really important.

Talk to your healthcare professional about whether it might help to do some CBT by yourself while you are waiting.