Cognitive behavioural therapy (CBT)

What is CBT?

Cognitive behavioural therapy, usually shortened to CBT, is a structured talking therapy that looks at the links between thoughts, feelings, physical sensations and behaviour. Rather than focusing only on the past, it works on what is happening now, helping you spot patterns that keep a problem going and practise different ways of responding to them.

The idea behind CBT is simple even though the effects can take real work to reach: thoughts, feelings and actions are connected, so a shift in one tends to move the others. Someone who feels anxious about a work presentation might think ‘I am going to make a fool of myself’, notice their heart racing, and then avoid volunteering for similar tasks in future. CBT helps you notice that chain as it happens, test whether the thought holds up, and try a different response, whether that is a small behavioural experiment, a breathing technique, or simply pausing before reacting. Sessions are structured and collaborative. You and your therapist agree what to focus on, set an aim for each block of work, and review progress along the way, rather than talking in a general way with no clear direction.

When CBT helps

CBT is most established for anxiety and depression, but the same approach is used for a wider range of difficulties. It is commonly used for generalised anxiety, social anxiety, panic, health anxiety, obsessive compulsive disorder (OCD), post traumatic stress, low mood and depression, and some difficulties with sleep, anger or living with chronic pain. It also suits people who want a structured way to work through a specific problem, such as procrastination, low confidence or a pattern of avoidance that has built up over time, rather than an open-ended look at everything going on in their life.

CBT tends to work well when there is a clear focus: a mood that has dropped, a fear that keeps things off limits, or a habit of thinking that turns small setbacks into much bigger ones. If your difficulties are longstanding, CBT can still help. The approach is adjusted to allow more time for understanding how a pattern developed before working on changing it, and a therapist will normally talk through with you whether CBT is a good match for what you are bringing, or whether another approach might suit better.

What to expect from a course of CBT

A course of CBT usually starts with an assessment, where you and your therapist talk through what has been happening, how it affects your day to day life, and what you would like to be different. From there, you will typically agree a small number of goals and a rough plan for how many sessions you might need, though this can change as the work progresses.

Each session tends to follow a similar shape: a brief check-in on how the week has gone, a review of anything tried since last time, a main piece of work such as examining a difficult thought or planning a small behavioural experiment, and a closing summary with something to try before the next session. Trying things out between sessions is a normal part of CBT rather than an optional extra, since much of the change happens in daily life rather than in the session itself. Therapists adjust the pace and the exercises to suit you, so this does not mean rigid worksheets for everyone. Some people prefer short written notes, others prefer a voice memo on their phone or a mental note to revisit later.

Sessions are usually weekly to begin with, moving to a longer gap between sessions as things settle, so that you have room to test out changes in real life before the next check-in.

The evidence for CBT

CBT has one of the largest evidence bases of any talking therapy. It is recommended by the National Institute for Health and Care Excellence (NICE) as a treatment option for a range of common mental health difficulties, including depression, generalised anxiety disorder, social anxiety, panic disorder, OCD and post traumatic stress disorder, usually alongside or as an alternative to medication depending on the person and the difficulty involved.

Trials carried out over several decades have tested CBT against other therapies, against medication and against no treatment at all. Taken together, they generally show that people who complete a course of CBT see a meaningful drop in symptoms, with benefits that tend to hold up over time because the skills learned continue to be used after therapy ends. Evidence of this kind describes what tends to happen across large groups of people. It cannot promise a particular outcome for any one person, and how much a course of CBT helps depends on the difficulty being treated, how the therapy is delivered and the working relationship between therapist and client.

CBT online for Brighton and East Sussex

We are clinical psychologists working online with adults across Brighton and East Sussex, from the seafront, the Lanes and North Laine up into BN1 and BN2, and out to Hove, Kemptown, Preston Park, Hanover, Withdean and Portslade. An online format suits a city with a steady mix of commuters, who can reach London Victoria and London Bridge from Brighton station in around an hour, students, and people who have moved down from London, many of whom need appointments that fit around a changing diary rather than a fixed local address.

CBT works well delivered this way because the core of it, the discussion, the practice and the review of what has changed, does not depend on being in the same room. A private space with a closed door and a stable internet connection is generally all that is needed, whether you are logging on from a flat near London Road station, a house out towards Withdean, or a desk during a break from commuting through Preston Park. We will update this site as the practice develops.

Frequently asked questions

How soon does CBT start to make a difference?

This varies a great deal depending on the difficulty and how long it has been going on. Some people notice small shifts within a handful of sessions, particularly with a specific fear or a recent low patch, while longer-standing patterns usually need more time to unpick and change. Your therapist will normally review progress with you at set points rather than leaving this vague.

Is CBT only about changing how I think?

No. CBT looks at thoughts, feelings, physical sensations and behaviour together, and in practice a lot of the work involves trying out different actions, such as approaching something you would normally avoid, rather than only examining a thought on paper. Changing what you do is often what shifts how you think and feel, not the other way round.

Can CBT help if a problem has been going on for years?

Yes, though the approach may need to be adjusted. Longstanding patterns are often more embedded, so a therapist may spend longer helping you understand how the pattern built up before moving into the more active, change-focused stage of the work.

What if I find the exercises between sessions difficult?

This is common and worth raising directly with your therapist rather than quietly dropping them. Exercises can usually be scaled down, changed, or approached differently, and working out why something felt hard is often useful information in itself.

Does CBT work as well delivered online as it does in person?

Research comparing online and in-person CBT generally finds similar outcomes for most common difficulties, provided sessions are structured in the same way and you have a private, reasonably quiet space to take the call. Some people also find it easier to fit consistent sessions around work or caring responsibilities when they do not need to travel.

How many sessions does a course of CBT usually involve?

This depends on what is being worked on, but many courses run for somewhere between six and twenty sessions. Your therapist will give you a clearer estimate once they understand what you are bringing, and this can be revisited as the work goes on.