What is cognitive behavioural therapy?
Cognitive behavioural therapy or CBT is a form of talking or psychological therapy (psychotherapy). It is used in the treatment of anxiety and depression. It may also be used to help with MS fatigue. CBT is based on the idea that how we think about a situation affects how we act, and our actions affect how we think and feel. CBT involves looking at problem areas and breaking them down into thoughts, feelings and actions. Working with the therapist you identify unhelpful thoughts and behaviours and look for ways to face situations in a more helpful way, such as learning strategies to handle feelings of depression and anxiety.
How is cognitive behavioural therapy given?
CBT can be delivered in a number of ways. Typically, CBT consists of a series of sessions lasting anywhere from half an hour to an hour. You might see a therapist in a group setting or one-to-one. CBT can also be delivered by computer or on the telephone. Face-to-face sessions can be tailored more to the individual, especially if they're delivered by a neuropsychologist. They may also be more suitable for people with more complex needs. Participants often report that it is beneficial to have a therapist there to guide them through what can be a demanding process. Computerised courses have the advantage of being able to be accessed at a time and a place that suits you, some courses also offer telephone or email support from a health professional alongside the programme.
CBT is available on the NHS, though availability varies across the UK. If you feel CBT may help you, or you would like more information, talk to your GP or MS nurse.
Research into CBT
A number of studies have looked at CBT as a treatment for MS-related symptoms including depression, anxiety, fatigue and pain. The results have been mixed but on the whole have shown that CBT has a small to moderate positive effect on the symptoms of MS. However, these effects are usually short-lived and the effects usually decrease after treatment has stopped.
A review of several studies found that CBT had a similar effect on managing depression as standard treatment with antidepressant drugs. Another study found CBT was more effective than supportive listening for people adjusting to the early stages of MS, particularly for people who were highly distressed.
A study of an approach where the CBT therapist contacted people by telephone found that it led to greater decreases in disability, fatigue levels and depression than an emotional support programme,
A trial comparing CBT with a relaxation training programme for MS fatigue found both were helpful, though CBT was more effective. Another study looked at why fatigue improved following a course of CBT, it was found that the participants had a better perception of their fatigue, increased their physical activity, had reduced levels of sleepiness and feelings of helplessness, and had increased physical functioning. However, once treatment stopped fatigue levels increased again and this was thought to be due to a reduction in physical activity, reduced concentration levels and an increase in sleepiness.
More research is needed on how to maintain the positive effects of CBT over the longer term.
- Journal of Psychosomatic Research 2018;106:13-24. Summary Cognitive behavioural therapy for MS-related fatigue explained: a longitudinal mediation analysis.
- Multiple Sclerosis Journal 2017;23(11):1542-1553. Summary Cognitive behavioural therapy positively affects fatigue in patients with multiple sclerosis: results of a randomized controlled trial.
- BMC Psychiatry 2016;16(1):435. Read the full article A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis.
- Journal of Clinical Psychology 2016;72(7):651-662. Summary Individual face-to-face cognitive behavioural therapy in multiple sclerosis: a qualitative study.
- International Journal of Qualitative Studies on Health and Wellbeing 2017;12(1):1325673 Summary A qualitative study of cognitive behavioural therapy in multiple sclerosis: experiences of psychotherapists.
- BMC Psychiatry 2014;14: 5. Read the full article Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis.
- Health Psychology 2007;26(5):554-563. Summary Reduction in disability in a randomized controlled trial of telephone administered cognitive behavioural therapy.
- Journal of Consulting and Clinical Psychology, 2013;81(2):251-262. Summary A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): does CBT work and for whom does it work?
- Psychosomatic Medicine 2008;70(2):205-213. Summary A randomized controlled trial of cognitive behaviour therapy for multiple sclerosis fatigue.
Mental health and MS: It's good to talk
Living with a long-term condition like MS does not only mean facing physical challenges, it can mean overcoming mental challenges too. Around half of all people with MS will experience depression at some point in their life. But depression is treatable, and understanding what support is out there if you are feeling low is really important. Here we look at counselling and cognitive behavioural therapy.
Living well with MS: a role for psychology?
A team in Surrey set up a psychology service offering CBT and MBCT, approaches that research has shown can help people adapt to and cope with living with MS.
Be kind to your mind
Practical steps you can take to improving and maintain your mental wellbeing.