What to Expect
CBT differs from many other psychotherapies because it's:
pragmatic – it helps identify specific problems and tries to solve them
highly structured – rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
focused on current problems – it's mainly concerned with how you think and act now rather than attempting to resolve past issues
collaborative – your therapist will not tell you what to do; they'll work with you to find solutions to your current difficulties
If you have CBT on an individual basis, you'll usually meet with a CBT therapist for between 5 and 20 weekly or fortnightly sessions, with each session lasting 30 to 60 minutes.
Exposure therapy sessions usually last longer to ensure your anxiety reduces during the session. The therapy may take place:
in a clinic
outside – if you have specific fears there
in your own home – particularly if you have agoraphobia or OCD involving a specific fear of items at home
The first few sessions will be spent making sure CBT is the right therapy for you, and that you're comfortable with the process. The therapist will ask questions about your life and background.
If you're anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They'll also ask about events that may be related to your problems, treatments you've had, and what you would like to achieve through therapy.
If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it's not appropriate, or you do not feel comfortable with it, they can recommend alternative treatments.
After the initial assessment period, you'll start working with your therapist to break down problems into their separate parts. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.
You and your therapist will analyse your thoughts, feelings and behaviours to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:
questioning upsetting thoughts and replacing them with more helpful ones
recognising when you're going to do something that will make you feel worse and instead doing something more helpful
You may be asked to do some "homework" between sessions to help with this process.
At each session, you'll discuss with your therapist how you've got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.
Confronting fears and anxieties can be very difficult. Your therapist will not ask you to do things you do not want to do and will only work at a pace you're comfortable with. During your sessions, your therapist will check you're comfortable with the progress you're making.
One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return.
A number of interactive online tools are now available that allow you to benefit from CBT with minimal or no contact with a therapist.
Some people prefer using a computer rather than talking to a therapist about their private feelings and for those with busy home and work lives it can be more convenient than having to travel for appointments.