![Illustration representing cognitive behavioural therapy](https://viacara.com/img/content/approaches-cbt-feature-light.webp) # Cognitive Behavioural Therapy (CBT) Learn how CBT works, what happens in sessions and what NICE says about it, and read about its forms for sleep, pain and self-help. ## What is *CBT*? Cognitive behavioural therapy (CBT) is a talking therapy. The NHS describes it as a therapist helping you change how you think and act. You and your therapist look at the situations you find hard. Together you work out what you think, feel and do in them. Then you try something different. CBT is a family of therapies rather than one method. The best known forms each have a section on this page. Source: [NHS: CBT overview](https://viacara.com/approaches/cbt/#ref-1) ## How it *works* A hard moment can start a loop. A thought changes how you feel, and the feeling changes what you do. What you do then feeds the thought. Say a friend does not reply to a message. You decide they are cross with you, feel low and stay in. Alone at home, nothing tests the thought. CBT works on one part of the loop at a time. The NHS names three ways in: - **Thoughts.** Questioning unhelpful thoughts and beliefs, and looking for other ways to see things - **Feelings.** Noticing emotions and body sensations without reacting to them - **Actions.** Changing what you do, such as returning to something you have avoided The *connections* CBT explores - **Situation** The therapist and client explore a difficult event or moment. - **Thoughts** They examine what the client thinks it means. - **Feelings** They notice emotions and physical sensations. - **Actions** They explore responses and possible changes in behaviour. These parts connect. The therapist helps the client examine thoughts and try different actions. CBT can include work on thoughts and behaviour. The balance depends on the client and the problem. Changing what you do is the behavioural side of CBT. It has [its own page](https://viacara.com/approaches/behavioural-therapy/), covering behavioural activation and exposure. Source: [NHS: CBT overview](https://viacara.com/approaches/cbt/#ref-1) ## What *sessions* look like Each session has a plan. You talk about a situation you found hard, then look at what you thought, felt and did. The NHS says a course usually runs to between five and fifteen sessions. The number depends on what you are having it for. You can meet one to one, join a group or work through [guided self-help](https://viacara.com/approaches/cbt/#guided-self-help). Between sessions you practise what you have worked on. The NHS says this practice matters, and you may keep a worksheet or diary. When the course ends, your therapist helps you plan how to carry on alone. Source: [NHS: CBT overview](https://viacara.com/approaches/cbt/#ref-1) ![How CBT sessions work in practice](https://viacara.com/img/content/approaches-cbt-mid-light.webp) CBT focuses on the connection between thoughts, feelings and behaviours ## Who is it best *suited* to? NICE writes the treatment guidance the NHS follows. Its guidelines name CBT for several difficulties. The table keeps NICE's own verbs. | Difficulty | What NICE says | | --- | --- | | Depression | Discuss individual or group CBT among the first-line options | | Generalised anxiety | Offer CBT or applied relaxation, if you choose a high-intensity therapy | | Panic disorder | Consider referral for CBT when panic is moderate or severe | | Social anxiety | Offer individual CBT developed for social anxiety | | OCD | Offer a choice of CBT including exposure and response prevention, or an antidepressant | | PTSD | Offer [trauma-focused CBT](https://viacara.com/approaches/trauma-focused-cbt/) | | Chronic primary pain | Consider CBT for pain, for people aged 16 and over | CBT can be a good fit if you: - Want a clear plan and a set number of sessions - Would rather work on what is happening now than on your past - Are ready to practise between sessions - Like to try something out and see what happens You do not need a diagnosis to get CBT on the NHS. In England you can refer yourself to NHS Talking Therapies for many problems, without speaking to a GP. Sources: [NICE NG222](https://viacara.com/approaches/cbt/#ref-3), [NICE CG113](https://viacara.com/approaches/cbt/#ref-4), [NICE