Cognitive Behavioural Therapy

Figures checked September 2026

Cognitive behavioural therapy — mostly shortened to CBT — is a structured, practical form of talking therapy. It’s the most widely used Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder in Australia, and it’s offered by Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder , Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder , Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder and occupational therapists. Some GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder with extra training deliver parts of it too.

The idea behind it is straightforward. What you think affects how you feel, and both affect what you do. Change one and the others tend to move with it.

So instead of spending a long time on your history, CBT looks at what’s keeping an unhelpful pattern going right now, and gives you things you can use, often on your own, to change it.

How it works

Most CBT starts by mapping a cycle.

Say you’ve begun turning down invitations to go places. You think I’ll have nothing to say and people will notice, which makes you anxious, so you stay home. The relief you feel makes staying home seem like the right call. Next time you’re invited, you’re even more likely to say no. You’ve protected yourself from the anxiety, and you’re also lonelier and further from the people around you.

Once you can see the loop, there are a few places to break it.

Working on the thoughts. This isn’t positive thinking, which is the most common thing people expect and the most common thing they’re surprised by. It’s closer to checking a claim: what’s the evidence, what else could explain it, what would you say to a friend who told you the same thing. Often done on paper, at least at first.

Working on what you do. Testing a prediction by trying the thing and seeing what actually happens. Or, for low mood, planning activity before you feel like it, because motivation usually follows action rather than coming first.

Facing what you’ve been avoiding, in steps. For fear and anxiety, this is the part that does most of the work — going towards what you’ve been steering around, a bit at a time, and staying long enough for the alarm to settle.

Learning what keeps it going. A lot of CBT is explanation: how panic works, why checking makes doubt worse, what happens to sleep when you try to force it.

What a session is like

Sessions run about 50 minutes and have a shape you’ll recognise after the first couple. A short check-in, a plan for the hour that you both agree on, work on something specific, and something to take away.

The first session or two is usually assessment — what’s happening, when it started, what you’ve tried, what you want to be different. Your therapist will often sketch out how they understand the pattern and ask whether it fits.

You’ll be asked to do things between sessions. Writing down thoughts, tracking sleep or mood, trying something out. This matters more than it sounds, because most of the change happens in the six days you’re not in the room.

Courses usually run somewhere between eight and twenty sessions, and the ending is normally talked about early rather than sprung on you.

Who it tends to suit

CBT works well for people who like knowing what they’re doing and why, and who want something practical they can use on their own.

It does best when you can name what you’d like to be different — panic attacks, a specific fear, avoiding things you used to do, sleep that’s gone wrong. The clearer the target, the better it tends to do.

It also suits you if you’d rather work on the present than spend a long time on things that have happened in the past, and if a set number of sessions appeals more than something open-ended.

What the evidence says

CBT has the largest evidence base of any psychological therapy. It’s the first thing most guidelines recommend for anxiety, depression, panic, obsessive compulsive disorder (OCD) and insomnia.

Most of that research tests CBT delivered as a full structured program by well-trained therapists in trial conditions. What’s offered in private practice is often CBT-informed, which uses the same ideas more loosely. That isn’t necessarily worse, but it also isn’t quite the thing that was measured.

The other thing worth knowing is what happens when CBT is compared with other established therapies rather than with no treatment at all. The differences are usually small. For many common difficulties, several serious approaches do about as well as each other.

Getting it in Australia

CBT is the easiest therapy to get in Australia. Who can provide it and what Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder will pay for are separate things, and it’s worth keeping them apart.

Who can provide it. Psychologists, counsellors, psychotherapists, mental health social workers and Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder all train in CBT. Some GPs are trained to deliver a small number of structured sessions themselves — Medicare calls this focussed psychological strategies. Psychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder may use it alongside prescribing medication. There’s more on the differences between these professions in who does what.

What Medicare Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder . A Mental Health Treatment Plan from your GP gives you a Medicare rebate on up to ten sessions a calendar year, but only with providers Registered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder under Better Access The Medicare program that gives rebates on mental health sessions with psychologists and some other professionals, through a Mental Health Treatment Plan. More in the jargon decoder , the Medicare program that funds mental health sessions. That includes psychologists, mental health social workers and mental health occupational therapists. It doesn’t currently include counsellors or psychotherapists.

Your first Referral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder is for six of those sessions. You then go back to your GP for a review before the last four, which catches a lot of people by surprise partway through.

The rebate is $149.05 a session with a Clinical psychologist A psychologist with an extra endorsement, which usually means two more years of training aimed at more complex problems. More in the jargon decoder and $101.55 with a registered psychologist. Fees vary widely, so the gap you pay varies too.

Work out what you’d actually pay rather than assuming the rebate makes it cheaper. Counsellors generally charge less than psychologists, but Medicare doesn’t give a rebate for counsellors. So a counsellor’s full fee can come out lower than what you’d pay a psychologist after the rebate, or higher, depending on what each one charges. Which suits you depends on what you need and what’s available where you live, not only on price — but the cheaper option isn’t always the one with the rebate attached.

There are free and low-cost online options too. This Way Up, MindSpot and MoodGym are Australian, structured CBT programs. MindSpot is free, MoodGym has a small fee, and This Way Up is free when a GP or therapist prescribes it, with a small fee otherwise. They suit some people and not others, since you mostly work through them on your own and supply the momentum yourself, though MindSpot can include support from a clinician. They’re a reasonable place to start for milder difficulties, or while you’re waiting for an appointment.

Telehealth A session by video or phone instead of in person. Medicare gives the same rebate for a session by video as in person. More in the jargon decoder works well for CBT. The structure carries over to video more easily than it does for approaches built around the relationship with the therapist.

If you’ve tried it and it didn’t help

This comes up often, and the reason usually points somewhere useful.

Some people find it doesn’t reach far enough. The thought gets examined, the logic is clear, and the feeling doesn’t budge. That often happens when a belief was learned early and repeated for years, so it’s less about what’s happening now and more about what happened then. Schema therapy and psychodynamic therapy were built for beliefs that old.

Some people can’t manage the work between sessions. If you’re running on empty, or your life is chaotic, tasks become one more thing to fall behind on. Approaches where the session is the work ask less of you outside the room.

And some people find the structure gets in the way of feeling understood. That’s important information about what you need, rather than a verdict on therapy generally.

If you’ve been offered CBT three times, that says more about what Australia has most of than about you.