If you have been suggested to get cognitive behavioural therapy to help you manage physical health issues, there are a few good reasons for this:
- Cognitive behavioural therapy is the most widely evidenced based treatment for effectively improving mood outcomes in time-limited therapy [1] and generally the primary therapy delivered for free in the NHS in England.
- Cognitive behavioural therapy has been adapted for use with a range of specific health conditions with efficacy in reducing physical symptoms including gut-directed CBT for irritable bowel syndrome [2], CBT with pacing for fatigue [3] and CBT for pain [4].
- Cognitive behavioural therapy lends itself well to a ‘biopsychosocial’ approach to health. That means, it is well suited to looking at the interaction between biological health experiences and psychological and social experiences. You can read more about this in our previous article.
Now, while there is lots of compelling research showing how effective CBT can be, as a health psychologist and CBT therapist (as well as a mindfulness practitioner and Eye Movement Desensitisation and Reprocessing EMDR Therapist), I feel there are very important things you need to be aware of when seeking psychological therapy for health issues.
In England, the free at the point of entry mental health service, Improving Access to Psychological Therapies (IAPT), currently provides CBT for a range of long-term health conditions including chronic fatigue, irritable bowel syndrome (IBS), chronic pain, cancer, cardiac conditions and diabetes. I used to lead on this long-term condition (LTC) pathway when I worked in the NHS, so I am familiar with the virtues of it as well as the issues.
Research suggests that those with long term conditions tend to have much poorer outcomes from therapy than those without LTCs, even where they end up receiving higher intensity treatment [5], [6]. As a former clinician who had a caseload predominantly of people with LTC’s, this very much reflects my experience. And yet, I don’t think this is because therapy wasn’t worthwhile for these people. The difficulty was the time-limited nature of therapy when working with a high level of complexity. Often patients I was seeing had multiple physical diagnoses, significant life stressors and low mood or anxiety disorders. Just working out how all these things impacted each other could take 3 sessions, leaving (if you were lucky) 9 sessions remaining.
A big part of CBT is home practice: The ability for people to reflect on what has been explored or tried in session and to build on these experiences in between sessions. Quite often the countdown of sessions acted as a ticking clock, adding pressure to both me and my patient as we tried our best to make the most out of our time together. The problem is that this sort of pressure can be hugely inhibiting to making progress in therapy. It adds to the stress and changes how the brain is processing, so that it is harder to engage in the therapeutic content [7], [8].
The other big issue is that, although there is ‘long term condition top-up training’ – for which I provide guest lecturing at UCL, Southampton University and at a time, King’s College London and University of East Anglia, the clinicians receiving the training have very limited time to reflect on it and practice it. They also don’t generally have access to specialised supervision. This is a real big issue, because it means that clinicians simply cannot be well-versed in the degree of knowledge that is often necessary to truly adapt therapy to specific physical health conditions.
This is by no means the fault or inadequacy of the clinician – it comes down to funding and time. A lot of IAPT sites are over-stretched with staff wellbeing poor and burnout high [9]. This means that there simply isn’t time, space or opportunity to provide truly tailored therapy to health conditions in many cases.
The final issue I think needs raising, is that CBT is not always the best approach. There are wonderful adaptions of CBT, deftly tailored to specific conditions like IBS, but for some conditions, additional psychotherapeutic modalities are necessary. For example, research shows that mindfulness can improve pain outcomes more so than CBT [10]. Approaches like acceptance commitment therapy has been shown to be highly beneficial for chronic pain and insomnia [11], [12] and pain reprocessing therapy and emotional awareness and expression therapy [13], [14] offer additional approaches that can be highly beneficial to those experiencing physical discomfort of any sort.
Potentially yes! During my time in IAPT I made peace with the fact that ‘recovery scores’ would not meet the targets of the service for a lot of my patients with chronic illnesses because of all the reasons I describe. And yet, I felt the therapy was meaningful and important for the individuals I was working with. I found myself being explicit with them about the constraints of time and how that may instil a sense of pressure on them and suggested some ways we could prevent that from happening. One of the things that I said, was that this could be considered a ‘treatment episode’. In this episode they take what they can and they work with it once therapy is over. Then, at a later point in time, they may decide it is a good time to come back to see what another treatment episode may help them with, now at a different point in their journey – even if only slightly. This really appealed to a lot of people I worked with.
