Cognitive behavioural therapy (CBT) referral
Being referred for cognitive behavioural therapy (CBT): a structured, evidence-based talking therapy that helps you change unhelpful patterns of thinking and behaviour to ease problems like anxiety and depression.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- CBT is a structured, practical talking therapy with strong evidence for anxiety, depression and several other problems.
- It is not instant — it usually takes a course of sessions and some practice between them — but the skills tend to last.
- NHS CBT is free across the UK. In England you can often refer yourself to NHS Talking Therapies; Scotland, Wales and Northern Ireland have their own psychological-therapies services and referral routes, so check what applies where you live. Private CBT is an option for speed or choice.
- Choose a therapist accredited by the BABCP (the UK body for CBT) so you know they are properly trained and supervised.
- If you ever have thoughts of suicide or self-harm and you are at immediate risk, call 999 or go to A&E anywhere in the UK. For urgent support you can call Samaritans free on 116 123 (day or night) or text SHOUT to 85258. In England, Scotland or Wales you can also call 111 and choose the mental-health option; in Northern Ireland call Lifeline on 0808 808 8000.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
A structured, practical approach with strong evidence for many common problems
CBT may not be the best first choice for some problems, which may need a different therapy or a combined approach.
The therapist checks CBT is the right fit and agrees goals with you. You may feel both hopeful and apprehensive — both are normal.
A clear relapse-prevention plan and worksheets to keep
The therapist checks CBT is the right fit and agrees goals with you. You may feel both hopeful and apprehensive —...
You build a shared understanding of the problem and start trying small changes. Some discomfort is expected as you...
Many people notice symptoms easing and skills becoming more natural. Practising between sessions drives much of...
You review what helped and make a relapse-prevention plan. Occasional setbacks are normal; a short booster course...
What is a cognitive behavioural therapy (CBT) referral?
Cognitive behavioural therapy (CBT) is a talking therapy that helps you change the way you think and act. It is based on a simple idea: thoughts, feelings, physical sensations and behaviour are all linked, so changing one can shift the others. A CBT referral is simply the step of getting you connected to a trained therapist.
CBT has more research behind it than any other talking therapy, and it is recommended for many common problems — including anxiety, depression, panic, obsessive-compulsive disorder, post-traumatic stress, phobias and health anxiety. It can also help people cope with long-term physical illness. It is practical and focused on the here and now, working on the difficulties affecting you currently rather than mainly exploring the past.
In England you often do not need a GP to refer you: you can usually refer yourself to the NHS Talking Therapies service. Elsewhere in the UK — Scotland, Wales and Northern Ireland — the NHS or HSC psychological-therapies services have different names and referral routes, so it is worth checking what applies where you live. A GP, psychiatrist or other clinician can refer you anywhere in the UK, and CBT is available privately too.
One honest expectation to set: CBT is not an instant fix. It usually runs over a course of sessions, asks you to practise between them, and works gradually. For many people that effort pays off with skills they keep for life.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
NHS versus private CBT
| NHS CBT | Private CBT | |
|---|---|---|
| Cost | Free | You pay per session |
| Access | Self-referral in England; GP or local route elsewhere | Self-arranged |
| Wait | Can be a wait in some areas | Often quicker to start |
| Therapy itself | Same evidence-based CBT | Same evidence-based CBT |
The therapy is the same approach in both settings. How you access NHS CBT differs across the UK: in England it is often the self-referral NHS Talking Therapies service, while Scotland, Wales and Northern Ireland have their own services and referral routes. Whichever you choose, check the therapist is BABCP-accredited.
Preparing for your programme
- Check how to access NHS talking therapies where you live — in England this is often the self-referral NHS Talking Therapies service, while Scotland, Wales and Northern Ireland have their own routes; a GP or specialist can also refer you.
- If going private, confirm the therapist is accredited by the BABCP and registered with a recognised body.
- Think about what you want to work on and what 'better' would look like for you.
- Be ready for an initial assessment, where the therapist checks CBT is the right fit and agrees goals with you.
- Plan for some time and energy between sessions to practise — this is where much of the benefit comes from.
- Bring a list of medicines and note any previous therapy, so the therapist has the full picture.
What happens
After referral, you usually have an assessment session. The therapist asks about the problem, how it affects you, and what you want to achieve, then checks whether CBT is the right approach or whether something else might suit better.
If CBT goes ahead, sessions are typically weekly or fortnightly and last around 30–60 minutes. Together you build an understanding of how your thoughts, feelings, body sensations and behaviour keep the problem going, then work on changing it — for example by questioning unhelpful thoughts, gradually facing avoided situations, or trying out new ways of responding.
Between sessions you are usually given things to practise, sometimes called homework. This is a core part of CBT and a big reason it works. A typical course runs from about 6 to 20 sessions, depending on the problem; some difficulties need fewer, some more.
Near the end, you and the therapist review progress and make a plan to keep using the skills and to handle any setbacks, so you can carry on as your own therapist afterwards.
