Can I do CBT on my own?

Guided self-help CBT, with support from a practitioner, can work about as well as face-to-face therapy for depression and anxiety; exercises done entirely alone suit milder difficulties or a first step. The free exercises here are a good start; if things persist, or come from deeper patterns below the waterline, a therapist will take you further.

What's the difference between CBT and ACT?

Classic CBT examines what a thought says, finds the blind spot and adjusts it; ACT doesn't debate whether it's true, and instead practises stepping back and putting energy into what you value. They complement each other.

How do I find a CBT therapist in Hong Kong?

Look for specific CBT training and membership of a professional body. Further down are TreeholeHK's counsellors and clinical psychologists who use CBT; read their backgrounds before you book.

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Therapy approaches, explained

Cognitive behavioural therapyCBT

Q: How many sessions does CBT take?

Usually 5 to 15 sessions, depending on what you're having it for. A focused problem may improve in a few; long-standing or complex ones take longer. Your therapist will estimate it with you after a session or two.

What troubles us is often not the thing itself but a blind spot in how we see it. Once you see the blind spot, the distress often eases.

Try a free exercise Find a therapist

CBT gives us many useful tools for rebuilding how we think and act. … Reason is surely one of our greatest gifts and strengths as human beings. But if we lean on it too hard and ignore everything else, I think there is a cost: it carries you further from your feelings, and from the deeper side of being human.

CBT's answer: distress often comes from a blind spot

Have you ever come home from a gathering that didn't go well, and found it wasn't just disappointment but a creeping doubt: am I unlikeable, am I unlovable? The next invitation comes and you'd rather skip it, yet the more you avoid people, the scarier they seem. It was only one evening. How did it turn into a verdict on your whole self?

1The worldview

How does a blind spot snowball? Thought, feeling and behaviour push each other along

The answer of cognitive behavioural therapy (CBT) to that opening situation is that much of our distress comes not from how bad things are, but from not thinking about them in the best way: the thought itself has gaps. ("Cognitive" simply means how we understand and interpret what happens.) When we find the blind spots in how we used to see things, the distress often eases.^[1]

The answer carries weight: CBT is often called the "gold standard" of psychotherapy, partly because it is the most researched approach, used with many different groups and broadly effective. It comes across as very rational, and that goes back to its philosophical roots: the Stoics of the Greek and Roman world held that we should focus on what we can control, and that we are disturbed not by events but by our views of them. That is where the core belief above comes from.^[2,3,]

How does a course of CBT put these together?

Now you know how it sees a person and how it works. The next questions: what is it actually like, does it work, and what is it not for?

Knowing roughly how well it works, what does it involve in practice? Doing CBT is, in a sense, learning a way of seeing the world and making the model and skills above your own. It is structured and goal-led, usually 5 to 15 sessions depending on what it's for, and the length varies from person to person.^[27]

1Assessment and goalsTalk through what's going on and agree on concrete, reachable goals.
2Map events, beliefs and consequencesUse the ABC model to link activating events, your beliefs, and the feelings and behaviour that follow, to see what keeps the problem going.
3Find the blind spots

Free CBT exercises

Want to try it yourself first? These free exercises are simpler versions of the skills above, with you step by step.

CBT videos

Episodes are in Cantonese.

A self-guided CBT path

Not ready to see a therapist yet? Start with these six steps at your own pace, one or two a week.

Courses

No dates are open for this approach right now. All our latest courses and events are on the events page.

Therapists who practise CBT

TreeholeHK's counsellors and clinical psychologists use CBT to fit what you need, alongside other approaches.

Beyond CBT: how other approaches look below the waterline

CBT works with the thoughts that surface; other approaches look after different parts of the iceberg. Start here to learn more.

Rather than argue with a thought, step back from it and move towards what you value.^[33]
An offshoot of CBT, first developed for people overwhelmed by intense emotions, teaching four skill sets: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.^[34,35]
The recommended first treatment for chronic insomnia, ahead of sleeping pills.

Other therapy approaches

FAQ

What is the core belief of CBT?

CBT sees the mind as feelings, thoughts and behaviour, each affecting the others. What troubles us is often not the event but our thoughts about it, and those thoughts often carry blind spots we can't see. Once we spot them, the distress often eases.

Why is CBT called the "gold standard"?

Partly because it is the most researched therapy, used with many groups and broadly effective. Gold standard doesn't mean no limits, though; the section covers them.^[3,4]

How many sessions does CBT take?

Want someone alongside you?

You can do the exercises on your own. When you're stuck, a trained therapist can take you further.

3The skills

How do you rewrite that verdict? Two doors, seven skills

Knowing where the blind spot is, the next step is rewriting it. The sadness from that opening evening won't lift because you tell yourself "today I'll be happy": feelings are hard to change directly, so CBT's skills use the other two doors: change the thought (the B in ABC), or change the behaviour (part of C). The seven skills below are what those two doors look like in practice.

