I am asked about Cognitive Behavioural Therapy in most sessions or at least during the introductory call. It is one of the most researched and widely practised forms of therapy in the UK, and for good reason. CBT has helped millions of people overcome anxiety, depression, trauma, and a range of other mental health challenges. In this post, I want to explain what CBT actually is, how it works, and whether it might be the right approach for you.
What is CBT? (Cognitive Behavioural Therapy explained)
Cognitive Behavioural Therapy, commonly known as CBT, is a structured, evidence-based talking therapy that focuses on the connection between our thoughts, feelings, and behaviours. The central idea is straightforward: the way we think about situations affects how we feel and what we do. When we struggle with our mental health, we often develop unhelpful thinking patterns that keep us trapped in cycles of distress.
I work with many men who initially feel sceptical about therapy, worried it will involve dwelling endlessly on the past or sitting in uncomfortable silence. CBT tends to resonate with them because it is practical, present-focused, and goal-oriented. Rather than spending months analysing childhood, CBT asks: what is maintaining your difficulties now, and what can we do about it?
The “cognitive” part refers to our thoughts, beliefs, and interpretations. The “behavioural” part focuses on our actions and reactions. CBT brings these elements together, recognising that changing either one creates a positive ripple effect on the other.
How does CBT work? (Understanding CBT techniques)
CBT operates on a simple but powerful model connecting thoughts, feelings, and behaviours. Let me give you a concrete example.
Imagine a young man I worked with who struggled with social anxiety. When invited to a friend’s gathering, his automatic thought was “Everyone will think I am boring.” This thought triggered feelings of anxiety and dread. His behaviour? He avoided the event entirely. The immediate relief reinforced his belief that he could not handle social situations, leading to increased isolation.
In CBT, we explored this pattern together. We identified the thought, examined the evidence for and against it, and considered alternative perspectives: “Some people might find me interesting, and even if someone does not connect with me, that is okay – it does not mean I am boring.” We then designed gradual behavioural experiments, perhaps attending a smaller gathering first, to test these new thoughts and build confidence.
Key CBT techniques include:
Thought records help you identify situations, notice automatic thoughts, recognise emotions, and develop more balanced perspectives. You might spend 10 minutes daily tracking your thoughts in a simple journal.
Behavioural experiments involve testing your predictions in real life. Rather than assuming disaster will strike, you try the situation and observe what actually happens versus what you feared would happen.
Exposure work means gradually facing feared situations in a structured way, allowing anxiety to naturally decrease over time as your brain learns the situation is safer than predicted.
Activity scheduling helps break cycles of avoidance or withdrawal by deliberately increasing positive, meaningful activities—even when motivation feels absent.
As a therapist who blends CBT with solution-focused therapy, DBT skills, and other approaches, I incorporate these techniques whilst also helping clients identify their strengths and envision their preferred future. This makes the work feel collaborative and empowering rather than formulaic.
What can CBT help with? (Common uses for CBT therapy)
CBT’s versatility is one of its greatest strengths. Here are the main areas where I use CBT principles:
For anxiety (including generalised anxiety, social anxiety, panic disorder, health anxiety, and phobias), CBT helps you recognise and challenge catastrophic thinking patterns whilst reducing avoidance behaviours. CBT techniques for anxiety are among the most researched and effective interventions available.
For depression, CBT addresses negative thinking about yourself, the world, and the future—what we call the cognitive triad. It helps you re-engage with activities and relationships that bring meaning, even when motivation is low.
For trauma and PTSD, trauma-focused CBT helps process traumatic memories and reduce symptoms like flashbacks, nightmares, and hypervigilance.
For OCD, CBT – particularly exposure and response prevention – is considered the gold standard psychological treatment, helping you resist compulsions and tolerate uncertainty.
For relationship difficulties, when combined with relationship therapy principles, CBT helps individuals and couples communicate more effectively and challenge the assumptions that create conflict.
For anger, eating difficulties, and substance use, CBT identifies triggers, addresses underlying beliefs, and develops healthier coping strategies.
In my work with adolescents in residential care, I have seen how CBT principles (especially when combined with DBT skills like distress tolerance) give young people practical tools they can use immediately when overwhelmed.
Does CBT actually work? (What the research says)
One reason I integrate CBT into my practice is the substantial evidence supporting its effectiveness. CBT is the most extensively researched psychotherapy, with thousands of clinical trials demonstrating its benefits.
Research consistently shows CBT is as effective as medication for depression and anxiety disorders, and may be more effective at preventing relapse. The National Institute for Health and Care Excellence (NICE) recommends CBT as a first-line treatment for numerous mental health conditions in the UK.
Studies show that 50-75% of people completing CBT for anxiety or depression experience significant improvement. The effects are often long-lasting because you learn skills you can continue using after therapy ends. This is what I emphasise with clients: CBT is not just about feeling better now, but about developing a toolkit for life.
