Name: Cognitive behavioral therapy
Creator: Dr Karen Martin
Published: 2023-02-22T17:53:30.503Z

Your doctor will discuss with you your current symptoms and past medical and mental health history and talk you through what CBT involves. The doctor will keep an eye on how you are doing and whether the CBT is helping; this may be via set questions that can be used to monitor your progress over time. 

What will the doctor do?

You may be fit for work if you are going through CBT treatment, depending on the severity of the mental illness and how it is affecting your day-to-day functioning. Your doctor can help you decide this.

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CBT is commonly used to help with depression and anxiety, but it can also be used to help with many other mental health conditions. It can help with a wide range of problems that have a psychological component to them, such as some sleep problems, irritable bowel syndrome (IBS), chronic pain, anger issues, and sexual dysfunction.

What can CBT help with?

You should speak to your doctor if you feel CBT could help you with your current symptoms. After discussing your medical history, they can refer you if they feel that CBT is right for you.

It can be challenging to determine if you are getting better as you're going through CBT. Your doctor is a good person to be able to help give you some feedback and will sometimes use objective scoring systems or benchmarks to assess your progress. Some simple things to look for may be improvements in symptoms. Day-to-day tasks may be easier, or easier more often than they were before.

When should I see my doctor?

Chronic pain is one of the toughest conditions to live with – either it’s unrelenting and making it impossible to get normal activities done, or it can come and go unpredictably, forcing you to cancel work or social plans. 

There are no clear figures as to how common chronic pain is but it may affect as many as one in three people. It's defined as persistent or episodic pain lasting more than three months and is a complex problem that isn’t just a simple physical one because it affects our mental health as well. As our nervous system adjusts to chronic pain, sensations become heightened and more widespread, and this complexity comes from our brain processing function, where pain can start to prevent everyday activities and dominate normal life. Our world becomes smaller and with less to distract us - and living in fear of pain - our pain sensation becomes even more heightened and worse. 

Chronic pain is more likely to come about from the slow pain fibers, which are loudly telling you that there’s injury: you should rest and recover by not moving much. This is opposed to the fast pain fibers that let you know your toe has been stubbed and makes you move away from the external threat (with much hopping and howling). But resting for months on end is not likely to serve any useful purpose, and often sets up new problems, both mentally and physically. 

We also now know there are two forms of chronic pain called primary chronic pain and secondary chronic pain. Chronic primary pain may affect around 1-6% of the population, and refers to the pain felt in conditions such as fibromyalgia, complex regional pain and chronic primary headache. Chronic secondary pain is more common and refers to pain from conditions such as low back pain, joint pain and shingles pain. 

Depression is the most common mental health condition with about 5-10% of adults experiencing it every year. It can be mild and last a relatively short time but about 25% of women and 10% of men have an episode of depression at some point in their lives that’s severe enough to need treatment. **The average length of an episode of clinical depression is 6-8 months.** It is a medical condition that can be serious, but most cases improve over time, and treatments such as lifestyle changes and talking therapies can help. It's very important to seek help early if you notice any persistent symptoms of depression.

Although depression affects people in different ways, the core symptoms are of persistently low mood or sadness, and a significant lack of enjoyment or interest in anything, even in activities you normally enjoy. It’s a marked difference from how you were before and you may also find it difficult to concentrate and focus. You may feel excessively tired, sluggish and lack motivation, and you may find it hard to start tasks or complete them. Your sleep may also change, such as sleeping in the daytime, finding it hard to get to sleep or to sleep through the night, and waking early in the morning. You may lose your appetite or begin over-eating. People with depression often describe feeling worthless or hopeless, and they often avoid seeing other people.

**Depression can be categorized as mild, moderate or severe** depending on the number of symptoms and how severely they are affecting you.

Everyone can feel a bit sad from time to time, if you are going through difficult times such as losing a loved one or a divorce, but this doesn’t necessarily mean you have depression. This can be a normal and appropriate response, and your coping strategies will help you get back on your feet.

This becomes more concerning if you’re feeling down for more than a few weeks and it’s getting worse, if it wasn’t in response to anything, or if you’re finding it hard to do your job or get everyday tasks done like washing or cooking. This is more like clinical depression.

**Depression can lead to persistent thoughts of suicide or self-harm.** This can have a significant impact on people's lives or be life-threatening and is why it is important to seek help if you are suffering from depression. Even the most severe depression can get better with the right support and treatment.