CG159](https://viacara.com/approaches/cbt/#ref-5), [NICE CG31](https://viacara.com/approaches/cbt/#ref-6), [NICE NG116](https://viacara.com/approaches/cbt/#ref-7), [NICE NG193](https://viacara.com/approaches/cbt/#ref-8), [NHS: CBT overview](https://viacara.com/approaches/cbt/#ref-1), [NHS: talking therapies](https://viacara.com/approaches/cbt/#ref-2) ## The *evidence* A 2012 review gathered 269 meta-analyses of CBT. Its authors found the strongest support for anxiety disorders, bulimia, anger problems and general stress, among others. For depression, a 2023 review pooled 409 trials. CBT had moderate to large effects against control conditions such as usual care and waiting lists. Sources: [Hofmann et al. 2012](https://viacara.com/approaches/cbt/#ref-9), [Cuijpers et al. 2023](https://viacara.com/approaches/cbt/#ref-10) ## Where the evidence *stops* The same review compared CBT with other talking therapies. CBT came out ahead by a small margin, which disappeared in most of the checks the authors ran. Trials report averages. They cannot say how one person will get on with one therapist. Source: [Cuijpers et al. 2023](https://viacara.com/approaches/cbt/#ref-10) ## Cognitive *therapy* Cognitive therapy is the best known strand of CBT. The Beck Institute describes it as a specific therapy that Aaron Beck developed in the 1960s. It rests on the idea that the way we see a situation shapes how we think, feel and behave. The Beck Institute calls CBT an umbrella term for a group of therapies. Outside the United States the two names are often used for the same thing. Some cognitive therapies are written for one difficulty. Cognitive therapy for PTSD is one of the [trauma-focused CBT](https://viacara.com/approaches/trauma-focused-cbt/) therapies NICE names. Mindfulness-based cognitive therapy builds on it, and has [its own page](https://viacara.com/approaches/mindfulness-based-therapy/). Sources: [Beck Institute: CT vs CBT](https://viacara.com/approaches/cbt/#ref-11), [NICE NG116](https://viacara.com/approaches/cbt/#ref-7) ## Rational emotive behaviour *therapy* Rational emotive behaviour therapy (REBT) came first. Albert Ellis developed it in 1955, and the Albert Ellis Institute calls it the pioneering form of CBT. Its starting point is that our thinking about an event, more than the event itself, leads to emotional upset. You learn to examine and challenge that thinking. The institute calls the main technique disputing: reworking a belief into something more realistic. A 2018 review found 84 studies of REBT. Against other treatments it found a medium effect, and its authors call REBT a sound psychological intervention. NICE does not name it in its guidance on depression or anxiety. Sources: [Albert Ellis Institute: REBT](https://viacara.com/approaches/cbt/#ref-12), [David et al. 2018](https://viacara.com/approaches/cbt/#ref-13), [NICE NG222](https://viacara.com/approaches/cbt/#ref-3), [NICE CG113](https://viacara.com/approaches/cbt/#ref-4) ## CBT for *insomnia* CBT for insomnia (CBT-I) is the version built for sleep. NICE's summary for primary care says to offer it first for long-term insomnia, at any adult age. It usually joins behavioural work, such as stimulus control and sleep restriction, with cognitive therapy and relaxation training. A GP may offer it face to face, or as an online programme. NICE recommends one such programme, Sleepio. It is for people who would otherwise get sleep hygiene advice or sleeping pills. NICE says face-to-face CBT-I is of limited availability in the UK. A digital programme could widen access to it. A 2015 review pooled 20 trials of face-to-face CBT-I. People fell asleep about 19 minutes sooner. They also spent about 26 minutes less awake in the night. about 19 minutes sooner asleep 20 trials of face-to-face CBT-I [Trauer et al. 2015](https://viacara.com/approaches/cbt/#ref-17) about 26 minutes less awake in the night the same trials [Trauer et al. 2015](https://viacara.com/approaches/cbt/#ref-17) Those trials left out people whose insomnia came with another sleep or health problem. See a GP if sleep has been bad for months, or if it is making daily life hard to manage. Our [sleep page](https://viacara.com/support/sleep/) covers what else can be going on. Sources: [NICE CKS: insomnia](https://viacara.com/approaches/cbt/#ref-14), [NHS: insomnia](https://viacara.com/approaches/cbt/#ref-15), [NICE HTG624](https://viacara.com/approaches/cbt/#ref-16), [Trauer et al. 2015](https://viacara.com/approaches/cbt/#ref-17) ## CBT for chronic *pain* For chronic primary pain, NICE says to consider CBT for pain for people aged 16 and over. It gives [acceptance and commitment therapy](https://viacara.com/approaches/acceptance-and-commitment-therapy/) as the other option. Chronic primary pain has no clear underlying condition, or it hurts more than an injury explains. This work does not treat the pain as imagined. NHS inform says the way people think and feel about pain affects how they experience it and how they cope. It sets out pacing: you start an activity, stop when it hurts, then build up the time you manage. NHS inform is plain that CBT does not promise to reduce pain. It says the techniques can leave you feeling more in control, with pain having less impact on your life. A 2020 Cochrane review drew on 59 studies of CBT for chronic pain. It found small or very small benefits for pain, disability and distress. Most of that evidence was moderate quality. Pain that is new, or that has changed, needs a GP first. Our [chronic illness page](https://viacara.com/support/chronic-illness/) covers living with a long-term condition. Sources: [NICE NG193](https://viacara.com/approaches/cbt/#ref-8), [NHS inform: chronic pain](https://viacara.com/approaches/cbt/#ref-18), [Williams et al. 2020](https://viacara.com/approaches/cbt/#ref-19) ## Guided *self-help* and bibliotherapy Guided self-help means working through a workbook or online course based on CBT, with a therapist alongside you. NICE describes a trained practitioner who encourages you to finish it and reviews how it is going. For less severe depression, NICE says to consider the least intrusive option first, and names guided self-help as that option. For generalised anxiety it names guided self-help as an early step, usually five to seven short sessions. A 2010 review compared guided self-help with face-to-face therapy for depression and anxiety. Across 21 studies it found no meaningful difference between them. Books used this way are sometimes called bibliotherapy. Reading Well, run by The Reading Agency, lists books that health experts and people with lived experience recommend. A health professional can suggest a title, or you can borrow one from your local library. Sources: [NHS: talking therapies](https://viacara.com/approaches/cbt/#ref-2), [NICE NG222](https://viacara.com/approaches/cbt/#ref-3), [NICE CG113](https://viacara.com/approaches/cbt/#ref-4), [Cuijpers et al. 2010](https://viacara.com/approaches/cbt/#ref-20), [Reading Agency: Reading Well](https://viacara.com/approaches/cbt/#ref-21) ## If CBT does not feel *right* If CBT sounds too structured, [person-centred therapy](https://viacara.com/approaches/person-centred/) lets you set the pace. If you want to understand how your past shapes you now, [psychodynamic therapy](https://viacara.com/approaches/psychodynamic/) looks there. If testing a thought feels like arguing with yourself, [acceptance and commitment therapy](https://viacara.com/approaches/acceptance-and-commitment-therapy/) takes another route. An [integrative therapist](https://viacara.com/approaches/integrative/) can blend CBT with other ways of working. For trauma, [trauma-focused CBT](https://viacara.com/approaches/trauma-focused-cbt/) and [EMDR](https://viacara.com/approaches/emdr/) each have a page of their own. On this page [What is CBT?](https://viacara.com/approaches/cbt/#what-is-cbt) [How it works](https://viacara.com/approaches/cbt/#how-it-works) [What sessions look like](https://viacara.com/approaches/cbt/#what-sessions-look-like) [Who is it best suited to?](https://viacara.com/approaches/cbt/#who-is-it-best-suited-to) [The evidence](https://viacara.com/approaches/cbt/#the-evidence) [Where the evidence stops](https://viacara.com/approaches/cbt/#where-the-evidence-stops) [Cognitive therapy](https://viacara.com/approaches/cbt/#cognitive-therapy) [Rational emotive behaviour therapy](https://viacara.com/approaches/cbt/#rebt) [CBT for insomnia](https://viacara.com/approaches/cbt/#cbt-for-insomnia) [CBT for chronic pain](https://viacara.com/approaches/cbt/#cbt-for-chronic-pain) [Guided self-help and