CBT has been adapted and tested across different populations, cultures, and age groups. It works in individual therapy, group settings, and guided self-help formats. Recent research shows that online CBT can be effective, making treatment more accessible across England and the UK.
Of course, no therapy works for everyone. Some people benefit more from longer-term relational work, or approaches that focus more on emotion processing. This is why I blend CBT with other modalities, to tailor the approach to each person’s unique needs.
What to expect in a CBT session
When someone starts CBT with me, we collaboratively map out difficulties and set clear, realistic goals. CBT is typically structured and time-limited (usually between 6 and 20 sessions, depending on the issue) though this remains flexible.
Each session follows a similar format: we start with a brief check-in and set an agenda together. We review any “homework” or experiments from the previous week (practice between sessions is crucial for progress). We then work on the main issue, which might involve exploring a recent difficult situation, learning a new technique, or planning behavioural experiments. We end by summarising what we have covered and agreeing on manageable tasks for the coming week.
If you miss homework occasionally, that is normal and becomes useful material to explore. What got in the way? Was the task too ambitious? Did avoidance kick in? This is all part of the learning process.
The therapist-client relationship in CBT is genuinely collaborative. I often describe it as working together as a team, with me bringing psychological knowledge and you bringing expertise on your own life. This collaborative approach works particularly well with the men I work with, who appreciate the practical, “let us figure this out together” stance.
Common misconceptions about CBT
“CBT is just positive thinking” – Not at all. CBT is about realistic thinking, not optimistic thinking. We examine evidence, consider alternative perspectives, and develop balanced thoughts, not just cheerful ones.
“CBT ignores emotions and the past” – While CBT focuses on present patterns, we absolutely address emotions and explore relevant past experiences, especially when they inform current beliefs. However, we do so with a clear purpose rather than open-ended exploration.
“CBT is cold or clinical” – Effective CBT happens within a warm, empathic relationship. The structure and techniques are tools, but the therapeutic relationship remains central to the work.
“You will be forced to face your fears immediately” – Exposure work is always gradual, collaborative, and within your control. We build a hierarchy together and work at a pace that feels challenging but manageable.
Is CBT right for you?
CBT tends to work well if you:
- Want practical strategies you can use independently
- Prefer a structured, goal-oriented approach
- Are willing to practice techniques between sessions
- Want to understand the patterns maintaining your difficulties
- Appreciate a collaborative, psycho-educational style
CBT might be less suitable as a standalone approach if you are seeking open-ended exploration of your life story, need primarily to feel heard and validated (though person-centred therapy offers this), or have very complex trauma requiring specialist trauma processing before skills work makes sense.
In my integrative practice, I often combine CBT with other approaches to provide the best fit for each individual.
How long does CBT take to work?
Many people notice some improvement within 4-6 sessions, particularly for anxiety. Depression may take slightly longer, typically showing meaningful improvement by 8-12 sessions. However, this varies considerably depending on the complexity of difficulties, how long they have been present, and how consistently you engage with between-session practice.
The effects of CBT often continue beyond the end of therapy as you keep applying the skills. Some clients return for “top-up” sessions months or years later when facing new challenges, using CBT as a resource they can access when needed.
Frequently asked questions about CBT
What qualifications should a CBT therapist have? Look for therapists accredited with professional bodies like BACP or BABCP (British Association for Behavioural and Cognitive Psychotherapies), with specific CBT training. I integrate CBT within a broader skill set alongside solution-focused therapy, DBT skills, and trauma-informed approaches.
Is CBT available on the NHS? Yes, through NHS Talking Therapies services (formerly IAPT), typically offering 6-12 sessions for common mental health problems. Self-referral is straightforward in most areas. Private therapy offers greater flexibility in session frequency, treatment duration, and integrative approaches tailored to your needs.
What if CBT does not work for me? If progress stalls, we explore why together. Sometimes the issue is the approach; sometimes it is the timing, readiness, or other factors. A good therapist will discuss alternatives rather than persisting with something that is not helping.
Can I do CBT online? Research shows online CBT can be effective. I offer both face-to-face and online sessions across England, allowing flexibility to suit your circumstances.
Moving forward with CBT
If you are struggling with anxiety, depression, relationship difficulties, or simply want to develop better coping strategies, CBT offers a practical, evidence-based path forward. It requires commitment and active participation, but the skills you learn become yours to keep long after therapy ends.
As someone who has witnessed CBT’s impact hundreds of times over – from helping men overcome social anxiety to supporting young people in care to manage overwhelming emotions – I can say with confidence that it works when the timing is right, the fit is good, and the person is ready to engage.
If you would like to explore whether CBT is the right approach for your situation, I offer integrative therapy to adults in Wokingham and online. I combine CBT with solution-focused therapy, DBT skills, and trauma-informed approaches to provide personalised, effective support. Get in touch to arrange an initial conversation about how I can help.
Image by Arek Socha