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.

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Uses of cognitive behavioural therapy (CBT)

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

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.

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How to find a cognitive behavioural therapist

There are different ways to access CBT.

CBT is freely available on the NHS, although services can be limited and waiting lists long in some areas. Your GP will be able to tell you what mental health services are available in your area, and refer you for assessment if appropriate. In many areas, you can also self-refer yourself for NHS talking therapy, without going through your GP. This is through an NHS service called NHS Talking Therapies (formerly known as Improving Access to Psychological Therapies (IAPT). You can also access CBT privately, which means you’ll need to pay for appointments.

If you’re looking for a private therapist, it’s important to ensure that your therapist is trained and qualified to deliver CBT. Many different healthcare professionals are trained in CBT. These include clinical psychologists, psychiatrists, counsellors, mental health nurses, and social workers. Check that they’re registered by a reputable body, like the British Association for Behavioural and Cognitive Psychotherapies (BABCP) or the British Association for Counselling and Psychotherapy. If you have private health insurance, contact your insurance provider to see what you may be covered for.

Considerations for cognitive behavioural therapy (CBT)

CBT is something you need to actively participate in. If you’re having sessions with a therapist, the idea is to work together, rather than the therapist telling you what to do. Some people can find it quite challenging. You must feel ready to actively change your thoughts and behaviour to get the most from CBT. You’ll also need to commit to practising the exercises. CBT isn’t a quick fix and it takes time to work at it.

If you’re not getting on with your CBT course, talk to your therapist, your GP or the organisation that provides the therapy. You might be able to try a different therapist or a different type of treatment that might work better for you.

The strongest evidence for CBT is in the treatment of depression, anxiety, and eating disorders, especially bulimia and binge eating disorder. CBT is as helpful as taking medicines for mild-to-moderate depression.

If you have severe depression, CBT can be used as a standalone treatment or you can take it with medicines for depression.

For more information, see our section on uses of cognitive behavioural therapy (CBT).

Yes, children and teenagers can have CBT to treat mental health conditions such as anxiety, depression, and obsessive–compulsive disorder (OCD). They can have CBT alone or in groups. If you’re a parent of a child having CBT, you may be asked to join in sessions too. You can access mental health support and treatments through your GP or local Child and Adolescent Mental Health Services (CAMHS) team. And there are organisations that offer specific support for children’s and teenagers’ mental wellbeing.

An accredited CBT therapist will treat your sessions as completely confidential. What you discuss in your CBT sessions won’t be discussed with anyone else unless you give your therapist specific permission to do so. The only other exception to confidentiality is if your therapist is concerned that you or someone you’re in contact with is at risk of harm. They’ll explain this before you start treatment.

Yes, you can do CBT using online programmes or self-help books. There are also free-to-access websites that provide information on CBT techniques. CBT does work better with support from a therapist though, particularly if you have a low mood. If you do decide to try an online programme, some are approved for use in the NHS – ask your GP for information if you’re unsure.

For more information, see our section: About cognitive behavioural therapy (CBT).

The key concepts of CBT are that your thoughts and feelings, your physical symptoms, and your actions and behaviour are all linked. CBT aims to reduce the cycle of negative thoughts and behaviour. CBT is a combination of cognitive therapy, where you look at unhelpful or negative patterns of thinking and behavioural therapy. Behavioural therapy examines how you behave in response to those thoughts.

For more information, see our section: About cognitive behavioural therapy (CBT).

Yes, CBT can be used to treat attention deficit hyperactivity disorder (ADHD), particularly if medicines have helped but you’re still having problems in some areas. For example, you may struggle socialising with people or have difficulty with self-control. Or you may find it difficult to deal with and express feelings. The best way to get the most from treatment is to combine it with other talking therapies. CBT can also be combined with ADHD medicines to get better results.

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