How does it work

Cognitive behavioural therapy (CBT) can help you make sense of overwhelming problems by breaking them down into smaller parts.

In CBT, problems are broken down into five main areas:

• situations
• thoughts
• emotions
• physical feelings
• actions

CBT is based on theconcept of these five areas being interconnected and affecting each other. For example, your thoughts about acertain situation can often affect how you feel both physically and emotionally, as well as how you act in response.

How CBT is different

CBT differs from many other Psychotherapy because it's:

• pragmatic it helps identify specific problems and tries to solve them
• highly structured rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
• focused on current problems it's mainly concerned with how you think and act now rather than attempting to resolve past issues
• collaborative your therapist won't tell you what to do; they'll work with you to find solutions to your current difficulties

Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.

For example, if your marriage has ended in divorce, you mightthink you've failed and that you're not capable of having another meaningful relationship.

This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.

Butrather than accepting this way of thinkingyou could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.

This optimism couldresult inyou becoming more socially active and you maystart evening classes and developa new circle of friends.

This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycleand even create new situations that make you feel worse about yourself.

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help youchange your negative thought patterns and improve the way you feel.

CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.

Exposure therapy

Exposure therapy is a form of CBTparticularly useful for people with phobias or obsessive compulsive disorder (OCD) .

In such cases, talking about the situation isn't as helpful and you may need to learn to face your fears in a methodical and structured way through exposure therapy.

Exposure therapy involves starting with items and situations thatcause anxiety, but anxiety that you feel able to tolerate. You need to stay in this situation for one to two hours or until the anxiety reduces for a prolonged period by a half.

Your therapist will ask you to repeat this exposure exercise threetimes a day. After the first few times, you'll find your anxiety doesn't climb as high and doesn't last as long.

You'll then be ready to moveto a more difficult situation. This process should be continued until you have tackled all the items and situations you want to conquer.

Exposure therapy may involve spendingsix to 15 hours with the therapist, or can be carried outusing self-help books or computer programs. You'll need to regularly practice the exercises as prescribed to overcome your problems.

CBT sessions

CBT can be carried out with a therapist inone-to-one sessions or in groups with other people in a similar situation to you.

If you have CBT on an individual basis, you'll usually meet with a CBT therapist for betweenfive and 20 weekly or fortnightly sessions, with each session lasting 30-60 minutes.

Exposure therapy sessions usually last longer to ensure your anxiety reduces duringthe session. The therapy may take place:

• in a clinic
• outside if you have specific fears there
• in your own home particularly if you have agoraphobia or OCD involving a specific fear of items at home

Your CBT therapist can be any healthcare professional who has been specially trained in CBT, such as a psychiatrist, psychologist, mental health nurse or GP.

First sessions

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.

If you're anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They'll also ask about events that may be related to your problems, treatments you've had, and what you would like to achieve through therapy.

If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it's not appropriate, or you don't feel comfortable with it, they can recommend alternative treatments.

Further sessions

After the initial assessment period, you'll start working with your therapist tobreak down problems into their separate parts. To help with this, your therapist may ask youto keep a diary orwrite down your thought and behaviour patterns.

You and your therapist willanalyse your thoughts, feelings and behaviours to work out if they're unrealistic or unhelpful and to determine theeffect they have oneach other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours.

After working out what you can change, your therapist willask you topractise 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 instead doing something more helpful

You may be asked to do some "homework" between sessions to help with this process.

At each session, you'll discuss with your therapist how you've got on withputting the changes into practice and what it felt like. Your therapist will be able tomake other suggestions tohelp you.

Confronting fears and anxieties can be very difficult. Your therapist won't ask you to do things you don't want to do andwill only work at a pace you're comfortable with. During your sessions, your therapist willcheck you're comfortable with the progress you're making.

One of the biggestbenefits of CBT is that after your course has finished, you can continue to apply the principles learnedto your daily life. This should make it less likelythat your symptoms willreturn.

Computerised CBT

A number of interactive software programs are now available that allow you to benefit from CBT with minimal or no contact with a therapist.

Themain programcurrently approved for use by the NHS is Beating the Blues , which isapproved for treating mild to moderate depression .

However, there are many similar computerised CBT (CCBT) packages that may also be effective.

Some people prefer using a computer rather than talking to a therapist about their private feelings. However,you may still benefit from occasional meetings or phone calls with a therapist to guide you and monitor your progress.

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