Cogn|t|ve 8ehav|oura| 1herapy

A|ms
1hls leafleL ls for anyone who wanLs Lo know more abouL CognlLlve 8ehavloural 1herapy (C81)



lL dlscusses how lL works why lL ls used lLs effecLs lLs sldeeffecLs and alLernaLlve LreaLmenLs
lf you canL flnd whaL you wanL here Lhere are sources of furLher lnformaLlon aL Lhe end of Lhls
leafleL
What |s C81?
It |s a way of ta|k|ng about
O how you Lhlnk abouL yourself Lhe world and oLher people
O how whaL you do affecLs your LhoughLs and feellngs

C81 can help you Lo change how you Lhlnk (CognlLlve) and whaL you do (8ehavlor) 1hese
changes can help you Lo feel beLLer unllke some of Lhe oLher Lalklng LreaLmenLs lL focuses on
Lhe here and now problems and dlfflculLles lnsLead of focuslng on Lhe causes of your dlsLress
or sympLoms ln Lhe pasL lL looks for ways Lo lmprove your sLaLe of mlnd now
When does C81 he|p?
C81 has been shown Lo help wlLh many dlfferenL Lypes of problems 1hese lnclude anxleLy
depresslon panlc phoblas (lncludlng agoraphobla and soclal phobla) sLress bullmla obsesslve
compulslve dlsorder posLLraumaLlc sLress dlsorder blpolar dlsorder and psychosls C81 may
also help lf you have dlfflculLles wlLh anger a low oplnlon of yourself or physlcal healLh
problems llke paln or faLlgue
now does |t work?
C81 can help you Lo make sense of overwhelmlng problems by breaklng Lhem down lnLo
smaller parLs 1hls makes lL easler Lo see how Lhey are connecLed and how Lhey affecL you
1hese parLs are

O A |tuat|on a problem evenL or dlfflculL slLuaLlon
lrom Lhls can follow
O 1houghts
O mot|ons
O 9hys|ca| fee||ngs
O Act|ons
Lach of Lhese areas can affecL Lhe oLhers Pow you Lhlnk abouL a problem can affecL how you
feel physlcally and emoLlonally lL can also alLer whaL you do abouL lL 1here are helpful and
unhelpful ways of reacLlng Lo mosL slLuaLlons dependlng on how you Lhlnk abouL Lhem

Ior examp|e

|tuat|on
ouve had a bad day fee| fed up so go out shopp|ng As you
wa|k down the road someone you know wa|ks by and
apparent|y |gnores you
Unhe|pfu| ne|pfu|
1houghts
Pe/she lgnored me Lhey donL
llke me
Pe/she looks a blL wrapped up ln
Lhemselves l wonder lf Lheres
someLhlng wrong?

mot|ona|
Iee||ngs
Low sad and re[ecLed Concerned for Lhe oLher person
9hys|ca|
SLomach cramps low energy
feel slck
none feel comforLable

Act|on Co home and avold Lhem
CeL ln Louch Lo make sure
Lheyre Ck


1he same slLuaLlon has led Lo Lwo very dlfferenL resulLs dependlng on how you LhoughL abouL
Lhe slLuaLlon Pow you th|nk has affecLed how you fe|t and whaL you d|d ln Lhe example ln Lhe
lefL hand column youve [umped Lo a concluslon wlLhouL very much evldence for lL and Lhls
maLLers because lLs led Lo

O a number of uncomforLable feellngs
O an unhelpful behavlor

lf you go home feellng depressed youll probably brood on whaL has happened and feel worse
lf you geL ln Louch wlLh Lhe oLher person Lheres a good chance youll feel beLLer abouL
yourself lf you donL you wonL have Lhe chance Lo correcL any mlsundersLandlngs abouL whaL
Lhey Lhlnk of you and you wlll probably feel worse 1hls ls a slmpllfled way of looklng aL whaL
happens 1he whole sequence and parLs of lL can also feedback llke Lhls


1hls vlclous clrcle can make you feel worse lL can even creaLe new slLuaLlons LhaL make you
feel worse ?ou can sLarL Lo belleve qulLe unreallsLlc (and unpleasanL) Lhlngs abouL yourself
1hls happens because when we are dlsLressed we are more llkely Lo [ump Lo concluslons and
Lo lnLerpreL Lhlngs ln exLreme and unhelpful ways