Is this programme right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- CBT may not be the best first choice for some problems, which may need a different therapy or a combined approach.
- If you are in crisis or at immediate risk, you need urgent support first rather than a routine therapy referral.
- CBT relies on active engagement; if you are unable to take part at the moment, timing or extra support may need addressing first.
- A practitioner without recognised CBT accreditation may not deliver genuine, effective CBT.
Delay or rearrange if…
- You are in crisis or at risk of self-harm — seek urgent help first (999 or A&E if at immediate risk anywhere in the UK; otherwise Samaritans 116 123, or 111 and the mental-health option in England, Scotland or Wales, or Lifeline 0808 808 8000 in Northern Ireland).
- Severe symptoms or major life upheaval make it hard to engage; stabilising support may be needed first.
- Heavy alcohol or drug use is making it hard to take part; this may need addressing alongside.
- You are unsure CBT is the right therapy; an assessment can help clarify before committing.
Alternatives to discuss
- Guided self-help based on CBT, often a good first step
- Other talking therapies, such as counselling, interpersonal therapy or psychodynamic psychotherapy
- EMDR for some types of trauma
- Medication, alone or alongside therapy, for moderate or severe symptoms
- Watchful waiting with lifestyle and social support for milder difficulties
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- A structured, practical approach with strong evidence for many common problems
- Skills you learn and keep, which can help prevent relapse
- Focus on the present and on changes you can make now
- Often a clear, time-limited course rather than open-ended therapy
- Available in flexible formats — in person, online, by phone, or as guided self-help
- Free access through the NHS for many people — in England often without needing a GP referral
Risks & complications
- Talking about difficult thoughts and facing avoided situations can feel uncomfortable, especially early on
- It takes time and effort, including practice between sessions
- Progress is often uneven, with better and harder weeks
- CBT may not suit everyone, or this particular problem may need a different therapy
- The first therapist may not feel like the right fit; you can ask to change
- Symptoms can feel more intense at first when you start facing fears (for example in trauma-focused work)
- Rarely, distressing memories or feelings surfacing in therapy can feel overwhelming; a good therapist works at a safe pace and has a plan if this happens.
CBT works best when it is the right therapy for your problem and delivered by a properly trained therapist. The main pitfalls are an unaccredited 'CBT' practitioner, an approach that does not fit your needs, or expecting instant results. If you are not seeing any benefit after a fair try, or the relationship does not feel right, it is reasonable to discuss this and consider a change of therapist or approach.
Published figures to discuss
CBT is low-risk, and outcomes vary by problem, severity and how well it fits. It has a strong evidence base across many conditions, but it does not work for everyone and is not instant. Because reported response rates differ widely between studies and conditions, it is more honest to say many people benefit than to quote a single percentage.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Response to CBT | Variable and problem-specific | CBT often helps anxiety and depression, but outcomes depend on formulation, homework, therapist skill and comorbidity. | Guide sourcesClinical context |
| Temporary distress during exposure or trauma work | Common and usually manageable | The plan should be paced, collaborative and include what to do if symptoms worsen. | Guide sourcesClinical context |
| Wrong therapy match | Recognised | CBT is not always the best first option for severe risk, active psychosis, unstable substance use or complex trauma without stabilisation. | NHS — Cognitive behavioural therapy (CBT) overviewnhs.ukSource-linked context |
| Access and dropout | Common practical issue | Waiting times, session frequency, digital format and between-session practice affect whether therapy is realistic. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. 'Afterwards' is about applying the skills, expecting ups and downs, and noticing change build over the course rather than after a single session.
- Feeling stirred up or tired after sessions that touch on difficult things
- Uneven progress, with some weeks better than others
- Anxiety rising at first when facing avoided situations, then easing
- Gradually using the skills automatically in everyday life
Aftercare
- Keep practising the CBT skills and techniques after the course ends.
- Use your relapse-prevention plan, especially at stressful times.
- Notice early warning signs and act on them rather than waiting.
- Stay in touch with your GP or referrer if symptoms return or worsen.
- Consider a booster session if you feel you are slipping back.
- Look after the basics — sleep, activity, connection and limiting alcohol — which support your mental health.
- A written relapse-prevention plan from your therapist
- Notes or worksheets you can keep using
- Details for arranging a booster session if needed
- GP or referrer aware of how therapy went
- Everyday supports in place: sleep, activity, connection
- A list of early warning signs to watch for
⚠ Get urgent help if…
- Mood dropping significantly, or feeling hopeless, during or after therapy
- Any thoughts of suicide or self-harm — if at immediate risk call 999 or go to A&E anywhere in the UK; for urgent support call Samaritans free on 116 123 or text SHOUT to 85258. In England, Scotland or Wales you can also call 111 and choose the mental-health option; in Northern Ireland call Lifeline on 0808 808 8000
- Feeling overwhelmed by memories or feelings stirred up in therapy
- Symptoms getting clearly worse rather than better over a fair number of sessions
- Increasing use of alcohol or drugs to cope
- A therapist behaving unprofessionally, making guarantees, or not being properly accredited
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A good course of CBT often means clear improvement in the problem you came with, along with practical skills you can keep using. For many problems CBT is among the most effective treatments available, though it works gradually and results vary from person to person.
