What is cognitive behaviour therapy (CBT)?

Cognitive behaviour therapy (CBT) is a type of psychotherapy.

CBT is based on the idea that your thoughts affect your actions and how you feel. By understanding and checking the way you think, you can better manage things that you find difficult.

CBT can help with many different things — including mental and physical health problems.

How does CBT work?

In CBT, you work with a therapist to recognise the patterns of thinking (cognition) and behaviour that cause you problems. It teaches you practical ways to learn more helpful and healthy habits, and challenge and break unhealthy habits.

CBT is individualised — this means that your CBT will be specific to you and your needs. CBT focuses on solving current problems you may be dealing with.

CBT has been around for many years. It's the basis of other therapies such as:

• acceptance and commitment therapy (ACT)
• mindfulness-based cognitive therapy
• schema therapy
• dialectical behaviour therapy (DBT)

What can CBT help with?

If you are experiencing something difficult that is impacting your life, CBT might be able to help. CBT can help children, teenagers and adults with emotional, psychological and psychiatric concerns.

CBT can help if you find yourself thinking in unhelpful ways about yourself or a certain situation. This might include:

• catastrophising — viewing something as worse than it is, or assuming the worst possible outcome
• personalisation — blaming yourself for everything
• overgeneralising — for example, saying you always make mistakes after making only one mistake

CBT is helpful for managing depression as well as anxiety, including:

• generalised anxiety disorder
• panic disorder
• social anxiety disorder
• health anxiety (hypochondria)
• phobias
• obsessive compulsive disorder

CBT has also been shown to help people with other mental illnesses, such as:

• post-traumatic stress disorder
• bipolar disorder
• eating disorders
• substance abuse
• problem gambling

CBT can help with other challenges in life, like dealing with relationship issues, anger and stress.

CBT can also help people with physical problems, such as:

• chronic pain
• fibromyalgia
• migraines
• insomnia

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

Who can provide CBT?

Different mental health professionals may provide CBT, including:

• psychologists and psychiatrists
• some doctors with training in mental health
• mental health nurses
• some counsellors

Your doctor can refer you to a mental health professional for CBT. Your doctor can also work with you to develop a mental health treatment plan if needed. This can help you access Medicare rebates for CBT.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Where can I access CBT?

CBT can be conducted in private or group sessions. It can be done in-person or remotely. Remote CBT can be done through:

• telehealth
• an online course
• online (e-therapy)

There are several online CBT programs (some free) that you can access including moodgym and SMART Recovery. Your doctor can also refer you programs like these.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

What can I expect from CBT?

CBT can be structured and usually has a set end point. It usually involves a session lasting one hour, once a week or fortnight. This depends on what you and your clinician need.

Over your first 1 or 2 CBT sessions, your therapist will take time to:

• get to know you
• learn about your past experiences
• learn about the things you are struggling with
• explain what CBT is
• discuss what you can expect from CBT

Your therapist will work with you to understand what you want out of treatment. Setting goals is a big part of CBT. Your goals will guide your treatment and help to monitor your progress.

CBT is an active therapy. This means that you will take part in your treatment, in partnership with your therapist. They will teach you skills to help you challenge and change unhelpful thoughts and behaviours. The skills you learn can also be applied to future problems.

You may be asked to practice the skills you learn or do other homework tasks between your sessions.

CBT can be used at the same time as other things, such as medicines and counselling.

What will happen in my CBT sessions?

After your first appointments, your sessions will often follow a structure:

• You and your therapist will focus on a situation you find difficult and discuss it.
• Together, you can then work out what your thoughts are about the situation, and how you behave in response.
• You will then work to identify which thoughts or behaviours are unhelpful or inaccurate.
• Your therapist will then use different strategies and provide you with different skills that may help you change your thoughts and behaviours.

There are many different strategies that your therapist may use in CBT. The 2 main focusses are cognitive therapy and behavioural therapy.

Cognitive therapy

Cognitive therapy focusses on changing unhelpful thoughts into helpful beliefs.

The main tool used in cognitive therapy is called cognitive restructuring. This is when you challenge your unhelpful thoughts and core beliefs. These might include a belief that you need to be perfect, or that you are not good enough.

First, you must identify the unhelpful thought or belief. Then, you can challenge it by asking yourself questions, like:

• “Is that helpful?”
• “Is that true?”
• “So what?”

Your therapist can guide you through this.

Behavioral therapy

Behavioural therapy focusses on changing unhelpful behaviours. There are different techniques your therapist may use to help you change behaviour. These include:

• relaxation techniques
• activity scheduling
• exposure therapy
• behaviour exercises

Activity scheduling is when you regularly make time for helpful or enjoyable activities during the day. This can help you to practice helpful behaviour and improve your mental health.

Exposure therapy is when you take small steps to interact with things or situations you may find difficult. Eventually, exposure therapy can help you to interact with these things without fear.

Your therapist may suggest behaviour exercises to challenge unhealthy behaviours. For example, you may believe that your work colleagues don't like you. So, you might not talk to them. A behaviour exercise could involve talking to 1 or 2 people at work. You may find you get along with a colleague or have similar interests. This can help you realise that your original belief isn't true, and help you change your behaviour.

When doesn't CBT work?

CBT may be difficult for people with learning difficulties and for those with complex mental health problems. A skilled clinician can adapt the therapy to suit everyone.

CBT focusses on current issues. It helps you understand and explore the underlying reasons for unhelpful thought patterns. However, it's focus is on improving your current wellbeing. Your therapist can discuss options with you if you have past experiences or trauma that you need help with.

Your involvement in CBT is important. You may need to do tasks in between sessions. Sometimes, these can encourage you to step out of your comfort zone. But you can talk with your therapist about what you are comfortable with. If you don't like the sound of CBT, your therapist can use other strategies and talk with you about your options.

How long does CBT take to work?

Your CBT program could be anywhere between 12 and 20 weeks. This depends on your situation and the treatment program you and your therapist agree on.

You can talk to your therapist about how long they think you will need to see them.

Resources and support

Your doctor can help if you have any questions about CBT. If you are finding it difficult to raise the topic with your doctor, try some tips for talking to your doctor about mental health.

If you are looking for a therapist, search for health services in your area. The Australian Psychological Society lists registered psychologists in Australia.

You can visit ReachOut for more information about CBT and other types of therapy. They provide online mental health services for young people and their parents.

If you want general mental health support and information, you can visit:

• MindSpot (anyone suffering from anxiety or depression) — call 1800 61 44 34.
• Beyond Blue (anyone feeling depressed or anxious) — call 1300 22 4636 or chat online.
• Black Dog Institute (people affected by depression and extreme mood swings) — online help.
• Lifeline (anyone experiencing a crisis or thinking about suicide) — call 13 11 14 or chat online.
• Suicide Call Back Service (anyone affected by suicide) — call 1300 659 467.
• Headspace — mental health information, group chat and online communities for young people.
• SANE Australia (mental health information, peer support and counselling support) — call the support line on 1800 187 263.
• MensLine Australia (telephone and online counselling service) — call 1300 78 99 78.
• This Way Up clinic (anyone with stress, anxiety and depression) — online courses.

For advice and to get connected to local mental health services, call Head to Health on 1800 595 212. Check the operating times.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.