What We Actually Do in CBT

Cognitive behavioural therapy sounds like a long name for something that is, at its core, quite concrete.

When someone asks me what we actually do in therapy, I often say: we look at patterns together. Thoughts, feelings and behaviour are connected. What we think influences how we feel, and that influences what we do.

The interplay of thoughts, feelings and behaviour

An example: someone sends an important message and doesn’t hear back for a day. Thought: “They must be annoyed with me, I’ve done something wrong.” Feeling: unease, tension. Behaviour: checking emails constantly, ruminating, writing an apologetic follow-up.

Same situation, different thought: “They’re probably just busy.” Feeling: neutral. Behaviour: wait.

The situation is identical; what differs is the interpretation, and that’s exactly where CBT starts.

Behavioural experiments: testing beliefs

Many beliefs that weigh on us are never directly tested. We assume something will happen, and we avoid the situation, which confirms the belief without it ever actually being put to the test.

Behavioural experiments flip this around. Someone who is convinced that others will reject them if they say no does the opposite: says no once, and observes what actually happens. The result is often very different from what was feared. This creates new experiences that affect the belief directly, not just intellectually, but felt.

For anxiety disorders and OCD, exposure is a central element: deliberately making contact with what is feared, in order to reduce anxiety over time.

Mindfulness and acceptance

Mindfulness plays an important role in my work. Not as a relaxation technique, but as an attitude: noticing what is present without immediately judging it. Closely connected is acceptance, the ability to allow difficult feelings rather than fighting them. An unfamiliar idea sometimes, but one that often helps where pure problem-solving reaches its limits.

Research base

Cognitive behavioural therapy is one of the most thoroughly researched therapeutic approaches in the world. For many conditions, including depression, anxiety disorders and OCD, it is recommended as the first-choice treatment in current clinical guidelines. That means not just clinical experience, but a broad evidence base from controlled studies.

How I work depends on what someone brings and what they want to change.

Nastassja Volkov, Licensed Psychotherapist