By Mark Ryan, BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist
Cognitive Behavioural Therapy (CBT) is one of the most widely used and researched forms of psychotherapy. Its structured approach and practical strategies have helped many people manage a range of psychological difficulties. A large review of meta analyses covering a wide range of problems found the strongest support for CBT in anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress (Hofmann et al., 2012).
However, while CBT is highly effective for many, it is not a one size fits all solution. Some people find it too rigid, too focused on symptoms, or lacking the depth needed to address deeper emotional or relational issues. In this post, I explore both the benefits and the limitations of CBT, what the research says about the alternatives, and how to work out which approach might suit you.
In brief
CBT is a short term, structured talking therapy with strong evidence, especially for anxiety. The NHS describes a course as usually between 6 and 20 sessions.
It is not right for everyone. The NHS notes that it may not be successful or suitable for everyone, takes time and effort, and that critics say it does not address underlying causes.
Other therapies also have evidence, including psychodynamic therapy, Acceptance and Commitment Therapy, schema therapy and EMDR, for different problems.
Matching therapy to your preferences, and the relationship with your therapist, are both linked with better outcomes.
If CBT hasn't helped, that is not a verdict on you, and there are other options.
What is Cognitive Behavioural Therapy (CBT)?
The NHS describes CBT as a talking therapy that can help you manage your problems by changing the way you think and behave. It is most commonly used to treat anxiety and depression but can be useful for other mental and physical health problems (NHS, n.d.). In my own words, CBT helps people understand how their thoughts, feelings and behaviours are connected and works on the idea that unhelpful patterns of thinking can feed emotional distress.
A common technique is identifying and examining unhelpful thinking patterns, sometimes called cognitive distortions. For example, someone struggling with social anxiety may believe, 'If I say something wrong, everyone will think I'm stupid.' CBT would help them examine this thought, look for evidence for and against it, and develop a more balanced perspective.
CBT also uses behavioural techniques. Two of the most used methods for treating anxiety disorders are exposure, where people gradually face their fears in a structured way, and cognitive therapy (Kaczkurkin & Foa, 2015). A review of the evidence concluded that CBT appears to be both efficacious and effective in the treatment of anxiety disorders, though the authors note that more studies are needed to determine which specific components lead to benefit and which patients are most likely to benefit (Kaczkurkin & Foa, 2015). If your difficulty is anxiety, I have written about the role of physical safety and the nervous system in anxiety, and if it is low mood, about sadness or depression and what OCD really is.
The benefits of CBT
Evidence based and widely researched
One of the greatest strengths of CBT is its research base. A review that surveyed 269 meta analytic studies and examined a representative sample of 106 of them, covering problems from substance use and depression to anxiety, eating disorders, insomnia and chronic pain, found the strongest support for CBT in anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress. Of eleven reviews that compared response rates between CBT and other treatments or control conditions, CBT showed higher response rates in seven and lower in only one (Hofmann et al., 2012). That is a strong record, though it is worth noticing that the support is stronger for some problems than for others, and that this is a review of meta-analyses and not of any single person's experience. The NHS also describes CBT as having been shown to be an effective way of treating several different mental health conditions (NHS, n.d.).
Structured and goal oriented
CBT gives people clear strategies to work towards change. It is a structured form of therapy, which can be particularly helpful for people who feel overwhelmed by their emotions or uncertain about where to start. The NHS describes sessions as working with a therapist to break problems down into their separate parts, such as thoughts, physical feelings and actions (NHS, n.d.).
Short term and time efficient
CBT is often delivered over a relatively short period. The NHS says a course of treatment usually lasts between 6 and 20 sessions, each lasting 30 to 60 minutes (NHS, n.d.). This can appeal to people who want relief from distress without committing to long term therapy.
Teaches practical coping skills
Rather than only exploring emotions, CBT equips people with tangible skills they can use to manage their mental health, such as thought challenging, relaxation techniques and behavioural experiments. In my experience these skills can be applied throughout life.
Helps develop self-awareness
CBT encourages people to become more aware of their thought patterns and how they affect emotions and behaviour. In my experience this self-awareness can be empowering and can provide lasting benefits beyond therapy.
