Cognitive Behavioural Therapy: How it works

CBT is currently recognised by the National Institute of Clinical Excellence (a government body responsible for deciding which treatment should be available on the NHS) as the most effective treatment for the a range of emotional problems including:

* Depression
* Low Self Esteem
* Anxiety
* Panic Attacks
* Eating Disorders
* Obsessive Compulsive Disorders
* Post Traumatic Stress Disorder
* Somatic Problems (e.g chronic pain, chronic fatigue)

It can also be helpful in resolving relationship problems, sleep disturbance, general life dissatisfaction & change. Results of CBT have been shown to be faster and more long lasting than many other types of treatment. It is suitable for both adults and children.

The underlying goal of Cognitive Behavioural Therapy (CBT) is to help you to become your own therapist. It aims to teach you practical and psychological skills that will enable you to choose healthier ways of coping with life, ways that won’t undermine your health and happiness in the way that your current ways of coping may. CBT can enable you to move forward in the way that you choose but only if you are an active and keen participant in the process. This is why CBT is often referred to as a ‘practical’ therapy because it is teaching you a particular skill that you then have responsibility for implementing. The following analogy illustrates well the process of CBT.

The River Analogy
When people are struggling with a problem (e.g. anxiety, depression, eating disorder) it is as if they are being swept along by a fast flowing river. All their energy is being expended on keeping afloat; clinging on to floating debris, treading water etc. All of these activities will probably keep them alive (at least in the short term) but they are at the mercy of the river, its current and its course. They are swept along with little or no say in the direction that they go. People often imagine that treatment is like a powerful speed boat that pulls you from the water to safety. However, although this would mean that you would be out of the water, you would still have no say in where you were going, you would still not be able to make the choices and decisions that suited you. The control would have shifted but not in to your hands.

What CBT aims to do is to help you to swim to the edge of the river and climb onto the bank. From this vantage point a more complete range of options becomes visible, options that were hard to see when you were struggling to survive the river. For example you may decide to build a raft, hire a speedboat or buy some wellington boot and paddle in the shallow waters. Or you may decide to jump back into the river and continue as before, but you will be doing so with a full awareness of the other options that are available to you. By teaching you the skills (practical and psychological) to solve your problem, CBT will enable you to reach a greater understanding of your problem and the other options that are available to you. It will help you take a step back from your problem and become your own therapist, standing on the bank of the river determining the course your life takes.

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Written by Dr Emma Gray DClinPsych, BA (Hons) Consultant Clinical Psychologist

I am a Consultant Clinical Psychologist available for face to face appointments in Richmond and East Dulwich as well as Telephone and Online Counselling Sessions. Should you wish to book online with myself or any of my colleagues then please go to for a Live Online Diary.
I work with adults, children, families and couples and use a rangeof… Read more

Written by Dr Emma Gray DClinPsych, BA (Hons) Consultant Clinical Psychologist

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