Cognitive behavioural therapy (CBT), online across New Zealand

What is CBT?

Cognitive behavioural therapy (CBT) is a structured, time-limited talking therapy built on the idea that thoughts, feelings, body sensations and behaviour all influence each other. You and your psychologist map the patterns keeping a problem going, then test and change them through practical exercises in and between sessions. It is the most extensively researched form of psychotherapy.

The idea behind CBT

Imagine you text a friend and they do not reply for a day. One person thinks "they're busy" and gets on with things. Another thinks "I've annoyed them" and feels a drop in their stomach, re-reads the message, and decides not to text again. Same event, different thought, very different feeling and behaviour. CBT starts from that observation: it is often not the situation itself but how we read it and what we do next that keeps distress going.

That does not mean problems are "all in your head" or that CBT is about thinking positively. Many of the thoughts that drive anxiety and depression feel completely true, and some are partly true. CBT treats them as predictions or interpretations that can be examined and tested rather than facts to be obeyed. It also pays as much attention to behaviour, since what you do (avoid, check, withdraw, over-prepare) is often what keeps the cycle running.

CBT is mostly focused on the present and on what maintains a problem now. Your history matters, because it explains where the patterns came from, but the work is aimed at changing what happens this week.

What a CBT session looks like

A CBT session has a shape. It usually begins with a brief check-in and a look at how the between-session work went, then settles on one or two things to focus on, then ends with a plan for the coming week. Sessions at Mindwell are 50 minutes.

In the middle part you might draw out a recent difficult moment on a simple diagram, take a specific thought and look at the evidence for and against it, design an experiment to test a prediction, plan a step up an exposure ladder, or rehearse a conversation you have been avoiding. Worksheets and short questionnaires are common, because they make patterns visible and let you both see whether things are changing.

The relationship is collaborative. Your psychologist brings the model and the techniques; you bring the knowledge of your own life and the willingness to try things out. You should expect to understand the reason for everything you are asked to do, and to be able to disagree.

What CBT is used for

CBT was developed for depression in the 1960s and 1970s, and specific versions have since been built and tested for a wide range of problems. At Mindwell the most common are:

• Anxiety, including panic disorder, social anxiety, health anxiety and specific phobias, where CBT is the first-line psychological treatment in clinical guidelines.
• Depression and low mood, where behavioural activation and cognitive work form the core.
• OCD, treated with exposure and response prevention (ERP), a form of CBT.
• Trauma and PTSD, using trauma-focused CBT alongside or instead of EMDR.
• Insomnia, with CBT for insomnia (CBT-I).
• Eating and body image difficulties and chronic pain, where CBT and ACT are often combined.
• Anger, work stress and perfectionism.

A 2012 review of 106 meta-analyses found the strongest evidence for CBT in anxiety disorders, somatic problems such as health anxiety, bulimia, anger and general stress, with good support across many other conditions. It is not the right tool for everything, and a good psychologist will say so.

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What the evidence says, honestly

CBT has been described as the current gold standard of psychotherapy, not because it is perfect but because it has been studied far more than any other approach, and no other therapy has shown itself to be consistently better. For anxiety disorders, a meta-analysis of 41 trials comparing CBT with placebo found moderate effects overall and large effects for generalised anxiety and OCD, and the odds of responding to treatment were about three times higher with CBT than with placebo.

The honest caveats matter too. Effects against an active placebo are smaller than effects against a waiting list. Some people do not respond, or respond partially. Studies often run for a fixed number of sessions, and real life does not. Clinical guidelines such as NICE recommend CBT for anxiety and depression because it has the strongest evidence, not because it works for everyone.

What this means for you: CBT is a reasonable first choice for most of the problems listed above, your psychologist should be tracking whether it is helping, and if it is not working after a fair trial, the plan should change.

Does CBT work online?

Of all the therapies, CBT has the most evidence for remote delivery. Two kinds of research are relevant, and it is worth being clear which is which.

