Cognitive behavioural therapy (CBT): everything you need to know

Here’s how cognitive behavioural therapy may help support common mental health problems

Let’s talk about mental health therapy. Or specifically, talking therapies, psychological therapies delivered by fully trained and accredited practitioners that may be able to help with a range of common mental health problems, such as anxiety and depression. It may also be a useful therapy for other mental and physical health problems.

It’s recommended to speak to your GP first if you’re not sure whether CBT might be suitable for you. The type of therapy you may be offered or recommended depends on which one is suitable for your particular symptoms. One type that’s gained popularity in the past twodecades due to the research behind its benefits, is cognitive behavioural therapy, more widely known as CBT.

Based on the concept that your thoughts, feelings, physical sensations and actions are all connected, CBT may be recommended on its own or in addition to other therapies, as part of a holistic approach, depending on the type and severity of symptoms. At its core, it can help provide practical ways to support your mental health on a day-to-day basis.

Interested to learn more and how it may help support mental health? From what it is to its potential benefits, how to access it and what a CBT session is like, we speak to an expert to find out everything you need to know.

If you’re experiencing a mental health crisis or are at risk of harming yourself or others, please call the YourMentalHealth Information Line on 1800 111 888. Alternatively, speak to the Samaritans any time, day or night, on 116 123, text HELLO to 50808, or speak to your GP.

What is CBT?

As Dr Panagiotis Karagiannis, registered counselling psychologist and clinical director at SupportRoom, explains that CBT is an “evidence-based method of therapy for individuals [which] has been proven to be effective in treating many difficulties that individuals face like depression and anxiety”.

According to the charity Mind, CBT combines two approaches of therapy: cognitive (relating to our thoughts) and behavioural (relating to our actions), meaning how we think about situations can affect the way we feel and behave. For example, if you interpret a situation negatively, you might experience negative emotions. And those bad feelings might lead you to behave in a certain way.

This combined approach is intended to make meaningful changes in how a patient conducts their lives. “[CBT] helps individuals by helping them decrease negative cognitions (thoughts) and beliefs about oneself and switch them with new positive ones,” explains Karagiannis.

“Additionally, it helps people change their behaviour and habits step by step, through managing distressing emotions and engaging with activities that cultivate positive emotions.”

Rather than putting the focus purely on the individual or therapist to bring about change, this approach creates “a collaborative relationship between them both”, says Dr Karagiannis.

Dr Karagiannis also suggests that length and duration of treatment is important. “Usually, CBT works in a time-limited manner, within a safe, confidential collaborative relationship that the client and the therapist form,” he says.

The HSE recommends 10 to 20 sessions, but sometimes sessions may continue over a longer period of time, “depending on the individual”, says Dr Karagiannis. Sessions may take place in a range of settings, including in a clinic, in your own home (if you have fears based in the home, or a fear of leaving the house, known as agoraphobia), or outside (again, if you have specific fears that are associated with being outside).

Who may benefit from CBT?

According to Dr Karagiannis, CBT has been shown to be an effective way of treating anxiety and depression, and may also be helpful in the treatment of:

• Post-traumatic stress disorder (PTSD)

• Bipolar disorder

• Eating disorders

• Obesity

• Psychosis and schizophrenia

• Substance abuse

• Behavioural addictions (for example, gambling)

• Self-esteem issues

• Work-related stress

However, he stresses this list is “not exhaustive” and CBT may also be useful in treating other conditions. For example, CBT has been used in treatment for long-term health conditions including irritable bowel syndrome (IBS), fibromyalgia and chronic fatigue syndrome (CFS). Although CBT cannot cure the physical symptoms of these conditions, it can help people cope better with their symptoms.

How does CBT differ from other talking therapies?

CBT differs from other forms of talking therapy, because it aims to empower you to tackle specific and current problems in your life, through practical day-to-day interventions, rather than focussing on issues from your past.

How can I access CBT?

CBT is available via the HSE. You can either refer yourself directly for talking therapy (which includes CBT) through its dedicated website or you can request a referral from your GP.

For those looking for ways to deal with worries, solve problems and boost their mental wellbeing, they can access self-help CBT techniques via HSE Every Mind Matters.

Finally, CBT is offered through some private practices and health insurance schemes.

How long does a CBT session last?

The timing of a CBT session can vary, says Dr Karagiannis. While some sessions might last an hour, they can be as short as 20 minutes. In a typical treatment course of between 10 and 20 sessions, sessions can last between 30 and 60 minutes.

What is a CBT session like? 

There are several different formats a session can take, including guided self-help and group settings, together with traditional one-to-ones. According to the NHS, during a session you’ll be encouraged by your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions, to work out whether they are unrealistic or unhelpful and to determine the effect they have on you.

Together with your therapist, you might also come up with changes that can help you work out how to change unhelpful thoughts and behaviours. While these changes vary, some examples include exposure therapy – a CBT technique where you purposely expose yourself to anxiety sources (eg certain items or scenarios) in a structured way.

According to Dr Karagiannis, some CBT therapists may integrate related approaches, such as cognitive behavioural hypnotherapy (traditional CBT conducted under hypnosis) or CBT that integrates positive psychology techniques, like expressing gratitude.

Successive sessions might involve a progress check-in around how you’ve applied these strategies to your life between sessions. It may be also recommended to complete some homework, such as filling in worksheets or keeping a journal, according to Mind.

What are the pros & cons of CBT?

According to Dr Karagiannis, the pros of CBT are:

• It can be delivered in a time-bound manner

• It’s highly structured, so can be provided in different formats, such as in groups and online

• It can be as effective as medicine in treating some mental health problems and may be helpful in cases where medicine alone has not worked

• It can help treat a broad scope of conditions

• One of its goals is for patients to eventually “become their own therapist” – empowering them to change themselves

• It teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished

Some cons might include:

• As a collaborative process between therapist and client, it requires patients to “commit to the process,” which may not be suitable for everyone with mental health conditions

• It involves a time commitment, both in sessions and in extra work

• Like most therapies, it does not address socio-economic influences that can affect someone’s health and wellbeing

• Finally, some might argue that situation-based CBT does not tackle root causes of trauma, ie, from a patient’s past

The takeaway

To sum up, for those with anxiety and depression, CBT may offer the helping hand you’re looking for. Conditions of this nature can be managed by your GP but CBT can still play a role as part of a holistic approach, depending on the symptoms.

CBT has proven its effectiveness in clinical trials over the past two decades. It’s a practice that’s become increasingly accessible and can help provide people with practical ways to improve their sense of wellbeing on a daily basis.