Cognitive behavioural therapy for long term conditions

Cognitive behavioural therapy (CBT) is a treatment underpinned by cognitive theory, which emphasises an individual's cognitions relating to their illness. There is good evidence for the use of CBT in managing numerous LTCs. CBT is a technique that sheds light on:

• how an individual thinks about themselves, the world and other people (known as the 'cognitive triad')
• how an individual's thoughts affect their feelings, as well as the impact of this on their behaviour

CBT can help you to change how you think ('cognitive') and what you do ('behaviour'), changing from unhelpful thoughts/feelings to more-helpful ones. Unlike some other talking treatments, such as psychotherapy, CBT focuses on the present (i.e. 'here and now') and current problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve individuals' state of mind now.

CBT can be delivered in several forms, including face to face, online, individually and in groups.

Therapists use the ABC formulation to understand triggering events that activate an individual's interpretation of an event, beliefs and self-evaluations, and consequences (emotions, behaviours and other thoughts). Watch this video to find out more:

CBT has been shown to help with many different types of psychological problems (e.g. anxiety disorders (phobias and social anxiety disorder), depression, stress, post-traumatic stress disorder and psychosis) (Kaczkurkin & Foa, 2022; Lewis et al., 2019; Santoft et al., 2019: Wood et al., 2020). Furthermore, CBT has been found to be effective when treating physical health problems like pain or fatigue (Liu et al., 2019; Mehta et al., 2019).

To look at how CBT can be applied to LTCs, we have outlined the following example:

An example of CBT applied to multiple sclerosis

Multiple sclerosis is a condition affecting the brain and spinal cord and is associated with a range of symptoms, including visual disturbances, movement issues and balance issues. Pain is also a common and severe symptom in patients with multiple sclerosis, impacting quality of life and daily functioning.

Gromisch et al. (2020) outlined that CBT plus standard care led to improvements in the pain severity, pain interference and depressive symptom severity of patients with multiple sclerosis. Twelve CBT sessions were offered, which included seven 60-minute individual face-to-face sessions and five 30-minute individual telephone sessions. Components of the CBT included:

• identification of idiosyncratic beliefs about pain and pain treatment
• instruction in cognitive (e.g. distraction) and behavioural (e.g. activity pacing) skills
• consolidation of cognitive and behavioural skills through activities such as role playing

During sessions, participants collaborated with a psychologist to develop behavioural goals and plans for using pain coping skills and practices (used as homework). Telephone sessions were used to emphasise adherence to behavioural goals, review previously taught materials and present new, relevant materials.

CBT can also be used to target other symptoms in multiple sclerosis, such as insomnia and fatigue (Chalah & Ayache, 2023; Siengsukon et al., 2021). The extent to which CBT is successful depends on a range of factors. We discuss some of the strengths and limitations of CBT here:

Strengths and limitations of CBT

Click to view a few of the strengths and limitations of CBT:

We will now move on to discuss another type of psychological treatment, which has gained greater support over the past ten years: acceptance and commitment therapy.