Cognitive behavioural therapy (CBT)

What is CBT?

Cognitive behavioural therapy, or CBT, is a structured talking therapy that examines how thoughts, feelings and behaviour connect, then helps you change unhelpful patterns rather than only exploring their causes. It is one of the most researched therapies in mental health and is used widely across the NHS and private practice.

The approach was developed in the 1960s by psychiatrist Aaron Beck, who noticed that patterns of negative or distorted thinking often kept people stuck in low mood and anxiety. Unlike therapies that spend most of their time on early life history, CBT works mainly in the present. Sessions are structured and goal-focused, moving between talking through a specific problem, testing out new ways of responding to it and reviewing what happened. Between sessions you will usually be asked to try something out, whether that is a piece of writing, a behavioural experiment or simply noticing a pattern, and bring it back to discuss.

At the core of CBT is a simple idea: how you think about a situation affects how you feel, and how you feel affects what you do next, which in turn feeds back into your thinking. A person who thinks a work presentation will go badly may feel anxious, avoid preparing properly and then perform less well, which reinforces the original thought. CBT breaks into that cycle at different points, sometimes by testing out whether a thought is accurate, sometimes by changing a behaviour first and seeing what shifts as a result.

Who CBT can help

Common difficulties

CBT has evidence behind it for a wide range of difficulties in adults, including depression, generalised anxiety, social anxiety, panic disorder, health anxiety, obsessive compulsive disorder, phobias and difficulties following a traumatic event. It is also used for insomnia, chronic pain management and low self-esteem, often alongside other support. Some people come to CBT with a clear diagnosis from a GP or previous assessment, others simply notice that worry, low mood or unhelpful habits are affecting daily life and want a structured way to address them. CBT tends to suit people who prefer an active, practical approach and are willing to try new strategies between sessions, rather than an approach built mainly around open-ended reflection.

When a different approach might suit better

CBT is not the only effective therapy, and it is not always the right fit. If a difficulty is rooted in longstanding relationship patterns, complex trauma or bereavement, a different approach, such as psychodynamic therapy or compassion-focused therapy, may be more suitable, and this can be discussed at assessment. CBT also asks for active participation between sessions, so it tends to work best when you have some time and willingness to try the tasks agreed with your therapist, even when motivation is low.

What to expect from a course of CBT

A course of CBT usually starts with an assessment, where your therapist asks about the difficulty you want help with, how it developed and how it affects you day to day. From this you and your therapist build a shared understanding, sometimes called a formulation, of what keeps the problem going. You will then agree specific, realistic goals together, which shape the rest of the sessions.

Each session tends to follow a similar shape: a brief check-in, review of the previous week’s task, work on the main topic for that session, and agreement of a new task to try before the next one. Techniques vary depending on the difficulty but often include noticing and questioning unhelpful thoughts, gradually facing situations that have been avoided and building new habits around sleep, activity or worry. Progress is usually reviewed at intervals against the goals set at the start, so you can see what is changing and adjust the focus if needed. A course is time-limited rather than open-ended, with an ending that is planned rather than left open.

What sessions involve

The relationship between you and your therapist matters throughout, since CBT works best when you feel able to be honest about what is and is not working. Sessions typically last around fifty minutes and take place weekly to begin with, though this can be reviewed as treatment goes on. You are free to ask questions about the approach at any point, and your therapist will explain the reasoning behind a particular technique rather than expecting you to follow it without discussion.

The evidence for CBT

CBT has one of the largest evidence bases of any psychological therapy, built up over several decades of clinical trials. The National Institute for Health and Care Excellence (NICE) recommends CBT as a treatment option for depression, generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder and post-traumatic stress disorder, among other conditions, and a specific form of CBT for insomnia is also recommended for sleep difficulties. This does not mean CBT suits everyone or works for every problem. Some people respond well quickly, others need longer or benefit more from a different approach, and your therapist will discuss this with you as treatment progresses.

CBT delivered online for Maidstone and Kent

We are clinical psychologists working with adults across Maidstone and Kent, delivering therapy online, covering areas including Bearsted, Allington, Barming, Loose, Penenden Heath and Tovil. Sessions take place over secure video call, so you can take part from home or anywhere private with a stable connection, without travel to and from Maidstone East or Maidstone West. Maidstone sits either side of the River Medway across the ME14, ME15 and ME16 postcodes, and clients we work with are spread across the town and the surrounding villages. Materials used between sessions, such as thought records or activity diaries, are shared digitally so you can refer back to them at any point. If you are unsure whether CBT is the right starting point, an initial conversation can help you decide together. We will update this site as the practice develops.