However, it is not for everyone. It is a brave step to come to therapy, to open things up and try and start figuring out things, only to then feel they are left unfinished with a lot of work to do. How unsettling and disruptive this will feel will depend on lots of things, like where you are in your health journey, your mood state, your access to other support, trauma history and neurotype (the way your brain works).
In the NHS there is limited scope for ‘picking’ your therapist, however you should always have the option to swap therapist if you don’t feel you are compatible. That happens and it is ok. It is important you feel comfortable with your therapist.
There are some things you might want to consider when trying to find a therapist or psychologist to support you with physical health issues:
- Your goals for therapy: do you want someone to help you emotionally manage or do you want someone who can help you understand and influence the interrelationship between your psychology and physiology?
- Your therapist’s knowledge and experience: does your therapist know about and have experience in supporting people with your health issues? Would they feel able to support you in physical symptom remission if that is possible? Would they be able to tell you whether that is possible?
- Your therapist’s approach to therapy: will they be focussing on using one model of therapy (e.g. CBT) to address your mental wellbeing or will they draw on a number of models of therapy (e.g. mindfulness, EMDR, compassion focussed therapy) to personalise according to your health and needs? Is their model of therapy compatible with you and your experience? You may like to research the type of therapy they provide and see if that feels like it would be useful to you.
When dealing with health issues, I often talk about there being three phases:
- Crisis phase; you are in the midst of difficulties and uncertainty with little clarity and generally overwhelmed having to focus on the specifics to get you out of crisis
- Coping phase: you are working out what helps you and what hinders you and it can feel uncertain and hard, but you have more of an equilibrium then when you were in crisis.
- Adaptation phase: you have found a way to work with the difficulties and are on more of an even ground. You may identify scope for improving things, but there is no great urgency.
In crisis mode, you require support, but it is often not the right time for therapy because you are too overwhelmed and have other fundamental things to sort out. For example, having just received a diagnosis. You would need to focus on medical treatment and practicalities around that to work out your prognosis and treatment options.
The coping phase is an ideal time to start therapy as you can be armed with knowledge and practices that help you get to the adaptation phase quicker.
When I first left the NHS, I quickly found myself inundated with referrals. This was because there was (and is) such a limited number of people specialising in truly evidence-based psychotherapy looking at the intersection between physical and mental health. It meant I had to turn many people down for therapy, which I really felt awful about.
Over the coming years, I decided I would try and scout out others like me that were working in private practice so that I could have people to refer to that I trusted. There is a lot of questionable therapy that goes on and I get very protective of my clients and those coming to me for support. I was so delighted when a former colleague of mine from the NHS said she wanted to work with me. I was well familiar with her work and was always so impressed by how much she helped her clients. From there I was fortunate to recruit another former colleague, my research collaborator and friend and two other health psychologists who had been on my mentorship and now we have a wonderful team of clinicians doing amazing work with clients. They all specialise in gut issues, pelvic and bladder issues and a full remit of other chronic health issues.
I understand that private CBT can be financially challenging, with sessions often costing £60-120 per hour, and NHS waiting lists can mean delays of several months before you're able to access support, which is the last thing you want to face when struggling - often alone - with your condition.
If you're keen to start working through some of these concepts in your own time - educating yourself on the mind-body science, understanding why you might be experiencing the symptoms you do, and beginning some meaningful self-exploration - then our
Body Mind Connect membership could be a valuable stepping stone for you.
Our programme offers neuroscience-informed resources, structured learning modules that can be taken at your own pace, and a supportive community of people on similar journeys, all designed to help you begin this important work and guide you through a journey. Sometimes taking that first step towards understanding your mind-body connection can be incredibly empowering, and help you feel more prepared and informed if you do wish access one-to-one therapeutic support, and if not, it provides a safe space to explore that in your own time.
The bottom line: CBT can be effective for physical health conditions, this has been shown through various pieces of research. However, the NHS has some limitation that can affect outcomes. Understanding these constraints can help you make decisions about the support you wish to seek.