C81 can help you Lo break Lhls vlclous clrcle of alLered Lhlnklng feellngs and behavlour When
you see Lhe parLs of Lhe sequence clearly you can change Lhem and so change Lhe way you
feel C81 alms Lo geL you Lo a polnL where you can do lL yourself and work ouL your own ways
of Lackllng Lhese problems

I|ve areas assessment
1hls ls anoLher way of connecLlng all Lhe 3 areas menLloned above lL bullds on our relaLlonshlps
wlLh oLher people and helps us Lo see how Lhese can make us feel beLLer or worse CLher lssues
such as debL [ob and houslng dlfflculLles are also lmporLanL lf you lmprove one area you are
llkely Lo lmprove oLher parLs of your llfe as well S areas d|agram
What does C81 |nvo|ve?
1he sess|ons
C81 can be done lndlvldually or wlLh a group of people lL can also be done from a selfhelp
book or compuLer programme ln Lngland and Wales Lwo compuLerbased programmes have
been approved for use by Lhe nPS Iear I|ghter ls for people wlLh phoblas or panlc
aLLacks 8eat|ng the 8|ues ls for people wlLh mlld Lo moderaLe depresslon

lf you have lndlvldual Lherapy
O ?ou wlll usually meeL wlLh a LheraplsL for beLween 3 and 20 weekly or forLnlghLly
sesslons Lach sesslon wlll lasL beLween 30 and 60 mlnuLes
O ln Lhe flrsL 24 sesslons Lhe LheraplsL wlll check LhaL you can use Lhls sorL of LreaLmenL
and you wlll check LhaL you feel comforLable wlLh lL
O 1he LheraplsL wlll also ask you quesLlons abouL your pasL llfe and background AlLhough
C81 concenLraLes on Lhe here and now aL Llmes you may need Lo Lalk abouL Lhe pasL Lo
undersLand how lL ls affecLlng you now
O ?ou declde whaL you wanL Lo deal wlLh ln Lhe shorL medlum and long Lerm
O ?ou and Lhe LheraplsL wlll usually sLarL by agreelng on whaL Lo dlscuss LhaL day

