For adults, young people and parents

Cognitive behavioural therapy (CBT)

CBT is a structured treatment with set parts. This page describes what it consists of, what a session looks like, and how long a course usually runs.

What CBT is

NICE recommends CBT for OCD, panic, social anxiety, generalised anxiety and depression. Its central idea is that what you think, what you do and how you feel affect one another, and that the way they feed into each other can keep a problem going long after whatever started it has passed. Someone has a panic attack in a supermarket, starts avoiding supermarkets, and never gets the chance to learn that they could have managed the sensations and got on with the shopping. CBT therefore focuses less on why a problem began than on what keeps it in place today, because understanding where a fear came from does not by itself remove it.

Most of the work is done by doing

Part of CBT is examining thoughts, for example identifying the prediction you are making and noticing when a possibility is being treated as a certainty. But talking rarely shifts a belief held at gut level, and that is the belief keeping the anxiety going. The change comes from what you do: going into the situations you have been avoiding, in planned steps, and dropping the things you do to feel safe while you are there. The main thing you learn is that you can handle the anxiety, and the not knowing, without the avoiding and the precautions, and that this gets easier with practice. Some of that practice is set up as a behavioural experiment, which is a deliberate test of a prediction, written down first in specific terms and checked afterwards. A prediction such as “it will be awful” cannot be tested, whereas “three people will look at me and one will comment” can. Finding out what actually happens is useful, but it is one part of the learning rather than the whole of it. A thought record and a behavioural experiment sheet are free on the worksheets page.

Behavioural experiments, worked through

Someone with social anxiety who is certain that going quiet will be noticed and judged says nothing for two minutes in a meeting, stays with the discomfort, and records what actually happened. Someone with panic who believes a racing heart means collapse runs up two flights of stairs on purpose to bring on the sensations, stays with them, and sees what follows. Someone with health anxiety goes a week without checking a symptom and records what the anxiety did over that week. Someone with generalised anxiety who believes an unchecked email will contain a serious mistake sends one without rereading it and notes what followed.

What a session looks like

Sessions are active and structured. If something significant happened in the week we deal with it, but there is a plan, and each session ends with a specific task to try before the next one, usually with a note of what you predicted and what actually happened. Most of the change happens in that practice between sessions. If a task repeatedly does not get done, it was pitched wrong or something is in the way, and we adjust it.

What happens in a CBT session, in order

1. A brief check on the week and any measures we are tracking.
2. An agenda, set together in the first few minutes.
3. Review of what you tried since last time and what it showed.
4. The main piece of work, such as refining the formulation, running an experiment, practising a skill or planning an exposure.
5. Agreeing the next task, written down and specific enough to do.
6. A short summary from you, in your own words, of what the session was about.

How CBT and ERP differ, and when each is used

ERP sits inside the CBT family and is the form of CBT that NICE names for OCD. For phobias, panic and health anxiety the main method is exposure therapy, which works on the same principle. Broader CBT has a wider range of methods, including work on beliefs, attention and imagery work for social anxiety, and experiments with uncertainty for generalised anxiety.

In OCD the cognitive part needs care, because examining evidence and reasoning your way to comfort can turn into another compulsion, and behavioural experiments are not the core of OCD treatment. I use the cognitive work sparingly there, to set up exposures and not to settle doubts. I do not take on depression as the main problem, but low mood is often present alongside anxiety and OCD, and I address it within that work, usually through activity scheduling, which means planning specific activities into your week.

Common questions

Written by Dr Daniel O’Rourke, PhD, ABPP, CPsychol, HCPC-registered Clinical Psychologist Last reviewed: September 2026