Depression is surprisingly common, affecting around 3 in every 100 people at some point in their lives. It's not commonly discussed, so it feels like a hidden illness. It can have a massive impact on your quality of life, and the journey through the course of the illness can be varied, and for some, long. But there is hope you will come through it.

There is no 'normal' course for depression, no textbook example – doctors tell their patients that you are you, and your condition is its own. But your condition may share a common trajectory with others before you reach a state of recovery. Let's take a look.

Talking therapy, also known as counseling, is used to help treat a range of mental health conditions. It can also help people struggling with various difficulties, including emotional or life events. Talking therapies are when you work with a qualified healthcare professional to talk or think through what is happening and help to understand your thoughts, feelings, or behavior patterns. You work through coping strategies and implement small positive changes in how you think, which can greatly impact your daily life.

There are many different types of talking therapy, with the best one matching your challenges. An example of talking therapy is [cognitive-behavioral therapy (CBT)](https://www.healthwords.ai/us/treatment/cognitive-behavioral-therapy) which can help people suffering from depression, anxiety, sleep problems, anger, sexual dysfunction, and other conditions. There are also different ways of participating in talking therapies, from one-on-one, with your spouse or family member, group sessions, online, or over the phone.

Talking therapies are usually done in regular sessions, such as weekly or fortnightly, for a set number of sessions, and tend to last between 30-60 minutes.

Antidepressants – your questions answered

It can feel like a huge decision to start antidepressants – treatment for clinical [depression](https://www.healthwords.ai/us/condition/depression-87) - and it’s a very personal determination; only you can know how your symptoms are affecting you and what your particular set of circumstances are. Your doctor is on hand to discuss this in detail, but in general antidepressants are usually reserved for moderate or severe depression rather than mild cases, and they can also help with other problems such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and certain pain syndromes.

Recognizing depression and knowing where to turn for help

The first thing to know is that you are not alone in feeling low. [Depression](https://www.healthwords.ai/us/condition/depression-87) is extremely common, with up to 5 in every 100 people suffering around the world. The second thing to know is that it is treatable, so you should seek help when you first notice the signs – we'll talk you through what to look out for. And finally, we'll outline where to go for treatment, even when things have spiraled, and you're in a severe depression or have thoughts of ending it all. If any of this rings true for you or a loved one, please read on.

Mental well-being first aid – top tips from medical experts

Our mental well-being is of huge importance as it has an impact on nearly every aspect of our lives. As we get busy or face challenges in our lives, it can be something we overlook or forget to make time for. Here are our top tips from our medical experts here at Healthwords on how to keep a check on your mental well-being and help yourself stay healthy. Good mental well-being does not mean you will always feel happy, but it can help us cope better with the challenges we face in day-to-day life. Aiming for contentment is more realistic.

Our first top tip is exercise. You may not look forward to exercising, but it can give a substantial boost to your mental well-being. Increased blood flow to the brain increases brain cell growth and the generation of new connections. Endorphins and dopamine are released, helping make us feel good and giving us better sleep. Resilience to stress is improved, and it has a positive impact on symptoms of depression and anxiety.

It helps posture, too – the better you hold yourself when you sit or stand, the fewer aches and pains you get, but evidence shows that you also feel more confident and content within yourself.

Stress is an umbrella term to describe how your body reacts to threats, demands, or injuries. An automatic protective response that many people are aware of is the 'fight or flight' reaction to stressful situations that come up suddenly. In the right setting, this can be life-saving or even sharpen your mind and help you focus.

However, if your stress response is inappropriate or your body is under constant threat, it can bring your nervous system into disarray and affect many aspects of your life, disrupting your health, mood, and relationships. Stress can be a cause or the result of a problem, but it's best to manage it and reduce it where possible to avoid it taking over your life.

PHQ-9 is a questionnaire that is used to help assess the severity of depression. The name stands for patient health questionnaire, and 9 questions ask about different symptoms and how often you experience them. 

Each answer is assigned a number of points out of 3, and once you add the points from the 9 questions, you will have a score out of 27. 

If you score 5 points or more, this suggests mild depression severity, 10 points and more for moderate, 15 points and more for moderately severe, and 20 points or more for severe depression. 