Live video sessions with a therapist, which is what Mindwell offers, have been examined in a 2021 meta-analysis of 56 within-group and 47 between-group studies. Video-delivered psychotherapy produced large improvements, with a negligible difference from in-person treatment and especially strong effects for CBT. A 2024 systematic review limited to randomised trials in anxiety disorders found telehealth and face-to-face treatment produced comparable results for symptoms, functioning and the therapeutic relationship.

Therapist-guided online CBT programmes, where you work through structured modules with a therapist's support by message or short calls, have been directly compared with face-to-face CBT in 31 randomised trials across 16 conditions. The pooled difference was close to zero. New Zealand's free Just a Thought courses can be used this way when a health professional prescribes a course and follows your progress; on your own they are self-guided, and people are more likely to finish them with support.

Both lines of evidence point the same way: it is the content of the therapy and the quality of the work that matter, not the room. Read our guide Is online therapy effective? for more detail.

CBT, counselling and other therapies: what is the difference?

CBT is a method, not a profession. In New Zealand, psychologists are registered with the New Zealand Psychologists Board under the Health Practitioners Competence Assurance Act and can be checked on the public register. Counsellors and psychotherapists are separate professions with their own training and bodies. Any of them may use CBT techniques; registered psychologists are trained to assess and formulate as well as treat, and CBT is a core part of most clinical and counselling psychology programmes. Our guide to psychologists, counsellors and psychotherapists covers the differences.

Compared with open-ended counselling, CBT is more structured, more focused on a defined problem and more likely to involve practice between sessions. Compared with other approaches used at Mindwell:

• ACT grew out of CBT but works on changing your relationship with thoughts rather than their content, and places values at the centre.
• DBT is a form of CBT built around skills for intense emotions, with a strong emphasis on acceptance alongside change.
• Schema therapy extends CBT to long-standing patterns formed early in life and draws on experiential techniques.
• EMDR is a distinct trauma-focused therapy that works with memories directly rather than through thought records.
• Psychodynamic and relational therapy focuses on relationship patterns and their origins, with less structure and homework.

Many psychologists blend approaches. What matters is that the plan is explained and the reasons for it make sense to you.

Is CBT right for you?

CBT tends to suit people who want a clear structure, want to understand what is going on, and are willing to try things between sessions. If you like the idea of a shared plan, measurable goals and a defined course of work, it is a good fit. It also suits people with a specific problem (panic, a phobia, OCD, insomnia) where a well-tested protocol exists.

It may be a less natural fit if what you want is open-ended space to explore, if the difficulty is mainly about relationship patterns rather than a defined problem, or if you have done a course of CBT before and found the thought-challenging element unhelpful. In those cases ACT, schema therapy or relational approaches may serve you better, and several Mindwell psychologists work across these. Saying what you want in the first session is the quickest way to get the right approach.

One thing to know going in: CBT involves work. Not punishing amounts, but regular practice. The sessions are where you learn the skills; the week is where they take hold.

Doing CBT with Mindwell

Mindwell is a telehealth practice, so every session is a 50-minute video appointment through Carepatron, running in your browser with no download. Book online any time, choose a psychologist or take the first available, and expect a first session typically within 7 days. No GP referral is needed. You will receive a confirmation email with your video link and a separate short intake form.

In the first session your psychologist will gather history, understand the problem and agree goals and a plan with you. From there, sessions are usually weekly or fortnightly. Each costs $199 + GST ($228.85 including GST), paid at booking, with a receipt you can use for insurance claims.

Several of our psychologists use CBT as a primary approach: Sandy Laurenson (CBT, ERP, ACT and DBT), Jeremy Mason (CBT and ACT, with a focus on eating disorders, chronic pain and anxiety), Katherine Lee (CBT alongside schema therapy, ACT and DBT), Dan Kerr (CBT and ACT alongside EMDR) and Jake Meads (practical, skills-focused work with anxiety, anger and depression). All are registered with the New Zealand Psychologists Board and work with adults 18 and over.

Related support: ACT therapy · DBT skills · Anxiety therapy · Depression counselling