Cognitive Behavioural Therapy(CBT)
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Overview
Cognitive Behavioural Therapy (CBT) is a structured, time-limited psychological therapy that helps people understand how their thoughts, behaviours, and physical responses interact to maintain emotional distress. It focuses on present-day difficulties and aims to develop practical skills that can be used beyond therapy.
CBT is not about positive thinking or ignoring emotions. It is a collaborative, skills-based approach grounded in psychological science. It draws on both cognitive models (how we interpret situations) and behavioural principles (how actions and avoidance maintain problems).
What this therapy focuses on
CBT helps people notice unhelpful thinking patterns, behaviours, and coping strategies that keep problems going, and gradually replace them with more adaptive alternatives. The approach is collaborative: therapist and client work together to understand the problem, set goals, and test new ways of responding.
What sessions are usually like
Sessions are structured with an agenda set at the start
Typical session length: 45–60 minutes
Frequency: Weekly or fortnightly
Time-limited: Yes (commonly 6–20 sessions depending on the problem)
Between-session work: Yes — practising skills, behavioural experiments, thought records, and reflection
Sessions often include reviewing homework, working on a specific topic, and planning the next steps
Session profile
Common uses and suitability
What problems it is commonly used for
Who this therapy may suit best
- People who want practical, skills-based tools
- Those comfortable with structured sessions and collaborative goal-setting
- Individuals willing to practise skills between sessions
- People seeking a time-limited approach with clear endpoints
When it may need adapting or may not be suitable
- Severe dissociation without prior stabilisation
- Acute crisis requiring immediate safety planning before therapy work
- When relational or developmental trauma dominates without appropriate modification (e.g., trauma-focused CBT or phase-based approach)
- Significant cognitive impairment may require adapted materials or delivery
- Complex personality difficulties may benefit from longer or modified CBT approaches
Where this therapy may not be enough
CBT may not be sufficient when difficulties are primarily relational or rooted in developmental trauma without adaptation. Complex presentations may require longer, modified, or supplementary approaches. CBT alone may not address systemic or environmental factors maintaining distress.
What happens in therapy
Thought Records
A structured way to notice and examine unhelpful thoughts, looking at the evidence for and against them.
Behavioural Experiments
Planned activities to test whether your predictions or beliefs are accurate in real life.
Exposure Exercises
Gradually and safely facing situations you have been avoiding, to reduce anxiety over time.
Activity Scheduling
Planning activities that bring pleasure, achievement, or connection into your daily routine.
Problem-Solving
A step-by-step approach to working through practical problems that contribute to distress.
Graded Exposure Hierarchy
Building a step-by-step ladder of feared situations, starting with the least difficult and working up.
Evidence Base
Guideline support
Strong and consistent. CBT is recommended by NICE guidelines for depression (NG222), generalised anxiety disorder (CG113), panic disorder (CG113), social anxiety disorder (CG159), OCD (CG31), PTSD (NG116 — trauma-focused CBT), eating disorders (NG69 — CBT-E), psychosis (CG178 — CBTp), and insomnia. The APA similarly recommends CBT for multiple conditions. The WHO includes CBT in its mental health intervention guidelines.
Strength of evidence
Strong across multiple conditions. CBT has the largest evidence base of any psychological therapy, with hundreds of randomised controlled trials and multiple meta-analyses demonstrating efficacy across a wide range of presentations.
Limitations
Effect sizes vary by condition and population. Therapist competence, adherence to protocol, and quality of formulation significantly affect outcomes. CBT may be less effective when delivered without adequate training or when the formulation does not match the presenting problem. Drop-out rates can be notable in some populations. The evidence base is stronger for some conditions (e.g., anxiety disorders, depression) than others (e.g., complex trauma, personality disorders without adaptation).
Evidence claims by condition
CBT is one of the most recommended talking therapies for depression, helping people change unhelpful patterns that keep low mood going.
CBT helps people with ongoing worry by teaching skills to manage anxious thoughts and reduce avoidance.
A specific type of CBT that includes exposure and response prevention (ERP) is the recommended talking therapy for OCD.
Trauma-focused CBT is one of the main recommended treatments for PTSD, helping people process traumatic memories safely.
Resources & Printables
For Adults
Understanding the CBT Model
A one-page guide explaining how thoughts, feelings, behaviours, and physical sensations connect.
Thought Record Worksheet
A structured worksheet for identifying and evaluating unhelpful thoughts.
Behavioural Experiment Planner
A template for designing experiments to test anxious predictions.
Relapse Prevention Plan
A structured plan for maintaining progress after therapy ends.
For Children (6–11)
For Teenagers (12–17)
For Parents & Caregivers
How CBT Helps Children
An explanation for parents about what their child will learn in CBT.
Supporting Skills Practice at Home
Practical tips for parents to help their child practise CBT skills.
School Communication One-Pager
A template for communicating with schools about CBT-related support needs.
Practitioner & Training Notes
Typical professional background
Clinical psychologists, psychiatrists, CBT psychotherapists, high-intensity IAPT therapists, and other mental health professionals with accredited CBT training.
Recognised training routes
Postgraduate diploma or MSc in CBT from a BABCP-accredited programme. Training typically includes supervised clinical practice with a required number of hours and assessed competencies. BABCP accreditation requires demonstrated competence against defined standards.
Registration considerations
BABCP (UK) maintains an accredited register overseen by the Professional Standards Authority (PSA). International equivalents exist in the US (Academy of Cognitive Therapy), Australia, and other jurisdictions.
Source Registry
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Last evidence review: January 2026. All sources are verified and checked on a scheduled cadence.