Online Therapy vs in Person Therapy: Which Is Right for You?

If you've recently started exploring mental health support, you may have come across the term CBT. But what is CBT, and why is it one of the most widely recommended forms of psychological therapy worldwide? In this beginner's guide, we'll explain what cognitive behavioural therapy is, how it works, what a typical session looks like, and who may benefit from this therapeutic approach.

What Is CBT?

So, what is CBT exactly? Cognitive Behavioural Therapy (CBT) is a structured, goal-oriented form of psychotherapy that focuses on the connection between our thoughts, emotions, physical sensations, and behaviours.

The central idea behind CBT is that the way we think about situations influences how we feel and act. Sometimes, people develop patterns of negative or unhelpful thinking that can contribute to emotional distress.

CBT helps individuals:

• Recognise unhelpful thought patterns.

• Challenge inaccurate or negative beliefs.

• Develop healthier ways of thinking.

• Learn practical coping strategies.

• Change behaviours that may be maintaining emotional difficulties.

What Is Cognitive Behavioural Therapy Based On?

CBT grew from the cognitive model developed by psychiatrist Aaron Beck in the 1960s. This model suggests that thoughts, feelings, behaviours, and physical sensations are closely linked. A shift in one part of that system can affect the others.

For example, two people may experience the same event but interpret it differently. One interpretation may lead to calm or confidence; another may trigger anxiety, shame, or withdrawal. CBT pays close attention to those interpretations, especially the automatic thoughts that arise quickly and often go unquestioned.

In therapy, that chain would be explored rather than accepted at face value. Is there evidence the friend is upset? Could there be another explanation? What happens when the anxious thought is treated as fact? The goal is not forced positivity, but a fairer and more realistic perspective.

The Aim of CBT

The main aim of CBT is to help people build healthier patterns of thinking and behaviour so that emotional distress becomes easier to understand and manage. In practice, that can mean reducing the intensity of anxiety, softening self-critical thoughts, improving coping skills, or gradually returning to activities that have been avoided.

CBT is also designed to be lasting. Rather than creating dependence on therapy, it aims to teach tools people can continue using long after treatment ends. These may include recognising triggers, questioning assumptions, setting realistic goals, and responding to setbacks without spiralling into old habits. In that sense, CBT often supports resilience as much as symptom relief.

What CBT Is Commonly Used For

CBT is one of the most extensively studied psychological therapies and is used across a wide range of difficulties. It is commonly offered for anxiety disorders, depression, panic disorder, social anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, health anxiety, stress and burnout, phobias, eating disorders, insomnia, and chronic pain. In the UK, it is widely recommended for several common mental health conditions, including anxiety and depression.

CBT for Anxiety

CBT is especially well known for treating anxiety. It helps people identify fearful predictions, challenge catastrophic thinking, reduce avoidance, and gradually face situations that have become loaded with fear. Relaxation, coping strategies, and behavioural experiments may also be used to test what happens in practice rather than relying on worst-case assumptions.

CBT for Depression

When someone is depressed, thinking often becomes narrowed by hopelessness, guilt, self-criticism, or a sense that nothing will change. CBT helps people notice these patterns and examine them more carefully. It also encourages behavioural changes, such as reintroducing meaningful, pleasurable, or necessary activities that depression has pushed aside.

CBT for Insomnia (CBT-I)

CBT for insomnia, often called CBT-I, is a specialised form of treatment for persistent sleep difficulties. It may include sleep education, sleep scheduling, stimulus control, relaxation strategies, and work on the beliefs and worries that often surround poor sleep. CBT-I is frequently recommended as a first-line treatment for chronic insomnia.

Cognitive Behavioral Therapy for ADHD

CBT can also be adapted to support people with attention-deficit/hyperactivity disorder. In this context, the focus is often on organisation, time management, problem-solving, emotional regulation, and reducing procrastination. It is commonly used alongside medication and other support strategies rather than as a stand-alone answer to every difficulty.

Trauma-Focused CBT

Trauma-Focused CBT is a specialist adaptation developed primarily for children and adolescents who have experienced traumatic events. It combines core cognitive and behavioural techniques with trauma-sensitive support to help young people process difficult experiences safely.

Enhanced CBT for Eating Disorders

Enhanced Cognitive Behavioural Therapy, often called CBT-E, is tailored for eating disorders. It addresses unhelpful beliefs about weight and shape, eating behaviours, emotional regulation, perfectionism, and self-esteem. It is widely used in the treatment of conditions such as bulimia nervosa and binge eating disorder.

What Is Behavioural Activation in CBT?

One important CBT approach, especially in depression, is behavioural activation. Depression often causes people to withdraw from the very activities that could help them feel more connected, capable, or energised. The result can be a cycle of low mood, less activity, and even lower mood.

Behavioural activation works by gently reversing that pattern. A therapist may help someone plan manageable actions that bring a sense of pleasure, achievement, or contact with other people. These steps are usually small and realistic, but over time they can interrupt the cycle of withdrawal and help rebuild momentum.

What Is a CBT Session Like?

Unlike some forms of therapy, CBT is usually structured and collaborative. A typical CBT session may include:

• Reviewing progress since the previous session.

• Discussing current difficulties.

• Identifying unhelpful thoughts or behaviours.

• Practising specific techniques or exercises.

• Agreeing on goals or homework for the following week.

• Sessions typically last between 45 and 60 minutes. Many people describe CBT as practical, active, and solution-focused.

What Is Socratic Questioning in Cognitive Behavioural Therapy?

