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Cognitive Behaviour Therapy (CBT)
Spot the thoughts that keep you stuck, test them, and build skills that hold up in real life
Cognitive behavioural therapy (CBT) is a structured talk therapy that helps you spot and change the thoughts and habits that keep you stuck. At Trillium Counselling, Registered Social Workers (RSWs) and Registered Psychotherapists (RPs) offer 50-minute CBT sessions in Kitchener-Waterloo and online across Ontario. Most people come for 6 to 20 sessions and practise new skills between them. Not every thought deserves your trust. CBT helps you check the evidence, then act on what's true.
Last updated: October 2026
What is cognitive behavioural therapy (CBT)?
CBT is a practical, short-term talk therapy built on a simple idea: the way you interpret a situation shapes how you feel and what you do next, often more than the situation itself (CAMH guide to CBT). Instead of spending most of your time on the past, CBT focuses on the problems showing up in your day-to-day life right now (CAMH).
It's also a team effort. You and your therapist set goals together, try new skills in session, and practise them between sessions, so that over time you can use them on your own.
Focused on now
You work on what's happening in your life today, not only on how it started.
Structured and goal-based
Each session has a plan, and you'll agree on clear goals you can track together.
Skills you keep
You leave with practical tools you can keep using long after therapy ends.
"CBT focuses on the here-and-now—on the problems that come up in day-to-day life."
"CBT places an emphasis on helping individuals learn to be their own therapists."
How does CBT work?
CBT looks at four parts of any hard moment: your thoughts, your emotions, your body's reactions, and what you do. Each one affects the others (CAMH). A quick, automatic thought such as "I'm going to mess this up" can bring a wave of dread, a tight chest, and the urge to avoid. Avoiding brings relief for now but often makes the next time feel harder.
A situation or trigger: your manager messages, "Can we talk at 3?"
Thoughts
What runs through your mind. "I must have done something wrong."
Emotions
How you feel. Worry, dread, maybe shame.
Body
What you notice physically, such as a racing heart, a knot in your stomach, or a restless night.
Actions
What you do next. Rereading the message, avoiding your manager, or calling in sick.
Change one part, and the others start to shift. CBT gives you ways in through both your thoughts and your actions.
In sessions, you'll learn to catch automatic thoughts, weigh the evidence for and against them, and reach a more balanced view (CAMH guide to CBT). On the action side, you might plan activities that lift your mood, or face a fear in small, planned steps instead of avoiding it (CAMH). For four skills you can start using today, from slow breathing to facing a fear in small steps, read our guide to CBT skills for everyday life.
What does CBT look like in real life?
Here's one situation, played out two ways. It's the kind of moment you might map out with your therapist on a thought record, a simple worksheet that slows a moment down so you can look at it clearly (CAMH guide to CBT).
The situation: you're on a plane waiting for takeoff, and your heart starts to race.
Without CBT skills
With CBT skills
CBT isn't positive thinking. The goal is to look at a situation from more than one angle and reach a conclusion that fits the facts (CAMH guide to CBT). New or unexplained chest pain always needs medical attention.
What can CBT help with?
CBT is particularly effective for anxiety and depression, and it has been adapted for many other concerns, including OCD, panic, phobias, PTSD, eating disorders, and substance use (CAMH). These are the main areas our therapists use CBT for; they're a starting point, not the full list.
Anxiety, worry, and OCD
Mood and grief
Trauma and body image
Life stages
Don't see what you're dealing with?
That doesn't mean CBT isn't an option. Our therapists also use CBT with clients facing a wide range of challenges, including:
- Panic attacks
- Phobias and specific fears
- Self-esteem and confidence
- Guilt and shame
- Addictions
- Disordered eating
- Living with ADHD
- Chronic pain and illness
- Life transitions
- Relationship and family conflict
- Boundaries and people-pleasing
- Work and life balance
Who provides CBT at Trillium Counselling?
CBT at Trillium Counselling is provided by Registered Social Workers (MSW, RSW) and Registered Psychotherapists (RP). Twenty of our therapists use CBT in their work, and five hold post-graduate certificates in CBT, most from Wilfrid Laurier University. All of them offer secure online sessions, and most also see clients at our Waterloo office.
