when to offer cbt for mental health disorders

Cognitive Behavioural Therapy (CBT) is recommended for several mental health conditions in the UK.

For adults with obsessive thoughts but no overt compulsions, CBT, including exposure to obsessive thoughts and response prevention of mental rituals and neutralising strategies, should be considered ². If adults with OCD refuse or cannot engage with treatments including exposure and response prevention (ERP), individual cognitive therapy specifically adapted for OCD may be considered ². For adults with OCD, cognitive therapy adapted for OCD may be considered as an addition to ERP to enhance long-term symptom reduction ².

In children and young people aged 12 to 18 years with mild depression, digital CBT programmes delivered via technology can be used ¹. For children aged 5-11 years with moderate to severe depression, individual CBT should be considered, adapted to their developmental level ⁷. For young people aged 12-18 years with moderate to severe depression, individual CBT should be offered for 3-6 months ⁷. If individual CBT is unsuitable or does not meet the clinical needs of a young person with moderate to severe depression, other options should be considered ⁷.

For adults with depression, individual CBT is a structured, goal-oriented intervention that focuses on how thoughts, beliefs, attitudes, feelings, and behaviour interact, teaching coping skills ³. It may be helpful for individuals who can recognise negative thoughts or unhelpful behaviour patterns they wish to change and who are willing to complete homework assignments ³,⁵. For more severe depression in adults, combination CBT with antidepressant treatment, individual CBT, and individual behavioural activation (BA) have good evidence for effectiveness and cost-effectiveness ⁵.

For adults with bulimia nervosa, if bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective, individual eating-disorder focused CBT (CBT-ED) may be considered ⁶. For children and young people with bulimia nervosa, if family therapy is unacceptable, contraindicated, or ineffective, individual CBT-ED may be considered ⁶. For binge eating disorder in adults, children, and young people, if evidence-based self-help programmes are unacceptable, contraindicated, or ineffective, group CBT-ED may be offered, or individual CBT-ED if group CBT-ED is refused or unavailable ⁶.

For adults with a mental health problem or anger management problem and a learning disability, individualized psychological interventions including CBT techniques may be used ⁴.