Cognitive Behavioral Therapy Online: How It Works And What To Expect

Cognitive behavioral therapy online (online CBT) is a form of talk therapy delivered via video, phone, or chat rather than in person, where a licensed therapist helps you understand how your thoughts, feelings, and behaviors are connected. Research suggests that online CBT can be as effective as in-person therapy for many mental health concerns, including anxiety and depression. If you're curious about how it works, exploring what to expect can help you decide whether it might be a good fit for you.

What is cognitive behavioral therapy?

Cognitive behavioral therapy is a form of talk therapy designed to help an individual better understand how thought patterns and beliefs are connected to emotions and behaviors. A CBT therapist may start by helping clients identify unhelpful thought patterns in their lives. These might be catastrophizing, assigning blame, jumping to conclusions, confusing emotions with facts, or partaking in other cognitive distortions. Once these patterns have been identified, the focus can shift to reframing and restructuring them, replacing unhelpful thought patterns with more helpful or positive ways of thinking.

While CBT can be delivered in different formats, online CBT typically refers to standard therapy sessions provided by a licensed therapist. The main distinction is that, rather than meeting in person, therapy is provided online, by phone, or via chat. This is different from self-guided CBT, which may involve structured self-help exercises without a therapist. Understanding this distinction can clarify what to expect as you explore the conditions online CBT may support.

What conditions can online CBT help with?

CBT usually focuses on learning to recognize unhelpful ways of thinking and reframing them more constructively. For this reason, CBT may equip individuals with the tools to address challenges in their lives as they arise, offering both short- and long-term benefits.

How effective is online CBT?

Research suggests that online CBT can be as effective as in-person therapy for many mental health conditions. Below, explore the results from a few recent studies:

• A 2017 review reported that online CBT could effectively treat both mental illnesses and psychiatric comorbidities of physical illnesses. It also noted that online therapy tended to be cost-effective for both the clients and society as a whole.
• A 2023 pre-post pilot study investigated the efficacy of online CBT specifically for depression and anxiety disorders. Participants displayed significant improvements in both depression and anxiety symptoms after nine weeks of online CBT.
• A 2025 retrospective cohort study found that short first-line treatments with therapist-guided online CBT were at least as effective as face-to-face CBT.

What happens during online CBT sessions?

Regardless of whether talk therapy sessions are conducted in person or via an online platform, the focus often remains the same: identifying and restructuring unhelpful thought patterns and behaviors in daily life. Online CBT can be administered in a few ways, depending on your preferences:

• Video calls, which may feel most similar to in-person sessions
• Voice or phone calls, for those who prefer not to be on camera
• Instant messaging or chat, for a more flexible, written format

Whatever format you choose, sessions often build on one another over time, with your therapist tailoring their approach to your goals.

Your first session

Your provider may choose to start with an initial session designed to get to know you better. They may also explain the principles of CBT and how the two of you might work together. After outlining goals for treatment, they can begin helping you address your life circumstances, current challenges, and mental well-being concerns.

Therapists might also inquire about your point of view, thoughts, feelings, and beliefs. These professionals can then teach you how to question, manage, and reframe the thoughts that may be causing you distress. Establishing this foundation can set the stage for the work that follows in later sessions.

Ongoing sessions and homework

As therapy continues, each session often builds on the last, allowing you and your therapist to track progress and adjust as needed. Your therapist may also provide you with additional exercises or "homework" assignments designed to help you put the strategies you've discussed into practice in your everyday life. Depending on your situation, they may recommend complementary practices, like self-care or support groups, designed to help you get more out of your sessions. These practical strategies often draw on a set of core CBT techniques.

Common CBT techniques and tools

There are several techniques a therapist may combine to create a treatment plan tailored to the individual. Below are some of the more common CBT skills and tools you might encounter:

• Cognitive restructuring to reframe unhelpful thoughts
• Behavioral activation to re-engage with meaningful activities
• Exposure techniques to gradually face feared situations
• Journaling or thought records to track patterns
• Relaxation and mindfulness practices to manage stress
• Problem-solving skills to navigate daily challenges

Cognitive restructuring

At the heart of many CBT sessions is cognitive restructuring, a process in which a therapist helps you notice cognitive distortions and reframe them. For example, you might have a tendency to expect the worst possible outcome, even when there's little reason to think it will happen. Together, you and your therapist can examine the accuracy of those thoughts and develop more balanced, realistic alternatives.

Behavioral techniques

Changing what you do can also shift how you think and feel. A therapist may help you identify avoidant or unhelpful behaviors and replace them with more productive alternatives. For instance, avoiding social situations due to anxiety might be gradually replaced with exposure to those situations, often starting small and building over time. These skills can be practiced with a therapist or, in some cases, on your own.

Can you do CBT on your own?

Self-help CBT resources do exist, and some people find them a helpful starting point. For example, UK-based ThinkCBT offers free downloadable worksheets and exercises. The Cognitive Behavioral Therapy Blog, courtesy of Dr. Albert Bonfil and CBTLA, also provides a wealth of information on CBT, along with a free CBT course and workbook.

That said, working with a therapist may offer personalized guidance, accountability, and professional support that self-guided approaches often can't match. Therapist-led CBT also has more research support behind it. For many people, a combination of professional guidance and self-directed practice can be a helpful approach. Cost and access are often part of this decision, so it can help to understand what online CBT typically involves financially.

How much does online CBT cost?

The cost of online therapy can vary by platform, therapist credentials, session frequency, and location. In many cases, online therapy is more affordable than in-person therapy—BetterHelp costs around $70 to $100 per week, while in-person sessions typically cost around $100 to $350 per session. Some online therapy platforms may also offer financial aid to those who qualify.

In addition, some providers on BetterHelp may be in-network with certain health plans, and co-pays average about $23/session for eligible members. Coverage varies by plan, provider, and therapist availability, so it can help to check your in-network status on the BetterHelp site.

Checking your insurance coverage

In select states, some providers on BetterHelp may be in-network with certain health plans, though the level of coverage can vary. For example, you may have a smaller co-pay with an in-network provider and higher out-of-pocket costs with an out-of-network provider, even if you receive a reimbursement. BetterHelp is currently working with insurance carriers to expand coverage; currently, providers may be in-network in select states, including VA, DC, MD, FL, NY, AR, IN, KY, TX, PA, IL, NC, MT, MI, CO, OK, CT, MO, NV, OH, NJ, TN, AZ, MA, NE, DE, WV, VT, NH, NM, AL, UT, and GA. To check your plan, some options include contacting the customer service number on the back of your card, reviewing your insurer's website, or looking through documents received by mail. If you don't see your state, BetterHelp's flexible subscription model continues to be an option to receive quality care from an extensive therapist network.

Benefits of online therapy for CBT

Online CBT may offer accessibility and flexibility that can be especially useful for CBT-based work. For those with limited local resources, busy schedules, or conditions that may make leaving home difficult, attending sessions from the comfort of your home may be beneficial. The ability to use in-app messaging to reach a therapist who may respond as soon as they are able can also be supportive when unhelpful thoughts arise between sessions. If this sounds like a good fit, you can connect with a licensed therapist through an online platform like BetterHelp, which has helped over six million users to date. BetterHelp now also offers psychiatry services through Uplift, an additional care option available alongside therapy that may include medication management when clinically appropriate, based on a provider evaluation.

*Based on finalized paid psychiatry visits with a copay. Insurance availability, coverage, and costs vary by state, plan, provider network, and provider availability.