Cognitive behavioural therapy (CBT)

Your health experts: Bianca Clarke, Cognitive Behavioural Psychotherapist, Bupa
Content editor review by Rachael Mayfield-Blake, August 2023
Next review due August 2026

Cognitive behavioural therapy (CBT) is a type of talking therapy that can help to improve your mental health. It aims to change negative thoughts and beliefs that can affect how you feel and behave. You’ll learn skills in CBT that may help you for the rest of your life.

About cognitive behavioural therapy (CBT)

CBT is based on the idea that your thoughts and feelings, your physical symptoms, and your actions and behaviour are all linked. It aims to reduce the cycle of negative thoughts and behaviour. You’ll learn how to recognise negative patterns in how you think or behave and how to change them. This means you can cope with these situations better. CBT is a combination of:

cognitive therapy, where you look at unhelpful or negative patterns of thinking
behavioural therapy, which examines how you behave in response to those thoughts

There are different ways of having CBT. You can have sessions with a professional therapist on your own or in a group. This might be face-to-face or on a phone or video call. Or you can learn how to do CBT by yourself using self-help books or a computer programme (usually online).

Some mental health teams and GP surgeries offer access to interactive online CBT programmes.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
NHS Services has a list of where to get urgent help for mental health.
Mind website. Click the ‘Get help now’ button on the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Uses of cognitive behavioural therapy (CBT)

CBT has been recommended as an effective treatment for many mental health problems, including:

anxiety and panic disorders
depression
obsessive compulsive disorder (OCD)
body dysmorphic disorder
post-traumatic stress disorder
bipolar affective disorder
schizophrenia and psychosis
eating disorders

You may also be offered CBT to help with:

anger issues
sleep problems
sexual or relationship issues
drug and alcohol addiction

CBT can also help you to cope better with certain physical problems that might have a mental (psychological) element. Examples include chronic fatigue syndrome (myalgic encephalomyelitis or ME), fibromyalgia, irritable bowel syndrome, tinnitus and chronic pain.

Depending on what you’re having it for, you may have CBT on its own or alongside medicines.

What happens in cognitive behavioural therapy (CBT)?

If you’re having CBT with a therapist, you’ll have an initial assessment in your first session. Your therapist will ask you a few questions about your background and the problems you’re currently dealing with. CBT focuses on problems that you’re dealing with right now, but you might look at how past events affect your thoughts and beliefs.

You’ll agree with your therapist what you want to focus on over your treatment course. In each session, you may discuss any new problems, review any ‘homework’ tasks you agreed to do and discuss new techniques to try. CBT works best if you work on things between your sessions as well as during them. This will allow you to practise the cognitive behavioural therapy techniques you discuss in the sessions.

Your therapist will probably encourage you to give some uncomfortable things a go, but it’s always your choice whether you do this or not. For example, if you have a dog phobia, your therapist will encourage you to face your fear by gradually working your way up to stroking a dog or being in the same room as one. You can start with something that feels less challenging and work your way up. Your therapist will ask or encourage you to do these kind of things but they won’t force you to do anything you’re uncomfortable with.

How long you’ll have CBT depends on why you’re having it, but it’s designed to be a short-term therapy. You’ll usually have between five and 20 weekly or fortnightly sessions, and each session will last around an hour. Sometimes, you might start with six sessions and have a review to see how you’re getting on.

CBT is all about learning specific skills that you can continue to use throughout your life. You continue to practise what you learn after you finish the series of sessions. But if you start to have difficulties again, you can ask for more sessions.

Cognitive behavioural therapy (CBT) techniques

Here are some example CBT techniques your therapist may try with you. If you’re doing CBT via an online or computer programme, you’ll work through self-guided sessions on your own. Some sessions are guided.

Techniques to break down problems into how you think and feel, your physical feelings and your actions. You’ll start to see how these are connected and how they affect you.
Keeping a diary of when you feel distressed or anxious. You may include what triggers a feeling, together with your mood, thoughts, and any physical symptoms at the time. This can help you identify any unrealistic or unhelpful thoughts, feelings, or behaviour.
Challenging negative thoughts and beliefs. This includes identifying where these may be wrong, and where there may be more rational alternatives.
Relaxation techniques, such as breathing exercises, which you can put into practice when you’re feeling anxious.
Distraction techniques, to change your focus on a problem.
Behavioural experiments. This is when you work with your therapist to confront situations that make you distressed or anxious and learn how you respond to them.

CBT technique for unhelpful thoughts (animation)

Cognitive behavioural therapy (CBT) is a type of therapy that can help to improve your mental health. It aims to change negative thoughts and beliefs you may have, that can affect how you feel and behave.

Hundreds of automatic thoughts pop into our head every day. Sometimes these are negative and unhelpful. But thoughts are not facts, so it’s helpful to challenge our thinking. A ‘thought record’ is one CBT technique that can help you look at negative thoughts in a more balanced way.

This exercise works well if you have a notepad and pen to write down your answers.

Step 1. Think about the situation that’s upsetting you. What emotions and feelings do you have?

How intense are they? Rate the intensity from one to 10, with 10 being the most intense.

Step 2. What is the negative thought?

Try and be specific about the thoughts running through your mind and write them down. Perhaps something hasn’t gone as well as you’d have liked. Your thoughts start spiralling and you start to think that everything always goes wrong and maybe even that you’re a bad person.

Step 3. Now it’s time to put your thoughts on trial. Focus on the facts – is there any factual evidence that this thought is true?

Does everything always go wrong? Are you really a terrible person? Was what happened your responsibility entirely? Would you say the same things to someone you cared about who was in this situation?

Step 4. Now, what is the evidence that this thought is not true?

Can you think of a time when something you did went well? What about your friends and family and how much they care and value you? What are the good things in this situation?

Step 5. Weigh up the evidence. Is there an alternative thought? A more balanced and realistic way of looking at things?

Perhaps alternative thoughts could be: Things didn’t go as well as I’d liked, but that’s ok. Everyone makes mistakes sometimes. I am a good, kind person. I am human and doing the best I can.

Step 6. Check back in with yourself. How do you feel now? Rate the intensity again from one to 10.

Remember, the way that you think about a situation affects how you feel. Try this exercise next time automatic negative thoughts start to affect you.

If you are worried about your mental health, please see your GP for help and support.