**The questionnaire isn’t for diagnosing depression but for assessing severity.**

[Anxiety](https://www.healthwords.ai/us/condition/anxiety-77) occurs when we feel under threat or [stress](https://www.healthwords.ai/us/article/stress-563) and is a normal part of life – it's actually helped our survival in the past. These days some mild anxiety can help us achieve (a bit of adrenaline may help us perform well in an exam or spur us on in a job interview) but it becomes a problem if it gets in the way of us going about our everyday life and stops us from doing things we’d like to do.

It’s common to feel anxious: you may feel worried, tense or panicked. Feelings can vary in intensity and you might get physical symptoms such as your heart racing, breathing quickly, a heavy feeling in the chest, feeling sick or shaky, sweaty and getting a [dry mouth](https://www.healthwords.ai/us/treatment/managing-dry-mouth).

You often then start to avoid situations that make you feel like this but if it stands in the way of you leaving the house or stopping you from doing certain things, it has started to become a problem.

Depression and anxiety: Any natural remedies to try?

Life can sometimes become difficult – stresses in your relationship, a heavy workload, or an exam or interview looming. Tension and negative thoughts can set in, even feelings of panic or gloom. You might want to try something yourself before getting a doctor's opinion, and non-medical products can be a good choice for mild symptoms – our pharmacist is here to advise you.

GAD-7 is a questionnaire that is used to help assess the presence and severity of generalized anxiety disorder (GAD). There are 7 questions (hence the name GAD-7) which ask about different symptoms and how often you experience them. The questions ask how often you have been bothered by these symptoms over the previous 2 weeks:

1. Feeling anxious, nervous or on edge
2. Not being able to stop, or control, worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it’s hard to sit still
6. Becoming easily irritable or annoyed
7. Feeling that something awful might happen

The score is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of “not at all,” “several days,” “more than half the days,” and “nearly every day,” respectively. GAD-7 total score for the seven items ranges from 0 to 21. Scores of 0-5 show mild anxiety, 6-10 moderate, 11-15 moderately severe anxiety and 15-21 severe anxiety

Anxiety is a feeling that occurs when someone feels under threat or stress. It is a natural response to a threat that actually can at times be helpful and has helped with the survival of humans across the ages. However, if it is excessive, persistent or affecting people's daily life then it may be an anxiety disorder. Generalized anxiety disorder is characterized by anxiety around lots of different things (usually everyday occurrences) rather than anxiety relating to one specific thing or situation.

Many university students suffer from mental health issues. These can be far-ranging such as [anxiety](https://www.healthwords.ai/us/condition/anxiety-77), [depression](https://www.healthwords.ai/us/condition/depression-87), or different eating disorders (like [bulimia](https://www.healthwords.ai/us/condition/bulimia-737) and [anorexia](https://www.healthwords.ai/us/condition/anorexia-718). University life may cause these problems to surface for the first time or it may exacerbate existing problems. Either way, it is important to understand that you are not alone and every university has plenty of resources for people suffering with their mental health.

Zyban (bupropion hydrochloride) is a prescription-only non-nicotine medication that can be prescribed by a doctor to help you [stop smoking](https://www.healthwords.ai/us/article/how-to-quit-smoking). This is best accomplished by using Zyban if you are fully committed to giving up smoking, alongside motivational support such as taking part in a counseling service.

Zyban should not be used with Chantix (varenicline) or nicotine replacement therapy like gums, lozenges or sprays. It is not licensed for those under 18 or women who are pregnant or breastfeeding, and caution is suggested with certain medical conditions and medications.

### How does Zyban work?

The exact mechanism of action for how Zyban works to reduce cravings for cigarettes is not known, however, bupropion is an inhibitor of the neuronal uptake of certain chemical messengers in the brain such as noradrenaline (norepinephrine), serotonin and dopamine. It works to reduce the pleasurable effects of smoking and nicotine, most likely linked to the release of dopamine, which gives the reward effect you feel if you do have a cigarette. It also reduces the usual withdrawal symptoms of anxiety and irritability.

St. John’s wort – for low mood / mild depression

St. John’s wort (Hypericum perforatum) is a plant with an extract that’s been used for centuries as a mood enhancer – it can help to relieve mild [depression](https://www.healthwords.ai/us/condition/depression-87) and mild [anxiety](https://www.healthwords.ai/us/condition/anxiety-77). You don’t need a prescription, it’s available from your pharmacy.