Can be delivered in different formats
CBT is adaptable and can be delivered in different formats, including individual therapy, group therapy, self-help books and online programmes. A review of Internet delivered treatments concluded that therapist guided Internet CBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. The same review noted that a significant minority of people do experience negative effects, though rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions (Andersson et al., 2019). The NHS notes that you can refer yourself directly to an NHS talking therapies service without a referral from a GP (NHS, n.d.).
Sometimes we need to dive deeper to understand what is going on for us…
The limitations of CBT
While CBT is a powerful therapeutic approach, it does have limitations. Some people find it less effective or struggle to engage with its methods. The NHS puts it plainly: CBT is effective in treating some mental health problems, but it may not be successful or suitable for everyone (NHS, n.d.).
It can feel too structured and rigid
CBT's structured nature is helpful for some, but others find it restrictive. In my experience, people who prefer a more open ended, exploratory approach may feel that CBT does not allow enough space for deeper emotional work.
It focuses on the present rather than the past
CBT tends to focus on current thoughts and behaviours rather than past experiences. The NHS notes that some critics argue that CBT addresses current problems and focuses on specific issues but does not address the possible underlying causes of mental health conditions, such as an unhappy childhood (NHS, n.d.). That can be beneficial for managing symptoms. But in my view some people, particularly those with complex trauma, may need a therapy that explores past wounds and unconscious patterns. That is my clinical perspective and not a research finding.
It may not address deeper emotional or relational issues
In my experience, CBT is excellent for symptom management but may not be as effective for people struggling with deep seated relational difficulties or identity related concerns. Approaches such as person centred or attachment-based therapy may be better suited to these. I am not citing a study here, because I could not find one I can stand behind that compares the approaches on relational problems specifically.
It can feel dismissive of emotions
Because CBT emphasises examining unhelpful thoughts, some people feel that their emotions are being invalidated rather than fully explored. In my experience this can be particularly hard for people who experience strong emotional responses or trauma, and a good CBT therapist will be alert to it.
It requires active participation
CBT often involves exercises between sessions, such as keeping thought records or trying behavioural experiments. The NHS lists the time that regular sessions and extra work between sessions can take as one of the downsides (NHS, n.d.). Not everyone has the energy, motivation or bandwidth to do this consistently, and that says nothing about their worth or their prospects.
It may not work for everyone
Even a therapy with a strong research record does not work for everyone. If CBT has not helped you, it may be that the approach did not match your needs or preferences, or that the timing was wrong. I have written separately about when therapy doesn't work yet, and about whether therapy is right for you.
Alternative therapies that may be more suitable for some people
If CBT does not feel like the right fit, there are other therapeutic options that may suit you better. Several have research behind them.
Psychodynamic therapy
Psychodynamic therapy explores unconscious processes, past experiences and deep-seated patterns that influence present difficulties. A meta-analysis of 23 randomised controlled trials with 2,751 patients tested whether manual guided psychodynamic therapy was equivalent to treatments already established as efficacious. It found equivalence for target symptoms both at the end of treatment and at follow up and suggested that further research should examine who benefits most from which treatment (Steinert et al., 2017). In my experience it often suits people who want to explore the roots of their distress in greater depth.
Person centred therapy
Developed by Carl Rogers, person centred therapy focuses on creating a non-judgemental and empathic space where you can explore your emotions at your own pace. In my experience it can be particularly valuable for people who feel they need emotional validation and support rather than structured techniques. I am not citing outcome research for it here, because I did not verify any, and I would rather say so than imply it.
Acceptance and Commitment Therapy (ACT)
ACT helps people accept their emotions rather than trying to change them and incorporates mindfulness and values-based action. A meta-analysis of 39 randomised controlled trials with 1,821 patients with mental disorders or somatic health problems found that ACT outperformed control conditions (Hedges' g = 0.57) at post treatment and follow up, and that its comparison with established treatments such as CBT did not reveal any significant differences (A Tjak et al., 2015).
