What happens in a first CBT session for anxiety
Not knowing what therapy involves is itself a reason people put it off. Here is what the first sessions actually contain, from the assessment to the first thing you try.
One of the things that keeps anxious people from starting therapy is, reasonably enough, anxiety about therapy. What will I be asked? Will I have to talk about my childhood? Will I be made to do something frightening? Not knowing is its own obstacle, so here is what actually happens.
Before the first session
It starts with a free 15-minute call. You describe what is going on, in whatever words you have, and ask me anything. I give you a straight answer about whether this is work I am well placed to do. There is no pressure to book anything afterwards. If a phone call itself is hard, you can send a written enquiry instead.
You do not need a diagnosis, a GP referral, or the right words for what is happening. Describing what your days look like is enough.
The assessment
The first one or two sessions are assessment, and assessment is mostly me listening carefully and asking specific questions. What happens, when, and what you do about it. What you predict before a difficult situation. What you avoid, and what you do to get through what you cannot avoid. What a bad day looks like, hour by hour, and what a good one does. How long it has been like this, and whether anything has changed it.
I will ask some history, because anxiety usually has a shape that was learned somewhere, but this is not a deep excavation of your childhood. It is enough to understand where the pattern came from, and then we work with the pattern as it is now.
By the end of assessment we agree clear goals, concrete ones rather than "feel less anxious", which is hard to measure: get on the train, sleep through, stop checking, go to the thing. We score where you are now with the same standardised measures used in NHS Talking Therapies, so that progress is something we can both see rather than something we hope for.
The map
Early on, usually in the first two or three sessions, we build a map of what keeps your anxiety going. This is the centre of CBT: the predictions your mind makes, the checking and avoidance that bring short-term relief, and the loop that keeps turning between them. We draw it, literally, from real recent examples, and most people see something they had not seen before. The anxiety turns out to have parts, and the parts turn out to be connected in a way that can be interrupted.
The first thing you try
From the first week, you will have something practical to do between sessions. It is deliberately small. It might be recording what happens when you do not check something. It might be a tiny step into a situation you have been avoiding. It might just be noticing, for a week, what you predict before each difficult moment and what actually occurs.
Nothing is sprung on you. Every step is agreed together, you always know what we are testing and why, and we start well within what you can manage. The point is information, not endurance. Most of the change in anxiety treatment happens between sessions, in your own week, which is why the between-session work matters more than what happens in the room.
If you have a panic attack in a session
It happens, and it is fine. Sessions are a safe place to understand panic rather than fear it. We would use it, gently, to look at what your body did and what you concluded from it, which is exactly the work.
Reviewing as we go
We review formally around session six: what has shifted, what has not, and whether the plan needs to change. A typical course runs 8 to 16 weekly sessions of 50 minutes, and we stop when you have what you came for. I am not interested in keeping people in therapy longer than the work needs.
Online or in person
Sessions are online across the UK and worldwide, or in person at Sanctuary Therapy Centre in Prestwich and Hebden Bridge. Online CBT matches in-person outcomes for anxiety, and working from your own home can make it easier to start. Sessions can be in English or Spanish.
If not knowing what happens has been the thing in the way, there is more on how I treat anxiety, and the free call exists for the questions this page has not answered.