CBT (Cognitive Behavioral Therapy)

That’s the lever CBT works. In practice it means getting a good look at the thoughts running underneath a hard feeling, the ones that fire so fast you don’t clock them as thoughts at all, and testing whether they’re actually true or just loud. A therapist might use Socratic questioning here, asking the kind of question that gets you to step outside your own head for a second. What would you say to a friend who told you this? How would someone else read that same moment?

For something like anxiety, telling yourself the fear isn’t rational never works, because you can feel it in your chest and your body has already decided it’s real. So CBT goes at it differently, building perspective from the outside in, and pairing it with small, real steps that show your nervous system the thing it’s bracing for isn’t the catastrophe it predicted.

• People stuck in thought loops that keep feeding the same bad feeling
• Anyone with anxiety, especially fears that don’t respond to reasoning
• People who want structure and concrete tools, not open-ended talk
• Those who do well with a bit of practice between sessions
• Anyone who wants to see the connection between what they think and how they feel, and get some leverage on it

CBT also shows up threaded through other work here. A number of our clinicians pull CBT tools into anxiety, depression, and trauma work, because the thoughts-feelings-behavior link is useful almost everywhere.

You and your therapist pick the thing you want to work on and stay pointed at it, rather than wandering. Early on, a lot of the work is noticing, catching the automatic thoughts that fire under a hard moment and getting them out where you can look at them. From there you test them and build other ways of seeing the same situation. Where it fits, that gets paired with doing, small graded steps toward the thing you’ve been avoiding. For anxiety, a therapist might scale it with you from zero to ten and work up the ladder a rung at a time. That can take a handful of weeks or a good stretch of them, depending on where you’re starting. You’ll usually have something to practice between sessions, because CBT is built to move out of the room and into your week.

Available in person or by telehealth. CBT is structured and skills-based, and it works well over video.

It sits in a larger toolkit, and which parts get used depends on you. Several of our clinicians pair it with DBT and ACT, since the three build on each other and cover different ground. DBT works acceptance and change together, with mindfulness, distress tolerance, and the idea that two things can be true at once. ACT works on psychological flexibility, getting clear on your values and looking honestly at whether your choices match them.

Holly Brooks is candid that CBT isn’t her default approach, and that anxiety is where she finds it genuinely useful, particularly Socratic questioning, where she’ll use examples from her own life to help someone step outside their own read on a situation. That’s the general shape of it here. The relationship comes first, and the evidence-based work gets brought in where it fits the person.