Fit matters as much as method. That's why we match you with a person, not only an approach.
You're welcome to book directly with one of the therapists below, or book a free 20-minute matching consultation where we'll help match you with a therapist who feels like a good fit.
Show all 20 therapists
Is CBT effective for anxiety and depression?
For many people, yes. Canada's depression treatment guidelines list CBT as a first-line talk therapy, and 6 to 12 months later, people who had CBT tended to be doing better than people who took antidepressants alone (CANMAT, 2023). The same guidelines found that therapy and medication together work better than either one alone, so if you take medication, CBT can be added rather than swapped in. Talk with your doctor before changing any medication.
For anxiety, a review of 41 studies involving more than 2,800 people found that CBT worked better than placebo for anxiety-related concerns, with the largest benefits for OCD and generalized anxiety (Depression and Anxiety, 2018). A later review of 69 studies found that improvements generally lasted up to a year after treatment ended (JAMA Psychiatry, 2020).
CBT works well by video, too. A 2021 review found that therapy by live video led to about the same improvement as in-person therapy, with the clearest results for CBT (Clinical Psychology & Psychotherapy, 2021). Our online counselling page explains how sessions work.
CBT doesn't click for everyone. If it isn't the right fit, your therapist can bring in other approaches, such as ACT, DBT, or EMDR, or help you switch to a therapist who works differently.
What happens in a CBT session?
Your first session or two are mostly about getting to know you: what's been happening, what you'd like to be different, and what CBT will look like for you. After that, most CBT sessions follow a familiar rhythm (CAMH guide to CBT).
- 1
Check in
A quick look at your mood since last time. Some therapists use a short questionnaire to track progress.
- 2
Look back
Review the practice from last week: what worked and what got in the way.
- 3
Set the agenda
Agree on one or two things to focus on today.
- 4
Work on it
Use CBT tools on a real situation from your week.
- 5
Plan your practice
Choose a small task to try before next time, then share how the session felt.
Practising between sessions
Much of the change in CBT happens between sessions, when you try new skills in your own life. The more you practise, the better CBT tends to work (CAMH guide to CBT). Homework is usually small, such as noting a thought, trying a planned activity, or taking one step toward something you've been avoiding. Our article on why your CBT therapist assigns homework explains what to expect.
How many CBT sessions will you need?
CBT is designed to be short-term. It usually runs 6 to 20 sessions, and 12 to 20 is common for anxiety and depression. Some people improve a lot in 4 to 6 sessions, while others need more than 20 (CAMH). For depression, Canada's guidelines suggest that 12 to 16 sessions work well for most people (CANMAT, 2023).
4 to 6
Sessions
Some people with one clear, focused goal see real change quickly.
12 to 20
Sessions
Common for anxiety and depression.
20+
Sessions
When concerns are more complex or have been around for a long time.
Sessions are usually weekly or every other week to start, then spaced out as things improve. You and your therapist will review your progress along the way and decide together when you're ready to finish.
Support Starts Here
Ready to try CBT? Book a free 20-minute consultation, and we'll help you find a therapist who feels like a good fit.
Is CBT right for you?
CBT tends to suit you if you want practical tools, enjoy working toward clear goals, and are open to practising between sessions. It may not be the right fit if you mainly want to explore your past, or if you're looking for supportive counselling without homework (CAMH guide to CBT). Many of our therapists blend approaches, so you don't have to choose one on your own.
How is CBT different from DBT, ACT, and EMDR?
| Approach | Main focus | Often used for | Learn more |
|---|---|---|---|
| CBT | Testing and changing unhelpful thoughts and habits | Anxiety, depression, OCD, and panic | You're on this page |
| DBT | A form of CBT that adds skills for intense emotions, distress, and relationships | Big emotions that feel hard to manage, and relationship conflict | DBT therapy CBT vs DBT |
| ACT | Making room for hard thoughts and feelings while you act on what matters to you | Anxiety, stress, and feeling stuck | ACT therapy CBT vs ACT |
| EMDR | Processing distressing memories with guided eye movements or tapping | Trauma and PTSD | EMDR therapy |
CBT in Kitchener-Waterloo and online across Ontario
Our office is at 55 Erb Street East, Suite 303, in uptown Waterloo, a short drive from Kitchener, Cambridge, and Guelph. If you'd rather meet from home, every therapist on our CBT team also offers secure video sessions anywhere in Ontario, so a busy week or a long drive doesn't have to get in the way.
