Cognitive Behavioural Therapy (CBT) FAQ
Most people know within the first few sessions if they are comfortable with CBT and whether it is meeting their treatment needs. The therapist will also check to see that CBT is the right “fit” for you. When the fit is not quite right, the therapist may adjust the treatment or suggest other treatment options. However, in general, CBT may be a good therapy option for you if:
- You are interested in learning practical skills to manage your present, day-to- day life and associated emotional difficulties
- You are willing and interested in practicing change strategies (“homework”) between sessions to consolidate improvement.
CBT may not be for you if you want to focus exclusively on past issues, if you want supportive counselling, or if you are not willing to do homework between sessions.
At your first visit, you and the CBT therapist will discuss:
- The nature and causes of your difficulties and factors that are maintaining them
- How the therapist will apply the CBT model to your specific problems
- How the tasks that you do in therapy can change different aspects of the problems
- Whether CBT is a suitable treatment approach for you
By the end of this first visit, you and the therapist will have developed a goal-oriented treatment plan to address your difficulties.
CBT is a treatment approach that teaches you skills to become your own therapist over time. You learn new skills in the therapy sessions, but ultimately much of the change occurs between therapy sessions when practising the skills in your own environment as part of homework. Early in treatment, the CBT therapist will suggest homework, such as monitoring thoughts and behaviours, taking steps to reduce avoidance behaviour, conducting experiments to test out predictions and completing worksheets to challenge negative thoughts or beliefs. As treatment progresses, you will learn to set your own homework between sessions to help you accomplish your treatment goals. Research demonstrates that the more you successfully practise the skills of CBT in your homework, the better the treatment outcome.
CBT is a time-limited, focused treatment approach. For problems such as anxiety and depression, CBT usually involves 12 to 20 sessions. However, the length of treatment can vary, depending on the severity and complexity of your problems—some clients improve significantly in four to six sessions, while others may need more than 20 sessions.
CBT usually starts out with weekly sessions. As treatment progresses, sessions may be spaced further apart, such as every two weeks or month. Once clients have finished a course of CBT, it is common for them to return for occasional “booster” sessions to keep up their progress, deal with any setbacks and prevent relapse of problems. Some programs are typically pre-set (e.g., a group meeting weekly at the same time for 12 weeks).
Preparing to discuss a specific problem at each session helps you to get the most out of CBT. Coming prepared helps to keep you focused on your goals for therapy. It also helps to build a therapeutic relationship between you and your therapist and to communicate well throughout the session.
Research on CBT demonstrates that it is an effective treatment regardless of gender, race, ethnicity, culture, sexual orientation or social economic status. CBT therapists are trained to recognize the importance of cultural values and to adapt their treatments to meet culturally unique needs. They are trained, for example, to:
- Be aware of their own personal values and biases and how these may influence their relationship with the client.
- Use skills and intervention strategies that are culturally appropriate for the client being seen.
- Be aware of how certain cultural processes may influence the relationship between the therapist and client.
As a client in CBT you should feel that you can openly discuss, aspects of your culture or work for example, and that your treatment will be delivered in a manner that is consistent with these values.
CBT has been adapted for use with children and has been shown in research to be an effective intervention for a variety of clinical problems that can emerge in childhood, including anxiety and depression. The content and pacing of the therapy is adjusted to be appropriate for the child’s level of development. Often, the CBT therapist will work with the parent and child — the younger the child, the more involved the parent will be in learning and delivering CBT strategies for their child’s problem.
Barriers to treatment can include:
- Perceived stigma associated with mental health treatment
- Difficulty identifying and distinguishing emotions and their intensity
- Difficulty in reflecting on thoughts
- Difficulty tolerating heightened emotions
- Not completing homework
- Low optimism toward improving
- Avoidance
The therapist will work with you to reduce these barriers and will also offer strategies that you can use to overcome barriers.
A major goal of CBT is for you to become your own therapist and to continue to practise CBT skills even after you are feeling better. You may also wish to return for follow-up or “booster” sessions from time to time.
A key component of CBT treatment is teaching relapse prevention strategies. This includes helping you learn to identify the triggers and early signs of relapse and to develop an action plan to prevent downward spirals of negative emotions.
