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

Posted byLauren Geall


Published 04 Mar 2020

What is CBT? 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.

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.

“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.

“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.

“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.

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.

Main Image: Erin Aniker

Images: Getty

‘I was half-insane with anxiety’: how I wrote myself into a breakdown

After exhausting himself with work, author Benjamin Myers was sent over a literal edge and into the River Derwent. He recalls his recovery and hunt for a cure Benjamin Myers Fri 3 Jan 2020 07.00 GMT

The Guardian

Last summer, in the midst of promotional chaos surrounding my new novel The Offing, I cancelled my own London book launch and instead drove to the Chatsworth estate in Derbyshire, a place I had never previously visited, and jumped in the river right in front of the very big house. It was not entirely an act of self-destruction or a plea for help. (No one knew I was there, the river was only five feet deep and I’m no Virginia Woolf.) It simply seemed like a more obvious thing to do than trying to persuade members of the public to buy my book, and an act more broadly in keeping with the spirit of the novel in question and my writing life in general.

Out in the middle of the bracing River Derwent, with one foot hovering over a deeper, much darker, metaphorical void, I reached beneath the first rock I came to and pulled out a large crayfish. I held the creature aloft, as if it were a totem or trophy. Lobster features significantly in The Offing and here was its freshwater cousin, so it must mean something, I thought. Something Very Important.

Facing the fact that such crustaceans have crawled the Earth for at least 100m years, my own ruminations, paranoia and worries suddenly seemed tragically over-thought. For a few moments, that tenacious crayfish brought me back into being and told me that everything was going to be all right. It intimated all this with its probing, beady eyes.

Relating this, I now realise I was perhaps driven half-insane with anxiety, and it was largely my own doing. Writing had put me there in the river, talking to a crustacean while elderly couples in North Face jackets looked on, instead of attempting to charm a smattering of London readers. Even in my drinking days, I never chatted to crayfish. There were puking jags, migraines and aching muscles. Food lost its flavour and noises became amplified

As the decade draws to a close and I tot up my published work – seven novels, one work of non-fiction, three short poetry collections – only now do I see why exhaustion triggered a tsunami of anxiety that hit so powerfully that I was laid up for several weeks, incapable of doing little but watch period dramas as I lay foetal on the sofa. What I can’t tell you about EM Forster adaptations really isn’t worth knowing.

Shit, as they say, had got real, in a very pathetic, very English way.

Numerous reports suggest we are currently in the midst of an anxiety epidemic, but it is often only evident when it is upon you, and mind and body switch into energy-saving mode. For me, anxiety goes way back. All those years reading Camus, Sartre and Hamsun and still I had failed to see the signs stacking up over the previous months: the rising sense of panic, the narcolepsy-like bouts of sleep at inopportune moments, the way my digestive system went into revolt. There were puking jags, migraines and aching muscles. Food lost its flavour and noises became amplified, so much so that I became fixated on a neighbour’s cockerel that crowed every morning from 3.55am, and which I wanted to strangle. Even the chimes of the local church bells sounded malevolent, as if mocking my shortcomings. Anxiety feels like you’ve had your skin removed.

Every day I was reading articles about mental health awareness – I think I even wrote some – while ignoring my own. I’d seen some friends get sectioned and others struggling, but I thought I was fine. I had a version of myself to sell to the world: that of the fully functioning human being. My GP when I saw him looked worse than I felt – “I’ve not had a holiday in eight months,” he wearily confided through a yawn – and I spent much of my allotted 12 minutes listening to his plight, finally diagnosing him as suffering from exhaustion.

I did what I could. I got out of bed to appear on BBC Radio 4 and then went straight back to it. I did photoshoots in my back garden, as that was as far as I could travel. I dined on rather a lot of tranquilisers before another appearance. I listened to the same two songs for the entire summer (Truth Hurts by Lizzo and Jogging by Richard Dawson). And so it went. To anyone who encountered me during this period I probably appeared fine, but I felt drunk all the time, even though these days I’m teetotal. Other authors sent nice messages secretly relating similar experiences and thankfully I have a wonderfully understanding agent and publicist who were looking out for me. Doing nothing is harder than you think. It involves saying no and suspending any sense of guilt at doing so

Courses of counselling mean I now understand the origins of my anxiety, but not how to banish it. I’m not entirely convinced it is possible to rid oneself of anxiety, just as we can’t rid ourselves of joy, excitement or desire, though swimming, meditation, yoga, long walks, CBT, massages, CBD oil, acupuncture and a 13-album box-set by Gong all help at different times. In the end, I’ve learned the only real cures are time spent with my wife and dog, and doing nothing.

Doing nothing is harder than you think. It involves saying no and suspending any sense of guilt at doing so. It involves feeling (though not necessarily being) selfish. It also means missing out on opportunities. Of course, all work is hard, and writing remains the best job in the world, even though it’s not technically a job, because most jobs – at least, until recently – offered sick pay, pensions, workers’ rights and some degree of stability. But the perks are many, chief among them the freedom to be selfish.

Underlying my summer meltdown was something more prosaic: wisdom-tooth problems and endless infections mere inches from my brain, yet every time I got given a surgery date it clashed with promotional opportunities. For my publicist, getting me to do things was no doubt like pulling teeth, yet getting a tooth pulled was all I wanted. The NHS treatment was wonderful, but the surgery was rough: some of my jawbone was removed and I was given fentanyl, a drug 100 times stronger than morphine. I eased into autumn with a swollen head, and nicely off my nut.

It’s at this point in such articles that we might conclude with a brief anecdote to illustrate redemption and a self-congratulatory payoff about how wonderful life is now the author has discovered spin classes and celery juice. This is not one of those pieces. I do feel better, for now. I’m still swimming, I’m writing a new novel. And I’m still aware that anxiety sits beneath everything, like bedrock. It’s a part of me, and especially insidious in the mornings. I think perhaps it’s a part of most of us as we enter the third decade of an utterly traumatic century. It’s wild out there in the world. All we can do is look out for each other and recognise the signs. And stay in bed now and again.

• The Offing by Benjamin Myers is published by Bloomsbury Circus.