CBT: what cognitive behavioural therapy is and how it works

What CBT is

Cognitive behavioural therapy, or CBT, is one of the most widely studied forms of psychotherapy. It grew out of the work of the American psychiatrist Aaron Beck, who developed cognitive therapy at the University of Pennsylvania in the 1960s while studying depression. The idea is simple: how we feel depends not only on what happens, but on how we interpret it. And what we do next either eases the difficulty or keeps it going.

Thoughts, feelings and behaviour: an everyday example

Imagine a colleague walks past you in the corridor without saying hello.

• One thought: “She’s annoyed with me. I must have done something wrong.” You feel anxious, your shoulders tense, and for the rest of the day you avoid her and replay yesterday’s conversation again and again.
• Another thought: “She was in a hurry, maybe she didn’t even see me.” You feel almost nothing and get on with your day.

The situation is the same, but the thought is different, and so are the feelings, the body’s reaction and what you do next. Because you avoid her, you never find out what really happened, so the first thought stays unchecked. CBT works with exactly these chains.

How CBT sessions work

CBT is structured and practical. We work together, as a team, and focus mostly on what is happening in your life now, although we also look at where certain beliefs came from.

• Goals. At the start we agree on concrete goals: for example, to sleep through the night, to go to the shops without panic, to speak up in meetings.
• A shared picture. I explain how your difficulty is put together: how thoughts, feelings, the body and actions keep each other going, and what we will do about it.
• Thought records. You write down situations, the thoughts that came up, your feelings and how strong they were. Then together we look for evidence for and against the thought and find a more balanced one.
• Behavioural experiments. Instead of only arguing with a thought, we test it in real life. If you think “If I say no, everyone will be upset with me”, we plan a small, safe step and see what actually happens.
• Practice between sessions. You will usually have small tasks for the week. This is not school homework: it is how new skills move from the session into your everyday life.

How long does it take? That depends on the problem and on you. As a guide, the UK’s NICE guidelines say that individual CBT for generalised anxiety usually means 12-15 weekly sessions, and for depression roughly 8-16 sessions, depending on severity. Sometimes fewer are needed, sometimes more.

What CBT helps with

CBT has a strong research base. NICE and the NHS recommend it, among other options, for:

• depression
• generalised anxiety and panic attacks
• social anxiety, phobias and obsessive compulsive disorder
• post-traumatic stress disorder, in its trauma-focused form
• insomnia and some eating disorders

“Recommended” does not mean “the only right method”. It means it is a well-tested option worth discussing.

What CBT is not

CBT is not just “think positive”. The aim is not to swap a dark thought for a bright one, but to check it against the facts. Sometimes an anxious thought turns out to be partly true, and then we work on what you can do about it.

CBT has its limits, too. It asks for active involvement and a willingness to try new things between sessions, which can be hard when you are exhausted. It does not suit everyone, and on its own it is not enough when someone is in an acute crisis or needs medical treatment. Then a doctor’s help comes alongside it or first. Medication is always a doctor’s decision.

How I combine CBT with body-oriented therapy and EMDR

In my work CBT is one of several tools. Some difficulties live not only in our thoughts but in the body: a tight chest, a clenched jaw, jumping at every sharp sound. Then I add body-oriented methods, so that you learn to notice tension and calm your nervous system, not only argue with a thought. When anxiety is rooted in a painful memory, we may work with it through EMDR after a period of preparation. We choose the combination together, based on what you need, and I always explain why we are doing what we do.

Where to start

If you want to see how much anxiety or low mood is affecting you right now, take the free GAD-7 (anxiety) and PHQ-9 (depression) tests on this site. They take a few minutes. A result is not a diagnosis, but it is a good starting point for a conversation.

If you would like to try CBT, book a free 15-minute intro video call. We will talk about what is troubling you and whether this approach suits you. My sessions are held in Armenian or Russian only, online from any country or in person in Yerevan.