CBT cannot guarantee that difficulties will never return, and not everyone responds to the first approach. What it offers is a structured, evidence-based way to feel better and to handle future setbacks more confidently.
One of CBT's strengths is that the skills tend to last, because you learn to be your own therapist. Many people stay well after a course, and a short booster can help if symptoms creep back. Keeping up the techniques, especially at stressful times, protects the gains.
Related tests, treatments or support
CBT is often combined with medication (for example for moderate or severe depression or anxiety), and it can sit alongside support for physical health conditions. For some problems, other therapies such as EMDR for trauma, or longer-term psychotherapy, may be more suitable or used in addition. Your therapist or GP can help you decide.
Follow-up & long-term care
Your therapist reviews progress through the course and helps you build a relapse-prevention plan at the end. Some services offer a follow-up or booster appointment. If you were referred by a GP or specialist, a brief letter on how therapy went is often shared with them; you can ask what it says and who sees it.
- Keep using CBT techniques and worksheets
- Apply your relapse-prevention plan at stressful times
- Arrange a booster session early if symptoms return
- Maintain sleep, activity and social connection
- Tell your GP promptly if mood or anxiety worsens
Repeat, follow-on and what comes next
- If the first therapist is not the right fit, you can ask to change.
- A different type of CBT, or a different therapy altogether, can be tried if there is no benefit.
- Booster sessions are common and helpful if symptoms return, rather than starting from scratch.
- The plan is reviewed through the course and adjusted to your needs.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear relapse-prevention plan and worksheets to keep
- An easy route to a booster session if symptoms return
- A brief, agreed letter to your GP or referrer where appropriate
- Signposting to urgent help should a crisis arise
- Support to keep applying the skills in everyday life
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you have NHS CBT (free) or private CBT (paid per session)
- The therapist's training, accreditation and seniority
- Number and length of sessions, which depend on the problem
- Format: in person, online, by phone, or guided self-help
- Whether specialised CBT (such as trauma-focused or OCD-specific) is needed
- Any reports or letters to a GP or referrer
- The therapist's BABCP accreditation and relevant experience
- Number of sessions included and the cost of extra ones
- Session length and format
- Whether an assessment session is charged separately
- Whether a relapse-prevention plan and GP letter are included
- Cancellation policy and how booster sessions are arranged
On the NHS? CBT is widely available free on the NHS across the UK. Access is through your local NHS or HSC psychological-therapies service: in England this is often called NHS Talking Therapies and may allow self-referral, while service names, eligibility and referral routes differ in Scotland, Wales and Northern Ireland. Private CBT offers the same evidence-based approach and may be chosen for speed or choice of therapist.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Assuming CBT is right without checking whether another therapy would suit better
- Not explaining that effort and between-session practice are part of the treatment
- Seeing a practitioner who is not BABCP-accredited but calls their work 'CBT'
- No clear plan for what happens if therapy is not helping
- No relapse-prevention plan or follow-up at the end of the course
Marketing red flags
- Guarantees of a cure or a fixed result from CBT
- Very short 'CBT' packages promising to fix complex problems instantly
- Practitioners with no recognised accreditation marketing CBT strongly
- Pressure to buy a large block of sessions upfront before an assessment
- Claims that one type of therapy works for absolutely everyone
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Is CBT the right therapy for my particular problem, or would another approach suit better?
- Are you accredited by the BABCP, and how much experience do you have with this issue?
- How many sessions are you suggesting, and how will we measure progress?
- What will be expected of me between sessions?
- What happens if I'm not improving, or the therapy doesn't feel right?
- How do I arrange a booster session if I need one later?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my programme, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this programme not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Do I need a GP referral for CBT?
How long does CBT take to work?
How do I know a CBT therapist is properly qualified?
Is CBT better than medication?
What if CBT doesn't help me?
Can CBT be done online or by phone?
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Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Cognitive behavioural therapy (CBT) overview BABCP — What is CBT? BABCP — Find an accredited therapist (CBT Register) Mind — Cognitive behavioural therapy (CBT) NHS — NHS Talking Therapies (self-referral) nidirect — Urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland) NHS England — 111 offering crisis mental-health support NHS inform (Scotland) — Get urgent mental-health help NHS 111 Wales — Mental health and wellbeing nidirect — Mental health emergency / crisis (Lifeline 0808 808 8000) NHS — Find NHS Talking Therapies for anxiety and depression (England) NHS inform (Scotland) — Psychological therapies and interventions NHS 111 Wales — Counselling nidirect — Mental health care professionals (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Psychotherapy / talking therapy · Treatment for anxiety disorders · Depression assessment and treatment · Health anxiety treatment · Obsessive-compulsive disorder (OCD)