"I know I'm overthinking it. I just can't stop."
Cognitive Behavioural Therapy (CBT) is a counselling approach that focuses on the relationship between thoughts, feelings and behaviour. Its starting point is that how we interpret a situation shapes how we feel; how we feel shapes what we do; and what we do, in turn, reinforces the original interpretation. The work usually involves identifying the thinking patterns and behavioural responses that keep you stuck, and then building more helpful ways of responding.
CBT is one of the most researched and widely used approaches in counselling today, and is especially common for anxiety and depression. This page explains what it is, what sessions are actually like, who and which concerns it suits, what it is not, and what the research says about how well it works.
1 counsellors on Solacare currently use Cognitive Behavioural Therapy (CBT). If you are considering it, you can go straight to the counsellors who offer this approach.
See counsellorsCBT holds that much of what troubles us is not the event itself, but how we read it and how we respond to that reading. The same event, read differently, produces completely different feelings and actions, and those actions then make the original reading feel even more certain. An example:
The work of CBT is to see this cycle clearly with you and find the link that is easiest to change. Sometimes that means examining how accurate the thought is (could there be other reasons your friend has not replied?). Sometimes it means changing the behaviour (send one more message and see what happens). Sometimes it means settling the body first. Change one link, and the others usually loosen with it.
CBT is not about thinking "better"; it is about thinking more accurately, then doing something different from before, so that experience can tell you whether the thought holds up.
The first session is mostly about understanding: what the concern is, when it started, how much it affects your life, and what you want to change. Your counsellor will ask fairly specific questions, briefly explain how CBT works, and set one or two initial goals with you. Techniques usually come later; the first session is about building a shared understanding.
CBT questions are specific, because the aim is to find patterns. You will often hear things like: "Was there a particularly difficult moment last week? What was happening? What went through your mind? What did you notice in your body? What did you do next?" Rather than "why do you think that is," CBT more often asks "what exactly happened."
Yes, this is a hallmark of CBT. Homework might be keeping a record of difficult moments and the thoughts that came with them, trying a small experiment (staying ten minutes in a situation you usually avoid), or practising a relaxation method. The amount is agreed with you and usually starts very small. You will not be scolded for not doing it, but people who do tend to progress faster.
Compared with other approaches, yes. Each session usually has a simple agenda: review last week's exercise, focus on one or two topics, sum up the main points and the practice before next time. It is not read from a script, though; your counsellor adjusts to how you are that day. If something big happened that week, that comes first.
Yes. CBT is one of the few approaches that teaches skills directly: how to examine a thought, how to approach something you have been avoiding one step at a time, how to settle your body. The aim is for you to learn to do it yourself, so that eventually you no longer need the counsellor. That is why CBT is often described as "learning to be your own therapist."
Here is a common flow. It is not a guarantee, and it varies between counsellors and between stages of the work:
CBT is usually weekly, around fifty minutes a session, and commonly runs eight to twenty sessions in total. It is a time-limited form of counselling: a rough number of sessions is discussed at the start and reviewed partway through.
No approach suits everyone. The lists below are not entry requirements; they are a way of sensing whether the style of CBT fits you:
In practice, many counsellors use CBT as a base and bring in elements of other approaches depending on your situation. You do not need to pick the "right" one before you start.
CBT is most often used for anxiety, depression, panic, social anxiety, phobias, obsessive-compulsive difficulties, insomnia and stress. It is also common for trauma (usually in an adapted, trauma-focused form), self-image and burnout. Whether it fits still depends on your situation and goals, not on the name of the concern. These are some of the concerns CBT is most often paired with; open any of them to see how the concern shows up and where counselling goes with it:
Worry that will not switch off, a body that stays tense, and difficulty relaxing.
Persistent low mood, loss of interest and motivation, and a sense that nothing matters.
When the past keeps shaping the present, and body and mind feel stuck in that moment.
How you see yourself, your sense of worth, and the voice that keeps criticising you.
When prolonged work stress has drained you and nothing about work feels worth the effort.
CBT is the approach most people have heard of, and also the one most people misunderstand. Some common misconceptions:
"CBT just tells you to think positive."
CBT does not ask you to believe nice things. It asks you to check how accurate your thoughts are. Sometimes the conclusion is "the situation really is bad," and then CBT turns to how you can cope with it, rather than forcing optimism.
"CBT is all logic and ignores feelings."
Emotion is where CBT starts; every exercise begins with "what were you feeling at that moment." CBT simply holds that changing thoughts and behaviour is the most direct way in, because emotion itself cannot be ordered to change.
"CBT is just filling in worksheets."
Worksheets are tools, not the whole thing. The core of CBT is still the conversation and the relationship between you and your counsellor. If the whole process feels like form-filling, that is CBT done badly, not CBT itself.
"CBT ignores the past completely."
CBT focuses on the present, but it does look at how your thinking patterns formed. If past experience is at the heart of the concern, your counsellor will work with it, or discuss whether another approach should be brought alongside.
CBT is the most researched of all counselling approaches. The UK's National Institute for Health and Care Excellence (NICE) lists CBT among the first-line psychological treatments in its clinical guidelines for both depression and anxiety, and the American Psychological Association's Society of Clinical Psychology includes CBT in its list of research-supported treatments for a wide range of concerns. The strongest evidence is for anxiety disorders, depression, panic, obsessive-compulsive difficulties, insomnia and post-traumatic stress.
The research also points to a few things worth knowing. First, for many concerns, CBT works about as well as other rigorously delivered approaches; it is not the "only thing that works." Second, outcomes depend heavily on the relationship with your counsellor, your situation and goals, and how much you engage with the practice, not just on the approach itself. Third, CBT delivered online works about as well as in person for anxiety and depression.
Many commercial sites only say "highly effective." CBT does have strong evidence, but it also has limits:
KK Li
Counsellor
MAGC, MSSPSY, PDAPSY
Hello，我係KK，曾任外資公司社畜三十多年，大約十年前因為感召而立志發展助人工作為人生第二職涯。 明白人生難免有起有落，無論你遇上學業, 事業上的壓力，人際關係，個人情緒健康等等問題, 我會透過輔導技巧加上人生經驗與你一起探索問題及其癥結﹐釐清你的感受與想法﹐並嘗試提出相應的行動計劃。
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Learning to allow difficult feelings to be present while living in line with what matters to you.
Concrete skills for regulating intense emotions, tolerating distress and handling relationships.
Addresses deep-rooted beliefs formed early in life that keep shaping relationships and self-worth.
Cultivating present-moment awareness so thoughts and emotions have less pull.
Explores the feelings, relationship patterns and early experiences beneath a concern.