CBT (cognitive behavioural therapy)

CBT, or cognitive behavioural therapy, is a structured talking therapy that focuses on how thoughts, feelings, physical sensations and actions affect one another. It usually works on present-day problems, sets clear goals, and includes practical exercises or tasks between sessions. CBT is widely offered in the UK, including through NHS Talking Therapies services.

What it means

The central idea in CBT is that it is often not an event alone that upsets us, but the meaning we give it. A thought such as "they must think I'm useless" can trigger anxiety, which leads to avoiding people, which then seems to confirm the thought. CBT tries to interrupt that loop.

Sessions are usually time-limited, often somewhere between six and twenty. The therapist takes an active role, explaining the model, agreeing goals and suggesting exercises. Progress is often tracked with questionnaires.

Where the idea comes from

CBT grew from two traditions. Behaviour therapy, developed in the mid-twentieth century, focused on learning and changing behaviour directly. In the 1960s and 1970s the psychiatrist Aaron Beck developed cognitive therapy, after noticing that his depressed patients had recurring automatic negative thoughts. His 1976 book Cognitive Therapy and the Emotional Disorders set out the approach. Albert Ellis had developed a related method, rational emotive behaviour therapy, a little earlier.

Over time the two strands merged into what is now called CBT. Newer approaches such as acceptance and commitment therapy and compassion-focused therapy grew out of the same family.

What it can look like in everyday life

Imagine you notice that every time your manager sends a short email, you think "I've done something wrong" and spend the evening worrying. A CBT therapist might help you spot that thought, look at the evidence for and against it, and try a different response next time. You might keep a written record between sessions.

Or imagine you have recently moved to Berlin and avoid phoning offices because your German feels clumsy. CBT might help you list the feared situations, from easiest to hardest, and work through them step by step.

A third example: a woman from a close family abroad feels she must reply to every relative's message within minutes. CBT might look at the belief behind that urgency. It may not explore what the duty means to her family or culture unless she brings that in.

In person-centred counselling

Person-centred counselling and CBT are different approaches. CBT tends to be directive and skills-based. Person-centred counselling is non-directive and relational, focusing on your experience and on the relationship as a space for understanding, at your pace.

I work in a person-centred way, so I don't set homework or teach techniques. If you know you want structured tools, worksheets and a clear plan, CBT may suit you better, and that is a perfectly good choice. The person-centred counselling page explains what my way of working involves.

Related ideas

CBT is often compared with person-centred therapy and with psychodynamic therapy. Psychodynamic work looks for patterns rooted in the past and in the relationship with the therapist. CBT mostly focuses on the here and now. Person-centred work trusts the client to lead and treats the relationship itself as the main source of change.

When to get more help

If you are struggling with severe anxiety, low mood or intrusive thoughts, a GP can tell you about NHS talking therapies, which often offer CBT. If you are unsure which approach suits you, the is online counselling right for me tool asks about this honestly.