cognitive behaviour therapy

Cognitive behavioural therapy (CBT) is a collaborative and solution-focused therapeutic approach. It helps individuals confront unhelpful ways of thinking and acting, with the aim of making their lives happier and more fulfilling through the development of beneficial thinking patterns and behaviours. CBT is a "brief therapy", usually requiring five-20 sessions, depending on the client's needs. The therapist works actively and collaboratively with the individual, to identify patterns of thoughts and behaviours that may be maintaining the problem. Then, through a logical and experimental process, clients develop the skills and techniques needed to remodel their way of dealing with life. Clients are encouraged to become their own therapists, so that they can successfully tackle difficult situations in the future.

CBT is a broad and continuously developing movement. It grew out of two schools of psychology: behaviourism and cognitive therapy. These were developed in the 1950s and 1960s, partly as understanding of brain functioning grew and partly as a reaction to psychoanalysis. The two schools focused primarily on what the individual experiences, believes, feels and does in the present. Westbrook, Kennerly and Kirk (2007) describe how modern CBT has successfully combined these theoretical and practical principles:

• The cognitive principle:
It is the interpretation of events, rather than the events themselves, that affects us.
• The behavioural principle:
Our actions powerfully affect our thoughts and feelings.
• The continuum principle:
Psychological problems can happen to anyone, they are an exaggeration of normal processes.
• The here-and-now principle:
Emphasising a focus on current problems, rather than past events, is usually more productive.
• The interacting systems principle:
Problems may be seen as interactions between thoughts, emotions, behaviour, physiology and the environment.
• The empirical principle:
The scientific evaluation of theories and treatments is very important.

CBT has become one of the most advocated forms of psychological therapy, largely due to its success and supporting experimental evidence. It is promoted by the NHS and health experts as being the most effective and efficient form of therapy available. It is recommended by the National Institute for Clinical Excellence (NICE) in its guidelines for the treatment of a wide range of psychological problems.

It continues to evolve and conduct research into the effectiveness of its methods. Interesting developments include the integration of mindfulness - a form of relatively simple meditation that has been defined as "paying attention in a particular way: on purpose, in the present moment and non-judgementally" (Kabat-Zinn, 1994, p4) - in treatments for depression, stress, personality disorder and chronic pain.

CBT is not a miracle cure, nor is it a passive treatment. It relies on good collaboration between client and therapist. Successful treatment is the reward for clients who can give honest feedback about the therapy sessions, who can identify how they feel, think and behave in different situations and who are willing to embrace change and try out new ways of thinking and behaving. Research evidence shows that such involvement, together with the completion of mutually-agreed therapeutic tasks outside the sessions, are good predictors of success. It is highly effective in teaching skills to manage all forms of anxiety, including OCD.