Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy, known as CBT, looks at how your thoughts, feelings, body and actions feed into each other, then helps you change the patterns keeping a problem going. It is the most researched talking therapy available in the UK and NICE’s first-line recommendation for anxiety, depression, OCD, panic and health anxiety.

What CBT is and the evidence for it

CBT grew out of the work of the American psychiatrist Aaron Beck and psychologist Albert Ellis in the 1960s, and it has since become the most extensively tested talking therapy in mental health. NICE recommends it as a first-line treatment for generalised anxiety disorder, panic disorder, social anxiety, depression, obsessive-compulsive disorder, health anxiety and, in a trauma-focused form, post-traumatic stress disorder, usually ahead of other psychological therapies. Hundreds of randomised controlled trials sit behind these recommendations, more than for any other talking therapy.

The model itself is straightforward, even if applying it takes skill. How you interpret a situation shapes how you feel about it and what you then do, and each of those feeds back into the others. A racing heart in a meeting can be read as a sign of danger or as a normal stress response, and that single difference in interpretation changes everything downstream. A course of CBT maps that cycle for your specific difficulty with a clinical psychologist, then looks for the points where it can be interrupted.

What CBT helps with

CBT has the broadest evidence base of any psychological therapy, which is why it is usually the starting point for most difficulties. It is used for anxiety in its various forms, generalised worry, social anxiety, health anxiety and panic, as well as for depression, obsessive-compulsive disorder and stress and burnout. For some presentations CBT is adapted into a specific protocol: exposure with response prevention for OCD, for example, or a trauma-focused version for PTSD and trauma, which has its own page here because the approach differs enough to warrant one. The common thread across all of these is a structured, practical way of working that focuses on the patterns keeping a difficulty going now, rather than only on where it came from.

What a course of CBT looks like

The first sessions are about assessment: understanding your difficulty, what keeps it active, and what you want to change. Your psychologist will usually introduce a shared model early on, a simple way of mapping how a trigger leads to a thought, a feeling, a physical sensation and a behaviour, so you can both see the cycle clearly rather than it staying implicit. From there, sessions become collaborative and practical. You might test out a belief you have been treating as fact, plan a piece of graded exposure to something you have been avoiding, or work through a thought record together line by line.

Tasks between sessions are a normal part of the process, not an optional extra tacked on. That might mean keeping a brief diary of thought patterns, trying a new response to a physical symptom when it arises, or approaching a feared situation in small, agreed steps. Most courses run for somewhere between eight and twenty sessions of about fifty minutes, reviewed at regular points rather than fixed from the outset. Your psychologist adjusts the pace and focus as the picture becomes clearer.

How CBT works online

CBT was one of the first talking therapies shown to translate well to video, partly because so much of the work is structured and shares easily on screen: a thought record, a hierarchy of feared situations, a worksheet, rather than materials passed across a desk. Sessions run over secure video, usually fifty minutes, with your psychologist sharing any tools you are using together as you go.

The main adjustment is around exposure work. In-person CBT sometimes involves practising a feared situation together in the room. Online, that practice is planned for your own environment and reviewed together at the next session instead. For a lot of people this turns out to be an advantage rather than a workaround, because the situations causing difficulty, a crowded commute, a work video call, a supermarket, are usually easier to practise from the place where they actually happen than to recreate in a clinic.

CBT and life in Islington

Islington’s N1 postcodes take in Upper Street, Angel, Highbury, Canonbury and Barnsbury, with the Victoria and Northern lines running through the area. A lot of the anxiety and low mood that brings people to CBT locally is tangled up with the pace of that working life, back-to-back meetings, a packed Victoria line commute, or the general difficulty of switching off between one thing and the next. Fitting therapy around an Upper Street working day is one of the practical reasons online sessions work well here, since there is no travel time either side of the appointment to find on top of everything else.

Who CBT may not suit

CBT suits people who want a structured, present-focused approach and are willing to try things between sessions. It works best for difficulties with a fairly clear pattern of thoughts, feelings and behaviour behind them. It fits less well if your main difficulty is longstanding and relational, patterns rooted early in life that turn up across most of your relationships, where schema therapy may be a better starting point. If the idea of homework puts you off, or you would rather explore where a difficulty comes from than change current patterns first, say so at assessment. Your psychologist will discuss alternatives rather than pushing ahead with CBT regardless.

Getting started

CBT here is delivered online. There is no need to wait for that before starting. If anxiety, depression, OCD or another difficulty CBT tends to suit is getting in the way of things, our get started page is the quickest way to tell us what is going on.