A central CBT technique is Socratic questioning. This means the therapist asks guided questions that help a person examine their thoughts more carefully instead of automatically believing them. The purpose is not to argue or dismiss feelings, but to create enough distance for a more balanced view to emerge.

Typical questions might include:

• What evidence supports this thought?

• What evidence does not support it?

• Is there another explanation for what happened?

• What would you say to a friend in the same situation?

• Are you treating the worst-case scenario as if it were certain?
  

What Is an Example of Cognitive Behavioural Therapy?

Understanding a real-life example can make CBT easier to understand.

Example:

• Situation: You make a mistake during a work presentation.

• Automatic thought: "I'm terrible at my job."

• Emotion: Anxiety and shame.

• Behaviour: Avoid speaking during future meetings.

In CBT, a therapist would help you examine this thought by exploring evidence for and against it. A more balanced thought might become:

"I made a mistake, but everyone makes mistakes occasionally. One presentation doesn't define my abilities."

Over time, this can reduce anxiety and encourage healthier behaviours.

How CBT Usually Works: 5 Common Stages

CBT does not usually follow a rigid, one-time sequence. These stages are a simplified way to understand the process, but in real therapy they are often revisited and adjusted over several sessions as new situations, thoughts, and behaviours come up.

Identify the problem or situation

The first step in CBT involves identifying the specific problem or challenge you would like to address. This could be anxiety, depression, stress, sleep difficulties, relationship issues, or any other concern affecting your wellbeing. Your therapist will work with you to clearly define the issue and understand how it impacts different areas of your life.

Explore thoughts, feelings, and behaviours

Once the problem has been identified, you'll begin exploring how your thoughts, emotions, physical sensations, and behaviours interact with one another. For example, someone who feels anxious about public speaking may think, "I'm going to embarrass myself," which leads to feelings of anxiety and avoidance behaviours, such as declining speaking opportunities.

Identify unhelpful thinking patterns

The next step is recognising negative or unhelpful thinking patterns that may be contributing to emotional distress.

Common cognitive distortions include:

• Catastrophising

• Black-and-white thinking

• Mind reading

• Overgeneralisation

Challenge and reframe negative thoughts

After identifying unhelpful thoughts, CBT encourages individuals to examine whether these beliefs are realistic, accurate, or helpful. Therapists often use techniques such as Socratic questioning to help clients look at situations from a different perspective. For instance, instead of thinking "I'm terrible at my job," a person might learn to reframe this thought as "I made a mistake, but everyone makes mistakes from time to time." Over time, this process can lead to healthier and more balanced thinking patterns.

Develop new behaviours and coping strategies

The final step focuses on applying new skills in everyday life. CBT is a practical therapy, so clients are encouraged to put what they learn into action outside of sessions. Depending on the person's goals, this may involve gradually facing feared situations, establishing healthier routines, practising relaxation techniques, or increasing participation in enjoyable activities.

What Age is CBT Suitable for?

CBT can be adapted for children, adolescents, adults, and older adults. For younger children, therapists may use:

• Games

• Stories

• Drawings

• Play-based activities

The suitability of CBT depends more on developmental stage, communication abilities, and individual needs than age alone.

What Is the Success Rate of Cognitive Behavioural Therapy?

Many studies have shown CBT to be highly effective for a range of mental health conditions. The exact success rate varies depending on the condition being treated, symptom severity, and individual circumstances. However, research consistently demonstrates significant improvements for many people receiving CBT for anxiety and depression.

The strongest outcomes typically occur when individuals actively engage in sessions and practise techniques between appointments.

How Effective Is CBT?

For moderate to severe depression or severe anxiety disorders, CBT may also be used alongside medication, depending on the person’s symptoms, preferences, and clinical needs. This does not mean CBT is less useful, but rather that combined treatment can sometimes offer more appropriate support.

Research consistently shows that CBT can be highly effective for many people and across many conditions, particularly anxiety and depression. That said, there is no single success rate that applies to everyone. Outcomes vary depending on the problem being treated, how severe it is, whether there are other complicating factors, and how actively the person is able to engage with the process.

In general, CBT tends to work best when people attend regularly, practise strategies between sessions, and give themselves enough time to build new habits rather than expecting an immediate transformation.

What to Expect During Treatment

If you're considering Cognitive Behavioural Therapy, it's natural to wonder what the process involves. While every therapist works slightly differently, CBT is generally structured, collaborative, and focused on helping you develop practical skills to manage your difficulties.

During the first few sessions, your therapist will usually spend time getting to know you, understanding your concerns, and discussing your goals for therapy. Together, you'll identify the thoughts, emotions, and behaviours that may be contributing to your current challenges.

Throughout treatment, you can expect CBT to involve:

• Setting clear and achievable goals.

• Exploring how your thoughts influence your feelings and behaviours.

• Learning practical coping strategies and techniques.

• Identifying and challenging unhelpful thinking patterns.

• Practising new skills both during and between sessions.

• Regularly reviewing your progress and adjusting goals when needed.

CBT is often an active form of therapy, meaning you may be encouraged to complete exercises or "homework" between sessions. These activities are designed to help you apply what you've learned in real-life situations and reinforce new coping skills.

The number of sessions required varies depending on the individual and the difficulties being addressed. Some people may benefit from short-term therapy lasting 6 to 12 sessions, while others may require longer-term support. Above all, CBT is designed to help you become your own therapist over time, equipping you with tools and strategies that you can continue using long after treatment has ended.

Evidence and Citations