Cognitive behavioural therapy (CBT)
Practical ways to work with the thoughts and habits that keep a difficulty going.
By Richard Mann · 15 October 2026
← Integrative therapy and the different approaches
When a problem keeps happening, it can be hard to see where to begin. You may avoid things because you feel anxious, withdraw because you feel low or check repeatedly because you cannot feel certain. These responses can bring relief in the moment while leaving you increasingly restricted.
CBT looks at the connections between a situation, your interpretation of it, your feelings, bodily responses and what you do next. Together, you and the therapist develop an understanding of what keeps the difficulty going and identify manageable ways to interrupt that pattern.
How can it make a difference?
CBT makes a difficulty more specific. Rather than starting with ‘I am bad at everything’, you might look at what happened before that feeling, the meaning you gave it and what you did afterwards. This can reveal places where a different response is possible.
The work can include examining a prediction, approaching something you have avoided or rebuilding activities that give a sense of connection and purpose. It is not about pretending that problems are imaginary. Real pressures and painful experiences need to be recognised, and any experiment should fit your circumstances.
What might sessions involve?
You agree what you want to work on and use actual situations to understand the pattern. A therapist might help you separate what you know from what you fear, or notice how checking and reassurance affect you over time. You may draw a simple map or make a brief note, if that helps.
An important part is trying things outside the session. That could mean a small behavioural experiment, a change to a routine or recording what happens when you respond differently. The next session is a chance to review what you learned. If a task was too much or did not help, that is information to use together, not a failure.
Different problems need different methods
CBT is not one worksheet applied to every difficulty. Work with depression may include gradually rebuilding activity; work with social anxiety may involve testing predictions and reducing protective habits. OCD treatment may include exposure and response prevention, planned carefully with a suitably trained therapist.
There is substantial research supporting CBT for a range of difficulties, but that does not mean it is the best fit for every person. The focus, pace and approach should be agreed with you. Some people want more space for grief, relationships or the origins of a pattern alongside structured work.
The message you keep rewriting
As an everyday example, imagine spending an hour rewriting a short email because you fear sounding foolish. An agreed experiment might be sending one low-stakes message after a reasonable check, then observing what actually happens. You would review both the outcome and the urge to seek reassurance. The aim is to learn whether you can cope with uncertainty, rather than obtain a guarantee that nobody will ever judge you.
What might change?
Less time caught in a loop
You may spend less of your day checking, avoiding or going over an event.
A wider everyday life
Activities and conversations that felt off-limits may become more manageable.
Skills you can keep using
You can learn to recognise a pattern and plan your next step.
These are possible signs of progress, not promises. What matters is whether the work is making a useful difference to your life. You and your therapist can review that together.
How this fits with integrative therapy
CBT can offer practical tools within integrative counselling. We can look at what keeps a difficulty going while also making room for the feelings, relationships and experiences that give it meaning. A technique needs to make sense to you, rather than become another thing to get right.
Read about integrative therapy and explore the other approaches →Sources and further reading
This article explains an approach in general terms. The right support depends on your needs, preferences and the practitioner’s training.
We can begin with a conversation.
You do not need to work out which approach you need before getting in touch. I offer a free 15-minute consultation to talk about what is troubling you and whether working together feels right.
Sessions are available in North London and online across the UK.
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