What is cognitive behavioural therapy?

What is cognitive behavioural therapy (CBT)?

Everybody has unpleasant feelings and problems from time to time. You may have difficulties with school, friends, family or something else. This is quite normal.

However, sometimes people can feel ‘stuck’ with these feelings and problems. The problem can seem to keep getting worse, and it can seem difficult to find a way out. In that case, a therapy called cognitive behavioural therapy (CBT) may be helpful.

Cognitive behavioural therapy is all about understanding the links between your thoughts, feelings and actions, and how these can form a cycle. It helps you to better understand your problems, and how you can develop strategies to break negative cycles.

Cognitive

The ‘cognitive’ part means our thoughts, images and interpretations of events. Talking about your thoughts can help you to understand the way you feel, and the way you act.

Behavioural

The behavioural part refers to our behaviours and actions. It means how we act, and how we do things.

Therapy

Therapy is a process that is used to help someone to understand their thoughts and behaviours and make changes to these. A therapist is somebody who provides therapy.

How does cognitive behavioural therapy (CBT) CAMHS work?

At your first appointment, you will come to CAMHS and spend around an hour talking with your CBT Therapist. The therapist will ask you about the things that are important to you, and about any difficulties going on that stop you from doing what you would like to be doing. Sometimes you may not even feel like doing anything, or like nothing is much fun anymore, which may be part of the problem.

You will get the opportunity to help the therapist understand what is going on in your life and what the problem is. The therapist will explain a little bit about whether CBT may be helpful for you, and if so, how this could help.

The first appointment may happen either in person, or over video call. If your first appointment is in person, your parent may be able to stay for part of the appointment. Sometimes for CBT sessions, it may be better for your parent or carer to wait in the waiting room, or you may prefer them not to be in the room. If this is the case, we will create time to catch up with them together, however, this is your choice.

From the next session onwards, you will start each session by setting a plan or agenda of things to talk about together.

Early on in CBT, you will work together with your therapist to create a good understanding of your problem and draw it out in a cycle or picture.

Phobia cycle

For example, if a person’s problem was that they were afraid of spiders, their drawing of the cycle of the problem might look like this.

1. Trigger: see a spider
2. Thoughts and feelings: I need to get away from the spider, it is not safe to be near the spider. Feel panic and anxiety
3. Physical feelings: feel sick, sweaty, dizzy, breathless and heart racing
4. Behaviours: run away from the spider, kill the spider or get someone to remove the spider
5. Thoughts and feelings: feel calmer, it is better now the spider has gone. I should avoid spiders
6. Physical feelings: unpleasant feelings go away, and feeling back to normal
7. Behaviours: adopting safety behaviours such as avoiding spiders, situations where spiders or spider webs might be. Looking out for spiders

You now falsely feel that your avoidance and safety behaviours have kept you safe, so you continue doing them. You have not learned that these behaviours are unnecessary and that you can handle being close to spiders and you can safely remove spiders from your home and so you might limit your life and miss out on things that you would enjoy and you remain stuck in the phobic cycle.

While this cycle shows how the young person keeps themselves safe from spiders, spiders can be anywhere, and so they quickly find themselves scared of going everywhere. This means that they are stuck as a result of this problem, which is really difficult.

What can I do about my phobia cycle?

You therapist and you will discuss ways in which this cycle can be broken. That may include ‘challenging’ the thoughts, or sometimes it includes doing something differently. CBT has lots of different techniques to help people do this, so your therapist can guide you to finding the right techniques for you.

As you come towards the end of your CBT therapy, you will also make a plan to keep the progress going after you end therapy. This means that you will be able to use what you have learnt in CBT whenever you need it.

The problem may not be completely gone at the time that you finish CBT, but we hope that the strategies you learn as part of CBT will help you to feel less stuck, and that you will use the techniques you have learned to help you to feel happier and more able to cope.

Frequently asked questions about CBT

How long does CBT take?

Most children and young people who have CBT will have between 8 and 20 sessions. Sessions are normally either every week or every 2 weeks.

How does CBT help?

Everyone has their own individual problems, and CBT helps you to understand the links between your thoughts, feelings and actions, and how these can form a cycle, and to come up with strategies to help with this.

You and your therapist will agree on some goals which you would like to work on based on your own problems and experiences.

Does my parent or carer have to be in the room during sessions?

It can be really helpful to involve family members in your therapy, but it is your choice whether they are in the room during sessions.

Is CBT the same thing as counselling?

CBT is not the same as counselling. Both are types of talking therapy, however, CBT has a particular format and structure, as laid out within this resource.

How do CBT sessions start?

Each session will start with you and the therapist deciding what things you would like to discuss, and talking about the techniques that will be introduced or practised in that session.

What will I do in my sessions?

You and your therapist will work through exercises to explore your thoughts, feelings and behaviours. You and your therapist will agree on exercises to be done at home before the next session.