How CBT works
A clear, structured therapy that focuses on the loop between what you think, how you feel, what your body does, and what you end up doing about it — and on changing the parts of that loop quietly keeping a problem going. Here is what that actually looks like, and what to expect if we work together.
What CBT is
Cognitive behavioural therapy is the most extensively researched talking therapy there is, and the one NICE and the NHS recommend first for anxiety, low mood, OCD, panic, and a long list of other difficulties. It is practical and present-focused: rather than spending months exploring the past, we concentrate on what is keeping a problem going now, which gives us something concrete to work with from the early sessions on.
The model underneath it is simple. What you think, how you feel emotionally, what your body does, and what you do (or avoid) all feed one another. When you are stuck, those loops are quietly maintaining the difficulty — worry that produces more worry, avoidance that makes the feared thing loom larger, checking that never quite settles. CBT is the work of finding which loops are keeping you stuck, and changing them.
A model for what’s happening, and a process for changing it
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We make sense of what’s happening now.
The situations that trigger distress, the thoughts that show up, the feelings in your body, and what you do (or avoid) as a result. We map the pattern in detail.
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We identify the cycle that’s keeping it going.
Rather than asking only why something started, CBT asks what is maintaining it now. That gives us something concrete to work with from the early sessions on.
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We test new ways of responding.
Behavioural experiments, exposure work, thought records, problem-solving, reducing reassurance and checking. Small changes that test the predictions anxiety and low mood quietly make.
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You build skills you can keep using.
The aim is not to stay in therapy. It’s to leave with a clearer understanding of your patterns, practical tools to work with them, and the confidence to use them on your own.
The two kinds of work: thoughts and actions
Working with thoughts (cognitive restructuring)
One half of CBT is learning to notice automatic negative thoughts — the rapid, habitual interpretations that fire in response to a situation — and to treat them as hypotheses rather than facts. This isn’t positive thinking or telling yourself everything is fine; it’s a more rigorous process of testing a thought against the evidence. Common patterns we look for include catastrophising (expecting the worst), all-or-nothing thinking, and mind-reading (assuming you know what others think). A simple thought record — situation, thought, feeling, evidence for and against, then a more balanced alternative — gradually makes those patterns less automatic.
Learning through action (behavioural experiments)
The other half is behavioural: structured activities designed to test the predictions those thoughts make. Rather than only challenging the thought “people will think badly of me,” we might plan a situation where you can gather real evidence about what actually happens. Behavioural experiments are powerful because they produce direct, lived experience — and experience is far more convincing than insight alone. It’s a large part of why CBT consistently outperforms purely insight-based therapies for anxiety in clinical trials.
What makes CBT different — and what the evidence shows
Three things set CBT apart. It is structured and time-limited, with a clear focus on agreed goals rather than open-ended exploration. It is collaborative — we build a shared understanding of the problem and test approaches together, rather than my interpreting your experience for you. And it is present-focused: your history is useful context, but the work is on what maintains the difficulty now.
It also has the largest evidence base of any talking therapy. It has been studied in hundreds of randomised controlled trials and is recommended by NICE as a first-line treatment for depression, generalised anxiety, panic, social anxiety, OCD, PTSD and health anxiety. Effect sizes across the anxiety disorders are typically moderate-to-large, and the gains tend to last — because CBT equips you with skills you keep using after therapy ends, rather than creating an ongoing dependence on a therapist.
What a session is like
The first few minutes are usually a check-in: how the week has been, what came up, whether the things we agreed to try last time were possible. From there we set a focus for the session and work through it together. Some sessions are conversational, others involve practising a specific skill, planning a behavioural experiment, or going carefully through a pattern that came up between sessions. The format adapts; the structure underneath doesn’t.
- A clear focus for each session
- Space to talk — but not just talking for its own sake
- Practical tools to take into the week, and review the next time
- A pace that feels manageable, not pushed
- Regular reviews of whether therapy is helping, and adjustments when it isn’t
You don’t need to know exactly what you want before you start. Part of the early work is getting clear on it together. There’s a fuller walk-through in what to expect from your first CBT session.
How long it takes, and whether it works
CBT is designed to be time-limited, with a planned ending rather than an open-ended commitment. Most courses run between 8 and 20 sessions, depending on what you’re working on — many people notice meaningful shifts within the first six to eight. We review progress regularly, and if something isn’t helping, we change it.
It is delivered online by secure video, anywhere in the UK. The evidence is clear that online CBT works as well as in-person for most difficulties — there’s more on that in online CBT versus in-person, and on what a course typically involves in how many CBT sessions you might need.
If you’d like to see the specific difficulties I work with most, the specialisms page breaks each one down. For what it costs, see fees and what private CBT therapy costs in the UK.
Common questions
What happens in a typical CBT session?
We usually begin with a short check-in on how the week has been and whether the things we agreed to try were possible, then set a focus and work through it together. Some sessions are conversational; others involve practising a specific skill, planning a behavioural experiment, or going through a pattern that came up between sessions. The format adapts to what you need, but the structure underneath stays the same.
How long does CBT take to work?
Many people notice meaningful shifts within the first six to eight sessions, though this varies with what you’re working on. CBT is present-focused, so we have something concrete to work with from the early sessions on, and we review progress regularly. If something isn’t helping, we change it.
Does CBT involve homework?
Yes — a lot of the change happens between sessions. You’ll usually take practical tools into the week, such as a thought record or a behavioural experiment, and we review how they went next time. These small experiments are powerful because they produce direct, lived experience, which tends to be far more convincing than insight alone.
Is CBT just positive thinking?
No. It isn’t positive thinking or telling yourself everything is fine — it’s a more rigorous process of treating an automatic thought as a hypothesis and testing it against the evidence. Alongside that, behavioural experiments let you gather real evidence about what actually happens, rather than simply trying to think more cheerfully.
How many CBT sessions will I need?
Most courses run between 8 and 20 sessions, depending on what you’re working on. CBT is designed to be time-limited, with a planned ending rather than an open-ended commitment, and we review progress as we go. The aim is for you to leave with skills you can keep using on your own.
You don’t need to have it all figured out.
The consultation is free, lasts fifteen minutes, and exists so we can both work out whether this is the right fit before either of us commits to anything. Sessions are £80 for fifty minutes.
Currently offering online sessions across the UK. Edinburgh in-person sessions coming soon.