Cognitive Behavioral Therapy (CBT)

The Loop Between Thoughts, Feelings and Behavior

Cognitive behavioral therapy starts from a simple observation. A thought shows up, often fast and without asking permission. A feeling follows it. Then you do something, or avoid doing something, and what you do feeds the next thought. Round and round it goes. When the loop is working for you, nobody notices it. When it is working against you, it can shrink a life down to a few safe rooms.

In CBT we slow that loop down enough to see it. What went through your mind right before your chest tightened? What did you do next? What did that teach your brain about the next time? None of this is about blaming you for your thoughts. Thoughts are not choices. They are habits your nervous system learned for good reasons, and habits can be relearned.

Once the loop is visible, there are two doors into it. One is the thought: checking it, questioning it, trying out a more accurate or kinder version. The other is the behavior: doing a small, deliberate thing differently and letting your brain collect new evidence. I use both, and which one we lean on depends on you.

Practical and Skills-Based

CBT is one of the most concrete approaches I draw on. Sessions often end with something to try in the week ahead, a short note to keep, or a small experiment to run. You are not being graded. The point of homework in CBT is information, and an experiment that goes sideways teaches us as much as one that goes to plan.

Skills we might work on include catching automatic thoughts, naming thinking traps such as all-or-nothing thinking or mind reading, breaking a big avoided task into steps small enough to start, and planning activities that bring back some energy when low mood has drained it. These are tools you keep, so that over time you rely on the room less and on yourself more.

Using CBT With Anxiety and Panic

Anxiety tends to make two predictions: that something bad is about to happen, and that you will not be able to cope when it does. Avoidance feels like relief in the moment, and it quietly confirms both predictions. CBT for anxiety gently tests those predictions instead of arguing with them.

With panic, part of the work is understanding what the body is doing during a surge, the racing heart, the tight breath, the sense of unreality, so the sensations become less frightening in themselves. From there we build a ladder of steps toward the things anxiety has taken from you, at a pace you agree to. You set the rungs. I will not push you up a ladder you have not chosen. You can read more about how I approach anxiety on my anxiety therapy page.

Adapting CBT for Children

Children as young as four can use the ideas behind CBT, as long as the language fits them. With younger kids, thoughts might become characters, a worry monster or a brain alarm that goes off too easily. Feelings might live on a thermometer they can point to. Practice happens through play, drawing and stories rather than worksheets.

Parents are usually part of the work with children, because the loop does not only live inside the child. How a family responds to worry or big feelings can keep the loop spinning or help it settle. I will show you what I am teaching your child so you can use the same words at home.

Adapting CBT for Autistic and ADHD Minds

Standard CBT can land badly for autistic and ADHD people when it is delivered from a manual. Being told your thoughts are distorted, when your read of a situation was accurate, is not therapy. It is invalidation. So I adapt it. The work stays literal and concrete. I say what I mean, I check that we mean the same thing by a word, and I use visual supports when they help.

For autistic people, that can mean separating genuine thinking traps from the real costs of sensory overload, masking or a world that is not built for you. For ADHD, it can mean shorter steps, external reminders and planning systems that work with your brain instead of against it. In both cases CBT is collaborative. We decide together what is worth changing, and what is simply you. More on this lives on my autism therapy and ADHD therapy pages.

What CBT Is Not

CBT is not positive thinking, and it is not a way of talking you out of your life. If something hard is happening, CBT does not ask you to pretend it is fine. It asks what is true, what is within reach, and what small next step would matter to you.

It is also only one approach among several I am trained in. Sometimes CBT is the main thread of our work, and sometimes it sits alongside somatic work, mindfulness or parts work. I don't get to choose what works. You do.