Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is a form of talking therapy commonly used to help people with anxiety, depression and other mental health issues.

The aim of CBT is to change the way someone thinks and the way they behave. It focuses on the connection between thoughts, feelings and behaviours. The idea is to develop coping strategies to help break negative patterns.  

Unlike some other forms of psychotherapy, CBT works to address someone’s current problems, rather than focusing on issues from their past or other factors that may have led to their negative thoughts, feelings, and behaviours. 

CBT is delivered individually, in group settings, or people may undertake self-guided therapy through a computer programme, application or book. Sometimes it is delivered as a short-term therapy with as few as 5-6 sessions. Other times it is delivered over a longer period. 

CBT usually involves the expectation of work between sessions, such as keeping a diary or completing a worksheet. 

Find out more about other types of therapy and psychotherapeutic philosophies. 

Availability  

For someone seeking mental health support through the NHS, CBT is by far the most likely treatment that they will be offered. The most common entry point to NHS talking therapy services in England is the Improving Access to Psychological Therapies (IAPT) programme and CBT accounts for between 60-70% of the therapy delivered through IAPT.  

CBT is also widely available in NHS services in Scotland, Wales and Northern Ireland though there is more variation between individual services due to a less centralised model of provision than in England. In NHS secondary care, where service users typically have more complex needs, CBT is also widely used, though there tends to be greater variation in the types of intervention people receive in this context. 

While the IAPT programme was designed to provide a range of evidence-based therapies for people experiencing common mental health problems, in many parts of the country it can be very difficult or impossible to access a therapy other than CBT through IAPT. This can create difficulties for people for whom CBT may not be the most effective form of therapy. 

The evidence 

There is considerable evidence to demonstrate the efficacy of CBT for people with depression, anxiety and other common mental health issues.  

In wider healthcare, the evidence that is typically considered the highest quality is gathered through ‘randomised-controlled trials’. There is some disagreement among psychotherapy researchers about whether it is appropriate to assess talking therapies in the same way as drug treatments – not least because it is not possible to provide ‘placebo therapy’.  

CBT – which is considered a ‘manualised’ therapy, meaning the model is easily replicable in trial conditions – has been shown to be effective through these trials, which has contributed to its prevalence within NHS mental health services. 

However, there is considerable evidence to suggest that other forms of therapy are at least as effective as CBT in clinical settings.  

Many psychotherapy researchers believe that the best way to improve outcomes from therapy is to match service users with the right type of therapy for them. For one person this might be CBT. For another it might be psychodynamic therapy or family and systemic therapy. Another person may benefit from couples therapy or person centred therapy. 

While CBT is a very effective intervention for many people in many situations, it is not a one-size-fits-all solution.