Cognitive behavioural therapy (CBT)

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.

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.

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.

• Cognitive behavioural therapy - Royal College of Psychiatrists website
• Cognitive behavioural therapy (CBT) - NHS Choices website
• Psychological therapies