CBD oil, also known as cannabis oil or cannabidiol oil, is formed by extracting cannabidiol from the cannabis or hemp plant and putting this chemical into the oil. It has recently become well known, with many health companies advertising it and selling it legally as a health supplement; however, the legality of cannabis-based vs. hemp-based CBD oil varies at both the federal and state level, making it very confusing for purchasers. Non-prescription CBD oil available to buy is not FDA-approved, and so these products undergo lower levels of scrutiny than medications. Because of this, there remain questions over the quality of these "health supplements" with potential variations in quality.

There is not a huge amount of research on CBD but it has been shown that in some people it can help in the treatment of severe epilepsy that doesn’t respond to standard treatments. It is also thought to have some anti-inflammatory properties and may help reduce [anxiety](https://www.healthwords.ai/us/condition/anxiety-77) and [chronic pain](https://www.healthwords.ai/us/article/chronic-pain-248). CBD oil has also been studied for severe sickness due to chemotherapy and severe muscle problems in a condition called multiple sclerosis. Some of these studies included a combination of both CBD and THC.

Potential side effects of taking CBD oil are sleepiness, dizziness, and bowel symptoms. It can also affect your liver and may interact with medications, including [painkillers](https://www.healthwords.ai/us/treatment/painkillers-666) and anti-epileptic medication.

Bipolar disorder is a mental health condition that used to be called manic depression. It can lead to extreme changes in mood, energy, and ability to function.

There are two distinct parts of the illness: periods of feeling depressed and low, and then huge emotional highs – called mania - where the person can be incredibly overactive. Unlike daily mood swings, people with bipolar may be in one state of either mania or depression for weeks or months at a time. In between these episodes, the person may feel normal and well. (Less commonly, some people with bipolar disorder can have what is known as a mixed bipolar episode, where they can alternate between depression and manic symptoms in a matter of hours). Bipolar symptoms can be severe and may affect your daily life, work, studies and relationships and is very different from the normal mood swings we can all have from time to time. If you have less severe mania symptoms, this is known as hypomania.

There are two types of bipolar disorder – Type I and Type II. Type I usually starts with manic symptoms, often mixed with [depression](https://www.healthwords.ai/us/condition/depression-87) whereas Type II only involves hypomania.

Around 2% of people develop bipolar disorder at some time in their life and it can occur at any age although it usually presents between the ages of 18 and 30. Men and women are equally affected.

The average length of a manic episode is four months, and six months for the depressive phase. It’s impossible to predict how long each manic depressive cycle will last, and the average number of episodes you may experience in your life if you have bipolar disorder is ten. Three quarters of people who have an episode of bipolar disorder have another one within four years.

Borderline personality disorder (BPD) is a lifelong mental health condition that is characterized by difficulties in regulating emotions and interacting with others. It is also known as an emotionally unstable personality disorder, and is a common and well-known type of personality disorder. 

Dr Karen Martin

Pharmacist and Head of US Content

Cognitive behavioral therapy (also known as CBT) is a type of talking therapy used to help treat a range of mental health conditions. It is based on the concept of helping a patient understand their thoughts and behaviors,  aiming to assist the patient to identify negative thought and behavior patterns and cycles, making adjustments to those and learning healthy coping strategies for dealing with challenges and difficulties. 

There are different ways to do CBT; it can be led by a therapist and done either 1:1 or in a group. CBT can be done without a therapist leading it, through book form (which walks you step by step through exercises), or online in the form of computerized CBT. It can also be conducted over the phone or via online video call. CBT is normally done in several weekly or fortnightly sessions, which can be between half an hour and an hour long. The minimum number of sessions tends to be around 4 but can be up to about 20 sessions. 

Cognitive behavioral therapy

What can CBT help with?

When should I see my doctor?

What will the doctor do?

Fitnote

Related topics

Chronic pain relief

Depression

Depression – road to recovery

Talking therapies

Antidepressants – your questions answered

Recognizing depression and knowing where to turn for help

Mental well-being first aid – top tips from medical experts

Stress

PHQ-9

Anxiety – seeking help

Depression and anxiety: Any natural remedies to try?

GAD-7 test

University mental health

Zyban (bupropion)

St. John’s wort – for low mood / mild depression

CBD oil

Bipolar disorder

Borderline personality disorder