Cognitive behavioural therapy is one of the best-studied treatments for anxiety. What actually happens in sessions, and what you can expect.
November 6, 20262 min read
By Zainab Adesola, BSW, MA, CCC
What CBT is
Cognitive behavioural therapy (CBT) looks at how your thoughts, feelings, body and actions affect each other. With anxiety, these often form a loop: a worried thought brings a rush of fear, the fear makes you avoid something, and avoiding keeps the worry going. CBT helps you notice the loop and change it, one piece at a time.
It’s practical, focused on the present and built around skills you can use in daily life. It’s also one of the most researched treatments for anxiety.
What sessions usually look like
- Understanding your anxiety. Early sessions explore what your anxiety looks like, when it shows up, what keeps it going and what you’d like to change. Many people find this alone a relief.
- Setting goals. Together you choose goals that matter to you, like driving again, sleeping better or speaking up at work.
- Learning skills. You might practise calming your body, catching thinking traps and testing anxious predictions against what really happens.
- Facing fears, step by step. You and your therapist plan small, gradual steps back toward what you’ve been avoiding, at a pace you agree on.
- Practice between sessions. Short exercises during the week, like a worry log or one small step, are where much of the change happens.
- Looking back and looking ahead. You track progress along the way, and plan how to handle setbacks after therapy ends.
How we work at Bethesda
Our therapists use CBT alongside other evidence-based approaches, such as solution-focused, narrative and trauma-informed care, and shape each plan around you. Sometimes that means noticing what’s already working and building from there. Sometimes it means looking at the story anxiety has been telling about you, and separating it from who you are.
We track progress with short questionnaires called outcome measures, so you and your therapist can see change over time.
How long it takes
Many people notice changes within the first several sessions. People who see a CBT therapist for anxiety usually have between 8 and 20 sessions, depending on what they’re working on. Your therapist will talk this through with you and review it as you go.
Getting started
Start with a free 15-minute call. We’ll talk about what’s going on and match you with a therapist. Sessions are online six days a week, until 11 PM on weekdays, Alberta Time.
This article is general information, not medical, legal or insurance advice. For advice about your situation, talk to your health care provider, your insurer or a lawyer.
Questions
Quick answers.
Do I have to talk about my childhood?
Not unless you want to. CBT focuses mostly on what’s happening now, though past experiences can help explain why certain patterns developed.
Is CBT just positive thinking?
No. It isn’t about swapping worries for cheerful thoughts. It’s about looking at thoughts realistically, testing them, and changing what you do.
What if CBT doesn’t work for me?
Tell your therapist. There are other evidence-based approaches, and a good therapist will adjust the plan to fit you.
Keep Reading
Related articles.
What to expect in your first therapy sessionNervous about your first session? Here’s what happens, from the free call to the end of hour one.
Avoidance keeps anxiety alive: small steps back to what you avoidAvoiding what scares you brings quick relief, and teaches your brain to fear it more. How to take small, steady steps back.
How to choose a therapist who fitsThe relationship with your therapist is one of the strongest predictors of how therapy goes. What to look for, what to ask on a free call, and when to switch.