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North Wales Child and Adolescent Mental Health Service

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Cognitive Behavioural Therapy (CBT)


What is CBT?


CBT is a way of talking about:



CBT can help you to change how you think (Cognitive) and what you do (Behaviour). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the ‘here and now’ problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.


It has been found to be helpful in:



How does it work?


CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:


   From this can follow:


Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it.


An example


There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them:




















The same situation has led to two very different results, depending on how you thought about the situation. How you think has affected how you felt and what you did.


In the example in the left hand column, you've jumped to a conclusion without very much evidence for it - and this matters, because it's led to:



If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself. If you don't, you won't have the chance to correct any misunderstandings about what they think of you - and you will probably feel worse.


This is a simplified way of looking at what happens. The whole sequence, and parts of it, can also feedback like this:


Situation




Thoughts





Actions                      Feelings


This ‘vicious circle’ can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.


CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them  - and change the way you feel. CBT aims to get you to a point where you can ‘do it yourself’, and work out your own ways of tackling these problems.


‘Five areas’ Assessment


This is another way of connecting all the 5 areas mentioned above. It builds in our relationships with other people and helps us to see how these can make us feel better or worse. Other issues such as debt, job and housing difficulties are also important. If you improve one area, you are likely to improve other parts of your life as well.


What does CBT involve?


The sessions


CBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme. In England and Wales two computer-based programmes have been approved for use by the NHS. Fear Fighter is for people with phobias or panic attacks, Beating the Blues is for people with mild to moderate depression.


If you have individual therapy:



The work


With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.


Together you will look at your thoughts, feelings and behaviours to work out:



The therapist will then help you to work out how to change unhelpful thoughts and behaviours .


It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend ‘homework’ - you practice these changes in your everyday life. Depending on the situation, you might start to question a self-critical or upsetting thought and replace it with a positive (and more realistic) one that you have developed in CBT recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.


At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping.


They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.


How effective is CBT?



What other treatments are there and how do they compare?


CBT is used in many conditions, so it isn't possible to list them all. We will look at alternatives to the most common problems - anxiety and depression.



Problems with CBT



How long will the treatment last?


A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment.


What if the symptoms come back?


There is always a risk that the anxiety or depression will return. If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practising your CBT skills, even after you are feeling better.


There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a ‘refresher’ course.


So what impact would CBT have on my life?


Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.


What will happen if I don't have CBT?


You could discuss alternatives with your doctor. You could also:


Situation

You’ve had a bad day, feel fed up, so go out shopping.  As you walk down the road, someone you know walks by and, apparently, ignores you.


Unhelpful

Helpful

Thoughts

He/she ignored me - they don’t like me

He/she looks a bit wrapped up in themselves - I wonder if there’s something wrong?

Emotional Feelings

Low, sad and rejected

Concerned for the other person

Physical

Stomach cramps, low energy, feel sick

None - feel comfortable

Action

Go home and avoid them

Get in touch to make sure they’re ok