In person in Waterloo
55 Erb Street East, Suite 303. Evening and Saturday morning sessions available.
Online anywhere in Ontario
Secure video from home, work, or a parked car. Read more about online counselling.
Students at the University of Waterloo and Wilfrid Laurier University can use our student counselling page to see how student health plans cover therapy.
How much does CBT cost, and is it covered by insurance or OHIP?
CBT costs $175 per 50-minute individual session at Trillium Counselling, online or in person. You'll find current fees, hours, and our cancellation policy on our hours and rates page.
CBT with a Registered Social Worker or Registered Psychotherapist is not covered directly by OHIP, but most extended health plans include it, as long as your plan covers your therapist's designation (RSW or RP). We direct bill most major insurers where your plan allows, including Manulife, Sun Life, Canada Life, Green Shield, Blue Cross, NIHB, and TELUS eClaims. Before your first session, check your annual coverage amount.
CBT FAQs
+How does cognitive behavioural therapy work?
How does cognitive behavioural therapy work?
CBT works on the idea that your thoughts, emotions, body reactions, and actions all affect each other. With a therapist, you learn to catch automatic thoughts, weigh the evidence for and against them, and reach a more balanced view (CAMH guide to CBT). You also change what you do, for example by planning activities that lift your mood or facing fears in small steps. Change one part of the cycle, and the others tend to shift.
+Is CBT effective for anxiety and depression?
Is CBT effective for anxiety and depression?
For many people, yes. Canada's depression treatment guidelines list CBT as a first-line talk therapy (CANMAT, 2023). For anxiety, a review of 41 studies found that CBT worked better than placebo, with the largest benefits for OCD and generalized anxiety (Depression and Anxiety, 2018). CBT doesn't work for everyone, so your therapist will check your progress with you and adjust the plan if you're not seeing change.
+How many CBT sessions will I need?
How many CBT sessions will I need?
Most people have between 6 and 20 sessions. For anxiety and depression, 12 to 20 is common, though some people improve a lot in 4 to 6 sessions and others need more than 20 (CAMH). Sessions usually start weekly or every other week, then space out as things improve. You and your therapist will review your progress and decide together when you're ready to finish.
+What happens in a CBT session?
What happens in a CBT session?
Your first session or two focus on getting to know you and setting goals. After that, most sessions follow a similar rhythm: you check in on your mood, review last week's practice, and agree on one or two things to focus on. Then you work through a real situation from your week using CBT tools and plan a small task to try before next time (CAMH guide to CBT).
+Do I have to do homework in CBT?
Do I have to do homework in CBT?
Usually, yes, though it's small and planned with you. Much of the change in CBT happens between sessions, when you try new skills in real life, and the more you practise, the better CBT tends to work (CAMH guide to CBT). Homework is usually small, such as writing down a thought, scheduling an activity you used to enjoy, or taking one step toward something you've been avoiding. Your therapist will tailor it to your week.
+What are common CBT techniques?
What are common CBT techniques?
Common CBT techniques include thought records, where you write down a situation, your automatic thoughts, and the evidence for and against them. Others are activity scheduling for low mood, exposure, where you face fears in planned steps, and problem-solving and relaxation skills (CAMH; American Psychological Association). Your therapist will choose the techniques that fit your goals.
+Is CBT just positive thinking?
Is CBT just positive thinking?
No. CBT doesn't ask you to swap hard thoughts for cheerful ones. It teaches you to look at a situation from several angles and reach a conclusion that fits the facts (CAMH guide to CBT). Sometimes the balanced thought is still uncomfortable, and that's okay. The aim is a response that matches what's really happening, so you can act on it.