Schema therapy
Schema therapy integrates elements of CBT with deeper emotional work and is used for long standing patterns of difficulty. In a multicentre randomised trial of 323 patients with cluster C, paranoid, histrionic or narcissistic personality disorders, a significantly greater proportion of patients recovered with 50 sessions of schema therapy than with treatment as usual or clarification-oriented psychotherapy, and dropout was lower (Bamelis et al., 2014). That trial did not include borderline personality disorder, so it speaks to the conditions it studied and not to every personality difficulty.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a specialised therapy for trauma that helps people reprocess distressing memories so that their emotional intensity reduces. A Cochrane review of psychological therapies for chronic PTSD in adults included 70 studies with 4,761 participants. It found that individual trauma focused CBT and EMDR were more effective than waitlist or usual care at reducing clinician assessed PTSD symptoms, and that there was no statistically significant difference between trauma focused CBT, EMDR and stress management immediately after treatment. The review assessed the quality of the evidence as very low and urged caution in interpreting its findings (Bisson et al., 2013). In other words, trauma focused CBT is also an evidence-supported option for PTSD, and the choice between them is often one of fit.
What the research says about choosing
Because several approaches have evidence, it is worth knowing what else matters. A meta-analysis of 35 studies of client preferences found that clients who were matched to their preferred therapy conditions were less likely to drop out prematurely (odds ratio of .59) and showed greater improvements in treatment outcomes (d = .31) (Swift et al., 2011). A review of 669 studies found a weighted dropout rate of 19.7 per cent, and dropout was not moderated by the orientation of the therapy (Swift & Greenberg, 2012). And a task force review concluded that the psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment (Norcross & Lambert, 2018). Put together, these findings suggest that your preferences and your relationship with the therapist matter alongside the label on the therapy.
Finding the right therapy for you
CBT is a valuable and effective therapy for many people, particularly those struggling with anxiety, depression and other specific mental health conditions. Its structured approach, practical skills and research backing make it a highly recommended treatment. I would not want anything above to put you off it if it might help you.
However, it is not the best fit for everyone. If you want deeper emotional exploration, struggle with complex trauma, or feel that your distress is more relational in nature, other approaches may suit you better. A few practical questions can help:
What do you want from therapy? Skills and strategies, or space to understand yourself, or both?
How do you feel about homework and structure? Some people find it motivating, others find it a burden.
Is it a specific problem or a long-standing pattern? Specific difficulties such as phobias or panic often suit a focused approach. Long standing relational patterns may need more time.
How does the therapist make you feel? The research on the relationship suggests this matters a great deal.
How will the therapist track whether it is helping? It is reasonable to ask, and I describe why in how to choose a couples therapist, which covers questions that apply to individual therapy too.
If you are unsure which therapy might be right for you, speaking with a qualified professional can help guide your decision. Therapy is a deeply personal journey, and what works for one person may not work for another. If you are wondering whether it is for you at all, 8 reasons people think therapy isn't for me may help. The key is to find an approach that meets your needs and helps you move towards healing and personal growth.
About the Author
Mark Ryan is a BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist, and the founder of Rise and Grow Therapy™, a private practice offering couples and relationship therapy across Kensington, Pimlico, and Angel, Islington in London, as well as online consultations. His approach draws first on Imago Relationship Therapy, alongside integrative relational, attachment based, Gottman, and systemic approaches. Mark works with couples of all kinds, including LGBTQ+ couples and those in non-traditional relationship structures such as consensual non monogamy, as well as with individuals working through relational issues.
References
A Tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30 to 36.
Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2019). Internet delivered psychological treatments: From innovation to implementation. World Psychiatry, 18(1), 20 to 28.
Bamelis, L. L., Evers, S. M., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3), 305 to 322.
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 2013(12), CD003388.
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta analyses. Cognitive Therapy and Research, 36(5), 427 to 440.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337 to 346.
NHS. (n.d.). Cognitive behavioural therapy (CBT). Retrieved 5 October 2026.
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303 to 315.
Steinert, C., Munder, T., Rabung, S., Hoyer, J., & Leichsenring, F. (2017). Psychodynamic therapy: As efficacious as other empirically supported treatments? A meta analysis testing equivalence of outcomes. American Journal of Psychiatry, 174(10), 943 to 953.
Swift, J. K., Callahan, J. L., & Vollmer, B. M. (2011). Preferences. Journal of Clinical Psychology, 67(2), 155 to 165.
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta analysis. Journal of Consulting and Clinical Psychology, 80(4), 547 to 559.