Through thought: cognitive restructuring

Four skills, from shallow to deep: catch the automatic thought and spot the trap; weigh the evidence with a thought record and Socratic questions to find a view that fits the facts better; then follow the thought down to the deeper beliefs.

Catch the automatic thought, spot the trap
Find the thought that flashed through your mind when the feeling was strongest, then check it against common thinking traps: overgeneralising, catastrophising, mind reading, all-or-nothing. You spot the trap yourself; the therapist doesn't label it for you. Back to the opening party, "people don't like me" is exactly overgeneralising.^[1,5,21]
Hear it in a session
1. Therapist
  After last Saturday's party you said you felt awful. What was the feeling: sad, embarrassed, something else?
2. Client
  Mostly sad… a bit humiliated too.
3. Therapist
  How strong was the sadness, 0 to 100?
4. Client
  About 80. I wanted to cry all the way home.
5. Therapist
  In that moment, what went through your mind? There may be more than one thought.
6. Client
  "They didn't want to talk to me." "I've messed up again." …And "people don't like me."
7. Therapist
  Which one stings most?
8. Client
  The last one.
9. Therapist
  Let me check I've got it: at the party you thought "people don't like me", and felt sad at about 80. Is that right?
10. Client
  Yes.
Notice: The therapist names the emotion and its strength first, finds the "hot" thought, checks their summary, and rates the feeling and the belief separately. The client spots the traps; the therapist accepts that the two people really didn't talk to them. Belief only moves from 90 to 75: naming a trap is a starting point, not a conclusion.
Method based on^[21,22]
The thought record
Take the thought you caught in the first skill and write it, with the situation and feeling around it, into columns (in effect, ABC on paper): situation, emotion (0–100), automatic thought, evidence for and against, a more balanced thought, then rate the emotion again. Beck's original version was called the Daily Record of Dysfunctional Thoughts.^[1,9]
Socratic questioning
This is how the evidence columns of a thought record usually get filled in. Like Socrates, questions instead of answers: ask for concrete facts, listen, summarise, then invite you to fit the new facts back onto the original thought. The therapist is not trying to persuade you but to investigate with you; one textbook describes therapist and client as "active participants in collaborating to investigate the validity of the client's interpretations and beliefs". One study of 55 adults in cognitive therapy for depression found that in early sessions, when a therapist used more of this questioning than usual, symptoms improved more by the next session.^[10,11,32]
Hear it in a session
1. Therapist
  Last time you said "people don't like me": 90 at first, 75 after we looked at the traps. Shall we go through that evening? What happened after you arrived?
2. Client
  I got there early. Yan was there and we talked for about half an hour, about her new job.
3. Therapist
  How did it feel, talking with Yan?
The downward arrow: finding the core belief
The skills above mostly work on automatic thoughts; this is how you reach the two layers below. Ask of an automatic thought, "if that were true, what would it mean to you?", layer by layer. It often leads from the thought to an "if… then…" intermediate belief, and then to a core belief.^[5,8]
Hear it in a session
1. Therapist
  The thought you wrote down is "Mandy and her friend don't like me". Shall we follow it down? Not to argue whether it's true, only to ask what it means to you. I'll write each step down. Is that OK?
2. Client
  OK.
3. Therapist
  Suppose it's true and they really don't like you. What would that mean to you?
4. Client
  That I'm not interesting enough, I guess.
5. Therapist
  And if you're not interesting enough, what would be so bad about that?

Through behaviour

Act first, and let new experience rewrite the thought. Three uses: get moving when depressed (behavioural activation), test a prediction (behavioural experiments), face a fear step by step (graded exposure).

Behavioural activation
It is the same loop as the opening evening, "the less you go, the scarier it gets", and it is especially strong in depression: we do less, and doing less makes mood worse. Behavioural activation works outside in: track what you do and how you feel for a week, then schedule small, concrete activities that bring pleasure or a sense of achievement. Studies found this part alone can work about as well as full CBT.^[17,18,19]
Hear it in a session
1. Therapist
  Let's look at last week's activity diary. Saturday 10am to 1pm you wrote "in bed, scrolling", mood 3.
2. Client
  Yeah, most weekends are like that.
3. Therapist
  That morning, what happened before you picked up the phone?

The dialogues are illustrative composites, not real clients; skills that stir strong emotion or touch on trauma should be done with a trained therapist.

Does it work? Will learning these really ease it?

CBT's claim is that changing thoughts and behaviour eases distress, including the snowballing doubt from the start. Does that hold up? CBT is the most researched psychotherapy, but how effective is "effective"? Below, question by question: how firm the evidence is, and what limits it.