+Is CBT covered by insurance or OHIP in Ontario?
Is CBT covered by insurance or OHIP in Ontario?
CBT with a Registered Social Worker (RSW) or Registered Psychotherapist (RP) is not covered directly by OHIP, but most extended health plans cover it, as long as your plan includes your therapist's designation. At Trillium Counselling, individual CBT is $175 per 50-minute session, and we direct bill most major insurers where your plan allows. Check your annual coverage amount before your first session.
+Can I get free CBT in Ontario?
Can I get free CBT in Ontario?
Yes, in some cases. Adults 18 and older with depression or anxiety-related concerns can get free CBT through the Ontario Structured Psychotherapy Program, in person or virtually (Ontario Health). It's a structured, short-term program. If you'd rather choose your own therapist, schedule, or approach, private CBT with an RSW or RP is often covered by extended health benefits.
+Can I do CBT online in Ontario?
Can I do CBT online in Ontario?
Yes. Every therapist on our CBT team offers secure video sessions anywhere in Ontario, and most also see clients in person in Waterloo. A 2021 review found that therapy by live video led to about the same improvement as in-person therapy, with the clearest results for CBT (Clinical Psychology & Psychotherapy, 2021). You'll need a private space, a device with a camera, and a steady internet connection.
+How is CBT different from DBT and ACT?
How is CBT different from DBT and ACT?
CBT focuses on testing and changing unhelpful thoughts and habits. DBT is a form of CBT that adds skills for intense emotions, distress, and relationships. ACT focuses less on changing thoughts and more on making room for them while you act on what matters to you. Many therapists blend these approaches, and your therapist will talk through which one suits your goals.
+Where can I get CBT in Kitchener-Waterloo or online in Ontario?
Where can I get CBT in Kitchener-Waterloo or online in Ontario?
Trillium Counselling offers CBT in person at 55 Erb Street East, Suite 303, in Waterloo, and by secure video anywhere in Ontario. Twenty of our Registered Social Workers and Registered Psychotherapists use CBT, and five hold post-graduate CBT certificates. Sessions run until 9 p.m. Monday to Thursday, 8 p.m. on Friday, and on Saturday mornings. Start with a free 20-minute consultation.
About the reviewer
Amy King, MSW, RSW, is a Registered Social Worker at Trillium Counselling who provides online therapy, with post-graduate training in CBT from Wilfrid Laurier University and training in EMDR. This page was reviewed by Amy for accuracy. Last reviewed October 2026.
Keep reading about CBT
Plain-language guides to the skills, the homework, and how CBT compares with other approaches.
4 CBT skills you can use in everyday life
Slow breathing, a thought record, breaking a task into steps, and facing a fear one small step at a time, with how-to steps for each.
Between sessionsWhy did my CBT therapist assign me homework?
Why CBT includes homework, what the research shows, what tasks usually look like, and what to do if you don't finish.
Comparing approachesCBT vs DBT: what's the difference?
How DBT adds acceptance and emotion skills to CBT, a side-by-side table, and how to choose.
Comparing approachesCBT vs ACT: is ACT a form of CBT?
How each handles difficult thoughts, what the research says about which works better, and how to choose.
ServiceAnxiety counselling in Kitchener-Waterloo and online
How our therapists use CBT and other approaches to help with worry, panic, and stress.
ServiceDepression counselling in Kitchener-Waterloo and online
Support for low mood, low energy, and losing interest, including CBT and behavioural activation.
Not sure yet? Let’s talk it through.
If you’d like to ask questions or explore your options first, book a free 20-minute matching consult or give us a call (226-752-8857) . One of our team members will help you find the right therapist and next steps that feel comfortable for you.
If you need help right now
Call or text 9-8-8, Canada’s Suicide Crisis Helpline. It is free, confidential and open 24 hours a day, every day. In Waterloo Wellington, Here 24/7 answers around the clock at 1-844-437-3247. If someone is in immediate physical danger, call 9-1-1.
Trillium Counselling does not provide crisis services. For non-urgent support, book a free consultation or call 226-752-8857.