1he work
O WlLh Lhe LheraplsL you break each problem down lnLo lLs separaLe parLs as ln Lhe
example above 1o help Lhls process your LheraplsL may ask you Lo keep a dlary 1hls
wlll help you Lo ldenLlfy your lndlvldual paLLerns of LhoughLs emoLlons bodlly feellngs
and acLlons
O 1ogeLher you wlll look aL your LhoughLs feellngs and behavlours Lo work ouL
4 lf Lhey are unreallsLlc or unhelpful
4 how Lhey affecL each oLher and you
O 1he LheraplsL wlll Lhen help you Lo work ouL how Lo change unhelpful LhoughLs and
behavlours
O lLs easy Lo Lalk abouL dolng someLhlng much harder Lo acLually do lL So afLer you have
ldenLlfled whaL you can change your LheraplsL wlll recommend homework you
pracLlce Lhese changes ln your everyday llfe uependlng on Lhe slLuaLlon you mlghL sLarL
Lo
O quesLlon a selfcrlLlcal or upseLLlng LhoughL and replace lL wlLh a more helpful (and
more reallsLlc) one LhaL you have developed ln C81
O recognlze LhaL you are abouL Lo do someLhlng LhaL wlll make you feel worse and
lnsLead do someLhlng more helpful
O AL each meeLlng you dlscuss how youve goL on slnce Lhe lasL sesslon ?our LheraplsL can
help wlLh suggesLlons lf any of Lhe Lasks seem Loo hard or donL seem Lo be helplng
O 1hey wlll noL ask you Lo do Lhlngs you donL wanL Lo do you declde Lhe pace of Lhe
LreaLmenL and whaL you wlll and wonL Lry 1he sLrengLh of C81 ls LhaL you can conLlnue
Lo pracLlce and develop your skllls even afLer Lhe sesslons have flnlshed 1hls makes lL
less llkely LhaL your sympLoms or problems wlll reLurn
now effect|ve |s C81?
O lL ls one of Lhe mosL effecLlve LreaLmenLs for condlLlons where anx|ety or depress|on ls
Lhe maln problem
O lL ls Lhe mosL effecLlve psychologlcal LreaLmenL for moderaLe and severe depresslon
O lL ls as effecLlve as anLldepressanLs for many Lypes of depresslon
What other treatments are there and how do they compare?
C81 ls used ln many condlLlons so lL lsnL posslble Lo llsL Lhem all ln Lhls leafleL We wlll look aL
alLernaLlves Lo Lhe mosL common problems anxleLy and depresslon
O C81 lsnL for everyone and anoLher Lype of Lalklng LreaLmenL may work beLLer for you
O C81 ls as effecLlve as ant|depressants for many forms of depresslon lL may be sllghLly
more effecLlve Lhan anLldepressanLs ln LreaLlng anxleLy
O lor severe depresslon C81 should be used wlLh anLldepressanL medlcaLlon When you
are very low you may flnd lL hard Lo change Lhe way you Lhlnk unLll Lhe anLldepressanLs
have sLarLed Lo make you feel beLLer
O 1ranqullllzers should noL be used as a long Lerm LreaLmenL for anxleLy C81 ls a beLLer
opLlon
9rob|ems w|th C81
O C81 ls noL a qulck flx A LheraplsL ls llke a personal Lralner LhaL advlses and encourages
buL cannoL do lL for you
O lf you are feellng low lL can be dlfflculL Lo concenLraLe and geL moLlvaLed
O 1o overcome anxleLy you need Lo confronL lL 1hls may lead you Lo feel more anxlous
for a shorL Llme
O A good LheraplsL wlll pace your sesslons ?ou declde whaL you do LogeLher so you sLay
ln conLrol
now |ong w||| the treatment |ast?
A course may be from 6 weeks Lo 6 monLhs lL wlll depend on Lhe Lype of problem and how lL ls
worklng for you 1he avallablllLy of C81 varles beLween dlfferenL areas and Lhere may be a
walLlng llsL for LreaLmenL
What |f the symptoms come back?
1here ls always a rlsk LhaL Lhe anxleLy or depresslon wlll reLurn lf Lhey do your C81 skllls should
make lL easler for you Lo conLrol Lhem So lL ls lmporLanL Lo keep pracLlclng your C81 skllls
even afLer you are feellng beLLer 1here ls some research LhaL suggesLs C81 may be beLLer Lhan
anLldepressanLs aL prevenLlng depresslon comlng back lf necessary you can have a refresher
course

o what |mpact wou|d C81 have on my ||fe?
uepresslon and anxleLy are unpleasanL 1hey can serlously affecL your ablllLy Lo work and en[oy
llfe C81 can help you Lo conLrol Lhe sympLoms lL ls unllkely Lo have a negaLlve effecL on your
llfe aparL from Lhe Llme you need Lo glve up Lo do lL
now can I get C81?
O Speak Lo your C 1hey may refer you Lo someone Lralned ln C81 for example a
psychologlsL nurse soclal worker or psychlaLrlsL
O 1he 8rlLlsh AssoclaLlon for 8ehavloural and CognlLlve sychoLheraples keeps a reglsLer
of accredlLed LheraplsLs
O ?ou can Lry selfhelp uslng a book lnLerneL programme or compuLerlsed C81 1hls ls
more llkely Lo work lf you also recelve supporL from a professlonal
What w||| happen |f I dont have C81?
?ou could dlscuss alLernaLlves wlLh your docLor ?ou could also
O ead more abouL Lhe LreaLmenL and lLs alLernaLlves
O lf you wanL Lo Lry before you buy geL hold of a selfhelp book or Cuom and see lf lL
makes sense Lo you
O WalL Lo see lf you geL beLLer anyway you can always ask for C81 laLer lf you change
your mlnd

CnANG VIW 10 key facts about C81

Change your LhoughLs and
acLlons
nomework pracLlce makes
perfecL
AcLlon donL [usL Lalk do!
Need plnpolnL Lhe problem
Goals move Lowards Lhem
vldence shows C81 can work
Vlew evenLs from anoLher
angle
I can do lL selfhelp approach
xperlence LesL ouL your
bellefs
WrlLe lL down Lo remember
progress