Depression: better than no treatment
Hundreds of trials agree that CBT helps depression more than a waiting list or usual care: about four in ten people saw their symptoms halve, against about two in ten in the comparison groups. Once unpublished studies are allowed for, the benefit shrinks by about 40%, but it remains.^[14]
Depression: compared with medication
In the short term, CBT works about as well as antidepressants for depression, and combining the two beats medication alone.^[14]
Anxiety and stress
Across many pooled studies, CBT has the strongest support for anxiety disorders, bulimia, anger and general stress. But over 80% of the anxiety trials compared it only with a waiting list; against usual care or a placebo pill the effect was small to moderate, and few trials were of high quality.^[3,13]
Insomnia: falling asleep and staying asleep
Compared with groups given no active treatment, CBT for insomnia (CBT-I) on average helped people fall asleep about 19 minutes faster and spend about 26 fewer minutes awake in the night, with sleep efficiency up about a tenth. Total sleep time barely changed.^[16]
Is it better than other therapies?
Counted strictly, CBT's effect is moderate and it is not clearly better than other established therapies. "Gold standard" means the most studied, not necessarily the most effective.^[13,14]
Does the benefit last?
When medication stops, much of its protection stops too; CBT's effect seems to outlast the treatment. In one study, people who had finished CBT (with up to three booster sessions) relapsed no more often over a year than people who stayed on medication, and a pooled analysis found CBT slightly ahead of medication at 6 to 12 months. But few trials have looked at this, so more evidence is needed.^[14,15]

And be honest about the numbers: even with CBT, more than half of people don't see their symptoms halve. That doesn't make CBT useless; it means no single therapy suits everyone.^[13,14]

References

1.Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
2.Epictetus. (c. 125/2008). Enchiridion, §§1, 5 (R. Dobbin, Trans.). In Discourses and selected writings. Penguin Classics.
3.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), 427–440. doi.org/10.1007/s10608-012-9476-1
4.David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9, 4. doi.org/10.3389/fpsyt.2018.00004
5.Burns, D. D. (1980). Feeling good: The new mood therapy. William Morrow.
6.Ellis, A. (1962). Reason and emotion in psychotherapy. Lyle Stuart.
7.Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford University Press.
8.Beck, J. S. (2021). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press. guilford.com
9.Greenberger, D., & Padesky, C. A. (2016). Mind over mood: Change how you feel by changing the way you think (2nd ed.). Guilford Press.
10.Padesky, C. A. (1993, September). Socratic questioning: Changing minds or guiding discovery? [Invited address]. European Congress of Behaviour and Cognitive Therapies, London. padesky.com
11.Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour Research and Therapy, 70, 32–37. doi.org/10.1016/j.brat.2015.05.004
12.Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. doi.org/10.1016/j.brat.2014.04.006
13.Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3), 245–258. doi.org/10.1002/wps.20346
14.Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: A comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105–115. doi.org/10.1002/wps.21069
15.Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O'Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., & Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62(4), 417–422. doi.org/10.1001/archpsyc.62.4.417
16.Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204. doi.org/10.7326/M14-2841
17.Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295–304. doi.org/10.1037/0022-006X.64.2.295
18.Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., … Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658–670. doi.org/10.1037/0022-006X.74.4.658
19.Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., … Finning, K. (2016). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): A randomised, controlled, non-inferiority trial. The Lancet, 388(10047), 871–880. doi.org/10.1016/S0140-6736(16)31140-0
20.Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (Eds.). (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.
21.Beck, J. S. (2024, December 5). Why CBT therapists don't challenge cognitions—and what they do instead. Beck Institute. beckinstitute.org
22.Centre for Clinical Interventions. (n.d.). Back from the bluez: Module 5, Unhelpful thinking styles; Module 6, Detective work and disputation. Government of Western Australia, Department of Health. cci.health.wa.gov.au
23.Padesky, C. A. (2019, July 18). Action, dialogue & discovery: Reflections on Socratic questioning 25 years later [Invited address]. Ninth World Congress of Behavioural and Cognitive Therapies, Berlin. padesky.com
24.de Oliveira, I. R. (n.d.). Downward/upward arrow. Common Language for Psychotherapy (CLP) Procedures. commonlanguagepsychotherapy.org
25.Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. W. W. Norton.
26.Richards, D. A., Rhodes, S., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., … Woodhouse, R. (2017). Cost and Outcome of BehaviouRal Activation (COBRA): A randomised controlled trial of behavioural activation versus cognitive–behavioural therapy for depression. Health Technology Assessment, 21(46), 1–366. doi.org/10.3310/hta21460
27.NHS. (2025). Cognitive behavioural therapy (CBT). Page last reviewed 28 March 2025. nhs.uk
28.National Institute for Health and Care Excellence. (2022). Depression in adults: Treatment and management (NICE guideline NG222). nice.org.uk
29.National Institute for Health and Care Excellence. (2011, updated 2020). Generalised anxiety disorder and panic disorder in adults: Management (Clinical guideline CG113). nice.org.uk
30.Schermuly-Haupt, M.-L., Linden, M., & Rush, A. J. (2018). Unwanted events and side effects in cognitive behavior therapy. Cognitive Therapy and Research, 42(3), 219–229. doi.org/10.1007/s10608-018-9904-y
31.Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40(12), 1943–1957. doi.org/10.1017/S0033291710000772
32.Dryden, W. (2017). Cognitive-behavioural counselling psychology (ch. 8, "Epistemologies: The ways of knowing"). In D. Murphy (Ed.), Counselling psychology: A textbook for study and practice. Wiley (BPS Textbooks).
33.Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
34.Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
35.Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. Guilford Press.
36.Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D., for the Clinical Guidelines Committee of the American College of Physicians. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133. doi.org/10.7326/M15-2175

