Cognitive Behavioural Therapy
Overview of Cognitive Behavioural Therapy (CBT)
For Newcomers to Therapy:
Cognitive Behavioural Therapy (CBT) is a type of talking therapy that helps people understand the connection between their thoughts, feelings, and behaviours. It is based on the idea that negative thought patterns can lead to distressing emotions and unhelpful behaviours. By changing these thought patterns or unhelpful behaviours, CBT aims to improve emotional well-being and encourage healthier behaviour.
CBT is structured and goal-oriented, typically involving weekly sessions with a therapist. During these sessions, you may learn to:
Identify Negative Thoughts or Worries: Recognise and understand the thoughts that contribute to your emotional distress.
Challenge and Reframe Thoughts: Change negative thoughts into more realistic and positive ones.
Behavioural Activation: Engage in activities that improve mood and reduce avoidance behaviours.
Essential Components of CBT:
Education: Learning about the CBT model and how thoughts, feelings, and behaviours interact.
In-between Session Work: Practicing new skills and techniques between sessions to reinforce learning.
Collaboration: Working closely with your therapist to set goals and track progress.
Research from the National Institute for Health and Care Excellence (NICE) supports the effectiveness of CBT for a variety of mental health conditions. For instance, NICE guidelines recommend CBT as a first-line treatment for depression and anxiety disorders.
For Those with Previous Experience of CBT:
People who have previously had CBT may seek further CBT for a number of reasons:
1. Depression and Anxiety Relapse:
Despite initial success, depression or anxiety symptoms can recur due to life stressors, significant changes, or unresolved underlying issues.
2. New Stressors or Life Changes:
Major life events such as loss, trauma, relationship issues, or job changes can trigger new or intensified symptoms.
3. Chronic Physical Health Conditions:
Existing health conditions such as Chronic Pain or Fibromyalgia, Irritable Bowel Syndrome (IBS), Chronic Obstructive Pulmonary Disease (COPD), Polycystic Ovary Syndrome (PCOS) and many other conditions may at times increase in severity or we may just find the symptoms harder to cope with.
New physical health conditions can be developed at any age and may stop us from being able to live the way we once did.
4. Forgetting helpful CBT strategies:
Over time, individuals may find that the skills and techniques learned in previous CBT sessions have been forgotten or they may have developed unhelpful habits.
5. Ineffective or Incomplete Previous Treatment:
Some issues may not have been addressed or fully resolved in the previous course of CBT or other Talking Therapy.
6. Personal Growth:
Individuals might seek further CBT to continue personal growth and development, aiming to enhance self-awareness, emotional regulation, and overall well-being.
7. Enhancing Coping Mechanisms:
To build on and improve existing coping mechanisms and strategies, individuals might return to refine and expand their skills.
Returning to CBT can be a proactive step towards maintaining and improving mental health and regaining control. Further CBT could help individuals become better equipped to handle both recurring and new challenges more effectively while also promoting personal growth and development. It can remind and reinforce previous insight gained about problems and CBT techniques. Returning to CBT can allow for deeper exploration and resolution of lingering problems or address unresolved difficulties.
Key Components and Interventions in CBT
Cognitive Interventions:
Cognitive Restructuring: Involves identifying and challenging distorted thoughts and beliefs and reframing them into more balanced and constructive ones. For example, changing the thought "I always fail" to "Sometimes I succeed, and sometimes I learn."
Thought Records: Keeping a diary to track negative thoughts, the context in which they occur, and the emotional response. This helps in recognising patterns and practising cognitive restructuring.
Behavioural Interventions:
Exposure Therapy: Gradually facing and overcoming fears in a controlled and safe manner, often used in treating phobias and anxiety disorders.
Behavioural Activation: Encouraging engagement in meaningful activities to combat depression and enhance mood.
Skills Training: Developing skills such as problem-solving, stress management, and social skills to improve overall functioning and coping strategies.
Research Supporting CBT
CBT has a strong evidence base. According to the National Institute for Health and Care Excellence (NICE) guidelines, CBT is recommended for the treatment of a wide range of common mental health difficulties, including:
Depression: NICE guidelines highlight that CBT is as effective as antidepressants for many individuals, particularly in cases of mild to moderate depression.
Anxiety Disorders: NICE recommends CBT for treating generalised anxiety disorder, social anxiety disorder, and panic disorder, citing its high efficacy.
PTSD: NICE supports the use of CBT as an effective treatment for PTSD, with strong evidence backing its ability to reduce symptoms.
A study published in the British Journal of Psychiatry found that CBT is effective in reducing symptoms of depression and anxiety and that these effects are often long-lasting (Cuijpers et al., 2016). Additionally, research published in The Lancet Psychiatry journal supports the use of CBT for treating various mental health conditions, noting its adaptability to different populations (Richards et al., 2016).
Average Number of CBT Sessions
The number of CBT sessions required can vary depending on the individual and the specific condition being treated. On average, a typical course of CBT consists of 12 to 20 sessions. For some conditions, such as mild to moderate depression or anxiety, people might see significant improvement within 6 to 12 sessions. More complex or severe conditions might require a longer course of therapy.
NICE guidelines suggest that for depression, a standard course of CBT can range from 16 to 20 sessions, while for anxiety disorders, treatment might range from 12 to 20 sessions. These sessions usually occur weekly or bi-weekly and involve active participation from the individual, including homework assignments and practical exercises.
For some individuals they may choose to have periodic or follow up CBT sessions as a way of helping to ensure that the learning and techniques from their CBT are remembered, are continued to be applied and to reduce chances of relapse.
Summary
CBT’s focus on both cognitive and behavioural change, along with its structured and evidence-based approach, makes it a powerful tool for improving mental health. Whether you are new to therapy or have some experience with CBT, working hard to understand and apply its essential components and specific interventions can help you make the most of this therapeutic approach.
With robust support from UK sources like NICE, CBT stands out as a recommended treatment for a variety of mental health conditions, underscoring its efficacy and adaptability. The average number of sessions required for CBT underscores its structured, short-term nature, making it an accessible and practical option for many individuals.