What is CBT and is it just gaslighting yourself?

Cognitive Behavioural Therapy, usually known as CBT, is a practical and collaborative form of therapy. It helps us understand the connections between what we think, how we feel emotionally, what happens in our bodies and what we do in response.

CBT is sometimes described as learning to “change your thoughts”. That is part of some CBT work, but it is an incomplete and rather unhelpful description. Good CBT is not about forcing yourself to think positively, dismissing genuine difficulties or trying to become someone you are not.

It is about becoming curious about the patterns that may be keeping you stuck and finding ways of responding that give you more choice.

Understanding the CBT cycle

Our thoughts, feelings, physical sensations and behaviours all influence one another.

Imagine that you are invited to a social event where you do not know many people:

• Thought: “They might think I’m awkward.”
• Feeling: Anxious and self-conscious.
• Physical sensations: A tight chest, a hot face or a racing heart.
• Behaviour: Staying quiet, leaving early or deciding not to go.

Avoiding the event might bring immediate relief. However, it may also mean that you never have the opportunity to discover that somebody was pleased to see you, that the anxiety might have settled or that being a little quiet would not have mattered.

Over time, the pattern can strengthen the original belief: “I can’t manage social situations.”

CBT helps us slow this cycle down and understand what is happening. We might explore the meaning you are making of the situation, what your body is responding to, what you need and whether there is a manageable experiment that could help you learn something new.

That does not necessarily mean making yourself attend every social event. A helpful outcome might be choosing to attend for half an hour, arranging to go with somebody you trust, allowing yourself some recovery time afterwards, or deciding intentionally that this particular event is not worth your energy.

The important difference is having a choice, rather than feeling controlled by anxiety or an established coping pattern.

Isn’t CBT just gaslighting myself?

This is a fair question, particularly if you have previously felt dismissed, misunderstood or told that your difficulties are “all in your head”.

CBT should never ask you to pretend that something is fine when it is not. It should not be used to explain away discrimination, sensory distress, trauma, inaccessible environments, physical illness or the genuine demands being placed upon you.

If a workplace is overwhelming, the answer is not automatically to challenge your thinking until you can tolerate it. We may need to consider reasonable adjustments, boundaries, communication, workload, sensory needs and whether the environment itself needs to change.

Similarly, if you have experienced rejection, criticism or exclusion, CBT should not insist that these experiences did not happen. Instead, we might explore how those experiences affect what you expect now, whether your mind is trying to protect you and what would help you feel safer without making your world increasingly small.

Thoughts are not automatically irrational simply because they are uncomfortable. Sometimes they are accurate. Sometimes they contain a mixture of evidence, prediction and previous experience. Sometimes the issue is not whether a thought is “true” or “false”, but whether treating it as a certainty is helping you.

Good CBT makes room for complexity.

What does neuroaffirming CBT look like?

Neuroaffirming CBT does not begin with the assumption that neurodivergent ways of thinking, communicating, moving or experiencing the world need to be corrected.

Instead, therapy considers the person and their environment together.

This may include exploring:

• Executive functioning, attention and working-memory differences.
• Sensory needs and overload.
• The energy involved in masking.
• Rejection sensitivity and previous experiences of being misunderstood.
• The effects of unpredictable demands or transitions.
• The difference between avoidance, self-protection and necessary recovery.
• Communication preferences and the need for direct, unambiguous information.
• Practical changes that could reduce unnecessary pressure.

CBT may also need to look different in the therapy room. We might use visual information, written summaries, repetition, concrete examples, shorter tasks or more flexible goals. We can adapt the pace and structure rather than expecting you to fit a standardised version of therapy.

The aim is not to train someone to appear less autistic or less ADHD. It is to help them understand themselves, reduce distress, advocate for what they need and develop strategies that genuinely fit their life.

Is CBT goal-focused?

CBT can be quite goal-focused, and I see this as a potential strength when those goals belong to the person coming to therapy.

A goal does not have to be dramatic or easily measurable. It might be:

• Being able to go to work without spending the whole evening recovering.
• Responding differently when panic begins.
• Understanding why certain situations lead to shutdown or overwhelm.
• Reducing the amount of time lost to worry or compulsions.
• Feeling more able to say no.
• Returning to something that anxiety has pushed out of your life.
• Developing a kinder and more accurate understanding of yourself.

Goals give therapy some direction and allow us to notice whether it is making a meaningful difference. They are not targets imposed by the therapist, and they can be reviewed or changed as our understanding develops.

Therapy should always be collaborative. I bring clinical knowledge and experience, but you bring expertise in yourself, your life and what matters to you. We work with both.

How might CBT help?

Depending on what you are experiencing, CBT can help you:

• Make sense of patterns that previously felt confusing or automatic.
• Understand the relationship between your mind, body and behaviour.
• Recognise coping strategies that help in the short term but create difficulties over time.
• Respond differently to worry, panic, intrusive thoughts or self-criticism.
• Gradually approach situations that have become frightening or restricted.
• Test predictions through safe, agreed behavioural experiments.
• Develop practical strategies for everyday difficulties.
• Build confidence in your own judgement.
• Make changes between sessions as well as talking about them in therapy.
• Identify when the person needs support to change and when the environment needs to change.

CBT is not the right approach for every person or every difficulty. Even when it is appropriate, it should be adapted to the individual rather than delivered as a rigid set of worksheets.

Why I chose to become a CBT therapist

I began my career as a mental health nurse. Nursing gave me a strong clinical foundation and taught me the importance of seeing the whole person, not simply a diagnosis or collection of symptoms.

However, I increasingly wanted to do more than support people through the most difficult moments. I wanted to understand, alongside them, what was maintaining their distress and help them create meaningful, lasting change.

Training in CBT gave me a framework for doing that. I valued its curiosity, its transparency and its focus on making therapy useful beyond the session itself. Rather than therapy being something mysterious that is “done” to somebody, CBT allows us to develop a shared understanding of what is happening and decide together where change may be possible.

I have since trained in other approaches, including Interpersonal Psychotherapy and EMDR, because no single model can meet every person’s needs. However, CBT remains an important part of how I work. At its best, it combines compassion and understanding with practical change.

For me, CBT is not about arguing you out of your feelings. It is about helping you understand why your responses make sense, noticing where you may have become stuck and working collaboratively towards a life that feels more manageable and more your own.

What happens in CBT sessions?

Early sessions usually involve getting to know you, understanding what has brought you to therapy and agreeing what you would like help with. Together, we begin developing a shared picture of the difficulty, including what may have contributed to it and what appears to be keeping it going now.

Sessions may include talking, mapping patterns, practising a skill or planning something to try between appointments. Any task should have a clear purpose and be agreed together. It is not homework for the sake of compliance, and it is useful to discuss honestly when something does not feel manageable or relevant.

As therapy progresses, we review what is helping, adapt what is not and consider how you can continue using what you have learned after sessions finish.

CBT should feel like something we are doing together, not a programme being applied to you.