Cognitive behavioural therapy – usually just known as CBT – is the talking therapy your doctor’s likely to refer you to for anxiety and stress. But what exactly is it and why is it so helpful?
What exactly is CBT?
Cognitive behavioural therapy (CBT) has been around since the 1970s, and if a doctor refers you for talking treatment, this is what it’s likely to be. If you haven’t already had it yourself, the chances are you know someone who has. Banish thoughts of lying on a couch while a therapist probes you about your childhood, or talking to a counsellor who reflects back what you say – CBT is very different.
While the more traditional forms of psychotherapy – like psychodynamic therapy - are largely based on looking into your childhood, exploring the origins of fear and trauma, and counselling is often about being ‘heard’ unconditionally, CBT is more active and focused on the present. A therapist will help you look at your thoughts and how they affect your feelings and behaviour. They will then work with you to find ways to challenge these thoughts. Over time, you start to think differently and the thoughts will have less impact. CBT is considered the gold-standard treatment for anxiety.
What does a CBT session involve?
It varies depending on the therapist and your issues, but as a general rule, the therapist will show you ways to identify anxious or stressful thoughts and begin to separate yourself from these, and to question them. They may start by asking you to talk about some of the things that are bothering you. They will then help you start to challenge your beliefs, often encouraging you to look at evidence for and against these.
For example, if you have health anxiety and are convinced you have a brain tumour, evidence that doesn’t support this belief may include the fact that you’ve been to the doctor and they aren’t concerned. There is usually also some evidence that may support your belief – with this example, you may consider that you have occasional headaches and without a scan, can’t be 100 per cent sure you don’t have a tumour. But your therapist will encourage you to view these thoughts in a different way. For example, even though you may not be able to be completely certain you don’t have a brain tumour, you can tell yourself headaches are much more likely to have another cause and if they carry on or get worse, you’ll go back to the doctor to try to get to the bottom of it. CBT is about getting a more balanced view, not giving you solid reassurance - this isn’t usually possible, and it’s important to break the reassurance-seeking cycle in anxiety disorders.
Your therapist may encourage you to notice how you feel emotionally and physically once you’ve weighed up the evidence, and compare it to how you felt before doing that. You might notice your muscles are less tense, for example. CBT can also involve gradually exposing yourself to the source of your anxiety. And it’s often combined with mindfulness – bringing close attention to the here and now, rather than letting worries take over. You may learn mindfulness of breathing meditation exercises as part of your therapy.
How long does it take to help?
It can start to work relatively quickly – on the NHS, you’re likely to have a short course of around six sessions, and that can be enough to make a difference. CBT’s effectiveness does depend partly on the skills of your therapist – and also partly on you. You’ll usually have ‘homework’ between your sessions, and after your course of therapy has finished, which may involve keeping a notebook in which you continually monitor and challenge anxious thoughts, and practising mindfulness exercises. It’s all about getting into different mental habits, and over time, you’ll notice the intensity of your anxious thoughts reduces. One of the real positives about CBT is that once you’ve learned the skills, you can go back to them whenever you need them in the future.
How can I access CBT?
Your doctor is the first port of call, although there can be quite a long wait for CBT on the NHS. If you want to access CBT privately, you can find a therapist at www.babcp.com There are also CBT books recommended by the NHS, which allow you to work through exercises to help ease anxiety and stress. These can be really helpful if you have less severe issues. Even if you’re more seriously affected, they can be a good starting point.