Cognitive behavioural therapy (CBT)
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.
What is 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.
What can cognitive behavioural therapy (CBT) be used for?
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 symptoms, stress or poor sleep linked to certain physical problems.
Examples include:
- chronic fatigue syndrome (myalgic encephalomyelitis or ME)
- fibromyalgia
- irritable bowel syndrome
- tinnitus
- 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, and your therapist will:
- ask you questions about how you feel
- discuss any past issues that may be relevant
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 taks you agreed to do
- 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 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.
How long you’ll have CBT depends on why you’re having it, but it’s designed to be a short-term therapy.
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.
- Learning how 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.
Cognitive behavioural therapy
Watch in 2 minutes 46 seconds
Do you ever beat yourself up with negative thoughts? Try our ‘thought record’ animation, which teaches you how to look at unhelpful thoughts in a more balanced way
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.
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 may be 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.
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The strongest evidence for CBT is in the treatment of depression, anxiety, and eating disorders, especially bulimia and binge eating disorder. CBT can be 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 can 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. CBT can also be combined with ADHD medicines to get better results.
Talking therapies for mental health
Bupa's mental health experts have created this information to explain more about the different types of talking therapies for mental health.
Anxiety
It’s normal to feel anxious sometimes. But if your anxiety is severe, it can interfere with your everyday life.
Depression
Read our guide for information about the symptoms, treatment and causes of depression.
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