· 6 min read
What is CBT? A plain guide to cognitive behavioral therapy
What cognitive behavioral therapy is, what happens in a course of CBT, what the research says about whether it works, and whether you can do it on your own.
Cognitive behavioral therapy (CBT) is a practical, short-term talking therapy. It works on the idea that what you think, what you feel and what you do are linked, and that changing the way you think about a situation or the way you respond to it can change how you feel. It focuses on problems in the present rather than digging through the past, and you practise skills between sessions.
That's the short answer. Here is the longer one, in plain language.
The core idea
Two people get the same message from their manager: Can we talk tomorrow?
The first thinks, She probably wants to plan next quarter. They feel mildly curious and go back to work.
The second thinks, I've done something wrong. I'm going to lose my job. Their stomach drops, they reread every email they sent this week, and they barely sleep.
Same situation, very different evenings. The difference sits in the thought in the middle. CBT teaches you to notice those thoughts, check them against the facts, and try different ways of responding. The link between thoughts, feelings and actions is often drawn as a triangle. Our guide to the CBT triangle shows how to use it with your own examples.
CBT doesn't ask you to think positively. It asks you to think accurately. Sometimes the fair version of a thought is still hard. It's just no longer the worst-case version.
What happens in a course of CBT
In England, the NHS says you'll usually have between 5 and 15 sessions, depending on what you're having it for. A typical course looks something like this:
- Getting a picture. You and the therapist talk about what's been happening and agree on goals.
- Learning the model. You map out how your thoughts, feelings, body and actions feed each other in situations that are hard for you.
- Working with thoughts. You learn to catch automatic thoughts, spot thinking traps and weigh the evidence, often with a thought record.
- Working with actions. You test your predictions with small experiments and slowly face things you've been avoiding, at a pace you agree on.
- Keeping it going. Near the end you make a plan for setbacks so you can keep using the skills on your own.
If you've seen "the five steps of CBT" online, they're usually a version of this list. The homework between sessions matters. It's where most of the change happens.
Does CBT work?
For many problems, yes, and it is one of the most studied therapies there is.
- A review of 106 meta-analyses, covering problems from depression and insomnia to chronic pain, found the strongest support for CBT in anxiety disorders, anger problems and general stress, and called the overall evidence for CBT very strong (Hofmann and colleagues, 2012).
- A later review of 144 trials concluded that CBT is probably effective for depression and anxiety disorders. The effects were large compared with waiting lists, but small to moderate compared with usual care or a placebo pill, and only a minority of the trials were high quality (Cuijpers and colleagues, 2016). In other words: it helps, and it is not magic.
- In the UK, NICE recommends CBT for generalised anxiety disorder, panic disorder and depression (NICE guideline CG113 covers anxiety and panic).
CBT doesn't work for everyone. Some people do better with medication, with a different therapy, or with both together. It also asks for effort: if you can't practise between sessions right now, that is worth telling your therapist.
Can you do CBT on your own?
Partly, yes. Self-help CBT is a real thing, not a watered-down shortcut.
- For generalised anxiety disorder, NICE recommends self-help based on CBT principles, on your own or with some guidance, as an early step before more intensive therapy.
- A large analysis of individual data from 13 trials found that self-guided online CBT, done without a therapist, reduced symptoms of depression compared with control groups (Karyotaki and colleagues, 2017).
Some CBT tools you can start with today:
- The thought record. Write down the situation, the thought, the feeling and the evidence. Our step-by-step guide has a worked example.
- Thinking traps. Learn the common ones, so you can name them when they show up. Start with our list of ten thinking traps.
- Worry time. Postpone worries to a set appointment each day instead of carrying them around. See journaling for anxiety.
- Defusion. From ACT, a close relative of CBT: noticing a thought as a thought. Try leaves on a stream.
What self-help can't do is see you from the outside. A therapist notices patterns you can't, adjusts the plan, and helps when you get stuck.
When to see a therapist instead
Self-help is a good start for everyday stress, worry and low mood. Please look for professional help if:
- your mood or anxiety has made daily life hard for more than a few weeks,
- you're avoiding more and more things,
- you have frightening thoughts that won't go away, or thoughts of harming yourself,
- you've been through trauma that still feels present.
In England you can refer yourself to NHS Talking Therapies. In the UK, the BABCP register lists accredited CBT therapists. Elsewhere, your doctor can point you to local options. If you feel unsafe right now, contact your local emergency number or find a helpline at findahelpline.com.
CBT, ACT and DBT: what's the difference?
- CBT asks: is this thought accurate and helpful? If not, what's a fairer one, and what could I do differently?
- ACT (Acceptance and Commitment Therapy) asks less about whether a thought is true and more about how tightly you hold it, and whether your actions follow what matters to you.
- DBT (Dialectical Behavior Therapy) was developed for very intense emotions. It adds skills for distress, emotion regulation and relationships.
They share a lot, and many therapists combine them.
Where Leaf by Leaf fits
Leaf by Leaf isn't therapy, and it doesn't replace a therapist. It's a cozy pixel-art journal that uses the thought record at its heart. In Untangle a thought you sit under an old tree and answer one plain question per page: what happened, what thought keeps coming back, how strong the feeling is, which thinking trap it might fall into, and what the facts are. At the end you write a fairer thought, rate the feeling again, and the tree lets the leaf go.
You can try all seven pages on the home page without buying anything. Nothing you write there is saved or sent.