Key takeaways: - CBT is well researched for health conditions like IBS, chronic pain and fatigue
- NHS therapy is time limited which can create pressure and isn't always enough for complex health issues
- When treating physical conditions, it is valuable if the therapist has some specialised training on dealing with those conditions
- Timing matters: it is important to consider what phase you are in, coping phase is better than crisis phase for example
- When choosing a therapist, consider their expertise and approach, and your own goals
- CBT is particularly helpful due to the ability to practice at home
Remember: Being told to have therapy for a physical condition can trigger certain emotions as a response, for example anger or confusion. This is normal, and understandable. But it can offer relief in some conditions and really help towards improving your wellbeing. If CBT is not something that is available to you, there are other ways to implement some home-based practices, for example with our Body Mind Connect membership or you can
complete this quiz that I created to help find some guidance.
References:
[1] C. W. Ong, S. C. Hayes, and S. G. Hofmann, 'A process-based approach to cognitive behavioral therapy: A theory-based case illustration', Front. Psychol., vol. 13, Oct. 2022, doi: 10.3389/fpsyg.2022.1002849.
[2] C. J. Black, E. R. Thakur, L. A. Houghton, E. M. M. Quigley, P. Moayyedi, and A. C. Ford, 'Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis', Gut, vol. 69, no. 8, pp. 1441–1451, Aug. 2020, doi: 10.1136/gutjnl-2020-321191.
[3] T. A. Kuut et al., 'Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis', Psychological Medicine, vol. 54, no. 3, pp. 447–456, Feb. 2024, doi: 10.1017/S0033291723003148.
[4] 'Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review - ScienceDirect'. Accessed: May 16, 2025. [Online]. Available: https://www.sciencedirect.com/science/article/pii/S221478292200094X
[5] N. Seaton, R. Moss-Morris, S. Norton, K. Hulme, and J. Hudson, 'Mental health outcomes in patients with a long-term condition: analysis of an Improving Access to Psychological Therapies service', BJPsych Open, vol. 8, no. 4, p. e101, Jul. 2022, doi: 10.1192/bjo.2022.59.
[6] J. Delgadillo, A. Dawson, S. Gilbody, and J. R. Böhnke, 'Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety', The British Journal of Psychiatry, vol. 210, no. 1, pp. 47–53, Jan. 2017, doi: 10.1192/bjp.bp.116.189027.
[7] R. M. De Geest and R. Meganck, 'How Do Time Limits Affect Our Psychotherapies? A Literature Review', Psychol Belg, vol. 59, no. 1, pp. 206–226, doi: 10.5334/pb.475.
[8] B. J. Lehman, Cane ,Arianna C., Tallon ,Shannon J., and S. F. and Smith, 'Physiological and emotional responses to subjective social evaluative threat in daily life', Anxiety, Stress, & Coping, vol. 28, no. 3, pp. 321–339, May 2015, doi: 10.1080/10615806.2014.968563.
[9] S. L. Armstrong, 'Camaraderie, cuts, and COVID-19: Factors affecting the wellbeing of NHS psychological therapists', Doctoral, UCL (University College London), 2023. Accessed: May 16, 2025. [Online]. Available: https://discovery.ucl.ac.uk/id/eprint/10179383/
[10] M. C. Davis, A. J. Zautra, L. D. Wolf, H. Tennen, and E. W. Yeung, 'Mindfulness and cognitive–behavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity', Journal of Consulting and Clinical Psychology, vol. 83, no. 1, pp. 24–35, 2015, doi: 10.1037/a0038200.
[11] L. S. Hughes, J. Clark, J. A. Colclough, E. Dale, and D. McMillan, 'Acceptance and Commitment Therapy (ACT) for Chronic Pain: A Systematic Review and Meta-Analyses', The Clinical Journal of Pain, vol. 33, no. 6, p. 552, Jun. 2017, doi: 10.1097/AJP.0000000000000425.
[12] J.-W. Shin, Kim ,Seonyeop, Shin ,Yoon Jung, Park ,Bomi, and S. and Park, 'Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial', Nature and Science of Sleep, vol. 15, pp. 523–531, Dec. 2023, doi: 10.2147/NSS.S409981.
[13] D. Maroti et al., 'Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial', Front. Psychiatry, vol. 12, Feb. 2021, doi: 10.3389/fpsyt.2021.620359.
[14] Y. K. Ashar et al., 'Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial', JAMA Psychiatry, vol. 79, no. 1, pp. 13–23, Jan. 2022, doi: 10.1001/jamapsychiatry.2021.2669.