bibliotherapy](https://viacara.com/approaches/cbt/#guided-self-help) [If CBT does not feel right](https://viacara.com/approaches/cbt/#if-cbt-does-not-feel-right) Related [Person-Centred Therapy](https://viacara.com/approaches/person-centred/) [Integrative Therapy](https://viacara.com/approaches/integrative/) [Behavioural Therapy and Behavioural Activation](https://viacara.com/approaches/behavioural-therapy/) [Acceptance and Commitment Therapy (ACT)](https://viacara.com/approaches/acceptance-and-commitment-therapy/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) [Therapy When You Are Autistic](https://viacara.com/support/neurodivergence/autism/) [Menopause and Perimenopause](https://viacara.com/support/menopause/) [Chronic Illness and Long-Term Conditions](https://viacara.com/support/chronic-illness/) [Eating and Body Image](https://viacara.com/support/eating-and-body-image/) [Perinatal Mental Health](https://viacara.com/support/perinatal/) [Trauma-Focused CBT](https://viacara.com/approaches/trauma-focused-cbt/) [Sleep Problems and Insomnia](https://viacara.com/support/sleep/) [Low Self-Esteem](https://viacara.com/support/self-esteem/) [Anger](https://viacara.com/support/anger/) Thanks for your interest. We're not taking on new clients at the moment. ## Interested in *CBT*? We ask what matters to you, then find professionals who fit. Leave your email and we'll let you know as soon as we're ready for you. This conversation helps us find you the right support. What you share helps us understand what you're looking for and find someone who fits. Your email keeps you updated on what's happening next and isn't shared with anyone we introduce you to. [Privacy policy](https://viacara.com/privacy/) [Terms of service](https://viacara.com/terms/) ## References 1. National Health Service (2025). *Cognitive behavioural therapy (CBT)*. [nhs.uk](https://www.nhs.uk/tests-and-treatments/cognitive-behavioural-therapy-cbt/) 2. National Health Service (2025). *Talking therapies*. [nhs.uk](https://www.nhs.uk/tests-and-treatments/talking-therapies/) 3. National Institute for Health and Care Excellence (2022). *Depression in adults: treatment and management (NG222)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng222) 4. National Institute for Health and Care Excellence (2011). *Generalised anxiety disorder and panic disorder in adults: management (CG113)*. [nice.org.uk](https://www.nice.org.uk/guidance/cg113) 5. National Institute for Health and Care Excellence (2013). *Social anxiety disorder: recognition, assessment and treatment (CG159)*. [nice.org.uk](https://www.nice.org.uk/guidance/cg159) 6. National Institute for Health and Care Excellence (2005). *Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31)*. [nice.org.uk](https://www.nice.org.uk/guidance/cg31) 7. National Institute for Health and Care Excellence (2018). *Post-traumatic stress disorder (NG116)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng116) 8. National Institute for Health and Care Excellence (2021). *Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng193) 9. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T. & Fang, A. (2012). *The efficacy of cognitive behavioral therapy: A review of meta-analyses*. Cognitive Therapy and Research. [doi:10.1007/s10608-012-9476-1](https://doi.org/10.1007/s10608-012-9476-1) 10. Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D. & Karyotaki, E. (2023). *Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients*. World Psychiatry. [doi:10.1002/wps.21069](https://doi.org/10.1002/wps.21069) 11. Beck Institute for Cognitive Behavior Therapy (2007). *Does Cognitive Therapy = Cognitive Behavior Therapy?*. [beckinstitute.org](https://beckinstitute.org/blog/does-cognitive-therapy-cognitive-behavior-therapy/) 12. Albert Ellis Institute (n.d.). *Rational Emotive Behavior Therapy*. [albertellis.org](https://albertellis.org/rebt-cbt-therapy/) 13. David, D., Cotet, C., Matu, S., Mogoase, C. & Stefan, S. (2018). *50 years of rational-emotive and cognitive-behavioral therapy: A systematic review and meta-analysis*. Journal of Clinical Psychology. [doi:10.1002/jclp.22514](https://doi.org/10.1002/jclp.22514) 14. National Institute for Health and Care Excellence (2026). *Insomnia: scenario, managing insomnia (Clinical Knowledge Summaries)*. [cks.nice.org.uk](https://cks.nice.org.uk/topics/insomnia/management/managing-insomnia/) 15. National Health Service (2024). *Insomnia*. [nhs.uk](https://www.nhs.uk/conditions/insomnia/) 16. National Institute for Health and Care Excellence (2022). *Sleepio to treat insomnia and insomnia symptoms (HTG624)*. [nice.org.uk](https://www.nice.org.uk/guidance/htg624) 17. Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. & Cunnington, D. (2015). *Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis*. Annals of Internal Medicine. [doi:10.7326/M14-2841](https://doi.org/10.7326/M14-2841) 18. NHS inform (2026). *Chronic pain and your mental health*. [nhsinform.scot](https://www.nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/chronic-pain-self-help-guide/) 19. Williams, A. C. C., Fisher, E., Hearn, L. & Eccleston, C. (2020). *Psychological therapies for the management of chronic pain (excluding headache) in adults*. Cochrane Database of Systematic Reviews. [doi:10.1002/14651858.CD007407.pub4](https://doi.org/10.1002/14651858.CD007407.pub4) 20. Cuijpers, P., Donker, T., van Straten, A., Li, J. & Andersson, G. (2010). *Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies*. Psychological Medicine. [doi:10.1017/S0033291710000772](https://doi.org/10.1017/S0033291710000772) 21. The Reading Agency (n.d.). *Reading Well*. [readingagency.org.uk](https://readingagency.org.uk/get-reading/our-programmes-and-campaigns/reading-well/) ## Related ### [Person-Centred Therapy](https://viacara.com/approaches/person-centred/) Learn how person-centred therapy works, what sessions look like and why the relationship with your therapist matters most. ### [Integrative Therapy](https://viacara.com/approaches/integrative/) Learn how integrative therapy combines different approaches to create a flexible, personalised experience. ### [Behavioural Therapy and Behavioural Activation](https://viacara.com/approaches/behavioural-therapy/) Learn how behavioural therapy works, why NICE lists behavioural activation for depression and how gradual exposure helps with fears and phobias. ### [Acceptance and Commitment Therapy (ACT)](https://viacara.com/approaches/acceptance-and-commitment-therapy/) Learn how acceptance and commitment therapy (ACT) works, what NICE says about it for long-term pain and what research shows for anxiety and low mood. ### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods. ### [Therapy When You Are Autistic](https://viacara.com/support/neurodivergence/autism/) Does talking therapy work for autistic adults? NHS data says yes, slightly less well than for others. Here is what good support looks like. ### [Menopause and Perimenopause](https://viacara.com/support/menopause/) Menopause can change your mood, your sleep and how you feel about yourself. Find a professional who works with the emotional side, alongside your GP. ### [Chronic Illness and Long-Term Conditions](https://viacara.com/support/chronic-illness/) A long-term condition is hard on your mind as well as your body. Find a professional who works with the emotional side, alongside your medical team. ### [Eating and Body Image](https://viacara.com/support/eating-and-body-image/) A hard relationship with food or your body is common and treatable. Find support that runs alongside your GP and NHS care. ### [Perinatal Mental Health](https://viacara.com/support/perinatal/) Low mood, anxiety or numbness in pregnancy or after birth are common and treatable. Find a professional who works with new and expectant parents. ### [Trauma-Focused CBT](https://viacara.com/approaches/trauma-focused-cbt/) Learn how trauma-focused CBT works, what happens in sessions, how it differs from EMDR and what NICE says about it and its main forms. ### [Sleep Problems and Insomnia](https://viacara.com/support/sleep/) Insomnia is thought to affect around 1 in 3 people in the UK. Find a professional who works with sleep and with what keeps you awake. ### [Low Self-Esteem](https://viacara.com/support/self-esteem/) Low self-esteem is a learned opinion of yourself, and it can change. Find a professional who helps you see yourself more fairly. ### [Anger](https://viacara.com/support/anger/) Anger is a normal feeling. When it comes too fast, too often or too hard, it can be worked on. Find a professional who helps you understand it.