Synopsis
Understand how collaborative formulation and behavioural experiments guide cognitive behavioural therapy, and select the appropriate disorder-specific intervention and treatment intensity.
- CBT links a particular situation with its interpretation, associated emotion, bodily response and behavioural consequences.
- Develop a shared, testable formulation of what maintains the person's difficulty rather than imposing a generic account of negative thinking.
- Behavioural experiments compare a prediction with observed results; they require a clear learning question and an agreed feasible task.
- For less severe depression, NICE describes individual CBT as usually eight sessions and guided self-help as usually six to eight supported sessions.
- Individual CBT for more severe depression usually involves sixteen sessions, with additional sessions when clinically needed.
- Use a disorder-specific protocol: social anxiety treatment differs from exposure and response prevention for obsessive-compulsive disorder.
- Review safety, functioning, the therapeutic relationship and meaningful outcomes alongside symptom measures throughout treatment.
Key red flags
An expressed intention to act on suicidal thoughts requires a timely safety assessment and an agreed urgent response, even when questionnaire scores have improved.
Reduced need for sleep with increased activity or disinhibition should prompt assessment for mania before attributing the change to successful activation.
Investigation priorities
Identify the target disorder, severity, impairment and competing treatment needs.
Management branches
Assessment identifies a difficulty for which a specific CBT intervention is recommended.
- Explain the relevant options, expected work between sessions, likely duration and alternatives, then agree a target that matters to the person.
- For depression distinguish less severe and more severe presentations, considering guided self-help first for less severe illness while respecting informed preference and clinical need.
- Refer to a practitioner competent in the required protocol, describing risks, comorbidity, access adjustments and previous interventions so that assessment is not unnecessarily repeated.