Firstly, CBT is an evolving therapy. This means that CBT today is not what CBT was 15 years ago. CBT for social anxiety used to mostly be about learning relaxation through controlled breathing, visualisation techniques, simple exposure, and replacing negative self-talk with cognitive coping strategies. These may still be used today, but through research CBT has moved on. Today, if you visit a well trained CBT practitioner your therapy might well be more focused on using behavioural experiments to gather evidence to counter negative beliefs, eliminating the use of safety behaviours, focusing outwardly to reduce self-focused attention, video feedback, and even exposure through virtual-reality.

The basic premises of CBT have continued to be the same; we can change our feelings and increase our quality of life through changing our thoughts and behaviour, but how we do that has changed over time. This is an important point to make for those who may have tried CBT a good few years ago or have been unlucky enough to visit a therapist who has not updated their training. If CBT has not helped you much in the past then it is quite possible that it could be more beneficial if you tried it again with more up-to-date techniques.

Much of the help I offer people resembles CBT and I may even use CBT terminology from time to time. In many respects it is CBT because I focus on helping people change the way they think and behave to overcome their social anxiety, but some of the theory and techniques I employ are unique and would not commonly be found in a typical course of CBT (although I hope that they will be in the future). So when answering the question, ‘does CBT work?’, the answer is not so straight forward. It really depends on what that CBT consists of. Not all CBT is the same.

A second point to make regards the relationship between therapist and client. In CBT this is commonly called the therapeutic alliance. It is important that you get on well with your therapist and feel like they are someone who can understand and help you. If you do not gel well together then it could be a significant barrier to progress. The idea of the therapeutic alliance is not so much that the therapist is there to help you, but rather that together, as a team, you can work through your difficulties. If you wanted to visualise this then you might like to see you and the therapist sitting together facing the problem as opposed to you sitting opposite each other with the therapist looking at you with the problem. If your therapist is not someone you can feel understood by, trust and cooperate with then sooner or later it will get in the way of the therapeutic process, so another answer to the question, ‘does CBT work?’ is that it depends on your relationship with your therapist.

Some personalities fit together better than others and it is not necessarily a failing of your therapist or yourself if you do not connect. If you do not get on well with your therapist then be brave and bring up the matter with them, it could lead to a major break-through in your progress. If things still are not working out, ask to see someone else. It is possible that they can refer you to a colleague who will be a better match. I understand that this can be difficult to do when you have social anxiety, but it might be a key step towards you making significant progress.

Finally, CBT never works for anyone. What I mean by this is that CBT is just a set of theories and techniques. It has to be you who puts in the time and effort to turn those theories and techniques into changes in your life. Although most people understand this, and it can seem patronising to state the obvious, the unfortunate truth is that a lot of people still stand back and take a passive approach to therapy in the hope that change will happen to them. Fear of failure is a big reason for this, but it is important to remember that if we do nothing, then nothing will change, and worse, our situation could even deteriorate.

As you can see, when someone asks the question, ‘does CBT work?’, the answer is not as straight forward as a simple yes and no. CBT does help many people overcome their social anxiety, but your success will depend greatly on what exactly your CBT consists of, how good your relationship is with your therapist and whether or not you are ready to make the commitment of time and effort that is required by it.

What have your experiences of CBT been?