What CBT actually does — and what it does not

Cognitive behavioural therapy is probably the most studied psychotherapy, which makes it both the best documented and the easiest to caricature.

Not just “thinking positive”

The cognitive part is only half the name. Much of the work is behavioural: testing predictions in real situations, gradually approaching what is avoided, and observing what actually happens rather than what was feared.

Where the evidence is strongest

• Anxiety disorders and panic.
• Insomnia, where structured protocols perform well.
• Certain depressive presentations, often compared with or combined with other treatments.

Honest limits

Effect sizes vary with the condition, the therapist and how closely a protocol is followed. “Evidence-based” describes an average across studies, not a guarantee for one person — and a method that suits a friend may not suit you.