Graded exposure

The same logic as a behavioural experiment, aimed at fear and avoidance. With a therapist, list a ladder of fears and face them one rung at a time, starting from the easiest. Before each step, write down your prediction, then see what actually happens. (Wolpe's systematic desensitisation uses the same ladder, paired with relaxation and often done in imagination first.)^[7,12]

Hear it in a session

Therapist
Last week you managed the dog photos. On the ladder we made, the next step is a three-minute video of a dog. Would you like to try it today?
Client
Yes… but I'm a bit scared.
Therapist
What are you most worried will happen if you watch it?
Client
That I'll be too scared to stand it and have to turn it off halfway.
Therapist
How sure are you that will happen, 0 to 100?
Client
80.
Therapist
Let's write that prediction down. The test is to watch all three minutes. What do you usually do to make it easier on yourself?
Client
Look away, or fast-forward. Sometimes I hug a cushion.
Therapist
Those make the test less accurate, so let's try without them this time. You're in charge; but watching to the end is the best test of your prediction.
Client
OK.
Therapist
(Halfway through) What are you feeling right now?
Client
Really scared, about 70. My palms are sweating.
Therapist
OK. Just keep noticing it.
Therapist
(After the video) Did what you were worried about happen?
Client
No. I was really scared, but I watched it all.
Therapist
How do you know?
Client
The video finished, and I didn't turn it off or look away.
Therapist
How surprising is that to you?
Client
Very. I was sure I couldn't do it.
Therapist
What did you learn from it?
Client
Even when I'm really scared, I can probably get through it, at least for three minutes.
Therapist
Let's write that on your record. What comes next is your choice: another video, or a different place, or a different dog.

Notice: The client chooses every step. The prediction is about the feared outcome ("I won't be able to stand it and will turn it off"), not the racing heart that will happen anyway; the test length is set in advance, and the client drops the small things they do to feel safe. During it they name feelings, with no reassurance; afterwards: did the feared thing happen, how do you know, how surprising was that, what did you learn? The point is the gap between prediction and reality, not waiting for anxiety to fall. Graded exposure should be done with a trained therapist.

Method based on^[12]

Cognitive behavioural therapyCBT

CBT's answer: distress often comes from a blind spot

How does a blind spot snowball? Thought, feeling and behaviour push each other along

How does a course of CBT put these together?

Free CBT exercises

CBT videos

Further reading

A self-guided CBT path

Courses

Therapists who practise CBT

Beyond CBT: how other approaches look below the waterline

Other therapy approaches

FAQ

Want someone alongside you?

Is the surface thought the whole story? Three layers: automatic thoughts, intermediate beliefs, core beliefs

Taking that evening apart: the ABC model separates event, belief and consequence

The opening evening, re-read with ABC: one party, two readings

How do you rewrite that verdict? Two doors, seven skills

Through thought: cognitive restructuring

Catch the automatic thought, spot the trap

The thought record

Socratic questioning

The downward arrow: finding the core belief

Through behaviour

Behavioural activation

Beyond social worries, what can CBT help with?

Does it work? Will learning these really ease it?

Depression: better than no treatment

Depression: compared with medication

Anxiety and stress

Insomnia: falling asleep and staying asleep

Is it better than other therapies?

Does the benefit last?

To be honest: seeing it clearly may not settle that evening (CBT's limits)

1Knowing it's irrational doesn't stop it

2Some things simply hurt

3What's below the waterline

References

睡不著怎麼辦？CBT-I 失眠認知行為治療自救

Is CBT Really the Best Therapy?

What Cognitive Behavioural Therapy Actually Does

The Negative Thoughts You Don't Realise You Have

When Your Mind Won't Stop

You're Not Overthinking — It Might Be Anxiety

Depression Is More Common Than You Think

Behavioural experiments

Graded exposure