Learn / On your own or with a therapist

On your own or with a therapist

4 minute read

This app works in two ways. On your own, it is a structured worksheet with guidance built in. Alongside a therapist, it is a place to plan the experiments you agree on in session, carry them out between sessions, and bring the results back. Both are reasonable ways to use it. It helps to be clear about what each can do.

What the research says

Self-guided CBT, delivered through books, websites, and apps, has been studied extensively. The findings are fairly consistent.

• Guided self-help, where a professional checks in even briefly, produces results comparable to face-to-face therapy for many people with anxiety and depression.
• Fully unguided self-help also helps, but the effects are smaller on average, and more people stop partway through.
• The difference matters most for people with more severe symptoms. A large analysis of internet-based CBT found that guidance made little difference for mild symptoms and a substantial difference for moderate to severe ones.
• Component studies suggest that the active ingredients include behavioral work of exactly the kind the app supports, and that human support mainly helps people keep going.

The practical reading: if your anxiety is mild and you are motivated, working through this on your own is reasonable and may be enough. If it is severe, long-standing, or getting in the way of work, relationships, or health, the app will do more for you as a companion to therapy than as a replacement for it.

Working with a therapist

If you are seeing someone, a few things make the app more useful.

• Agree the experiment in session. Most therapists who use CBT will recognize the seven-step structure. Plan the experiment together, then use the app to carry the plan out of the room.
• Do the first version together where you can. Many experiments, especially ones that involve deliberately producing the feared outcome, are best done with the therapist first and repeated alone afterwards.
• Bring the record back. Share as PDF from any belief or experiment. The review page, with the re-ratings and the "what it tells me" section, is usually the most useful part to discuss.
• Keep homework manageable. A follow-up experiment should not be much harder than the one you just did.

When to get support rather than go it alone

Some things are not well suited to solo work with a worksheet, and it is better to say so plainly.

• Trauma. Beliefs tied to a traumatic memory, flashbacks, or nightmares. Experiments can be part of treatment for post-traumatic stress, but they are done alongside memory-focused work with a trained therapist, not alone.
• Real medical risk. If a feared outcome involves a genuine physical condition, such as a heart or breathing problem, talk to a doctor before experiments that raise your heart rate or change your breathing.
• Thoughts of harming yourself. If you are having thoughts of suicide or self-harm, please reach out for support now. In the United States, call or text 988 to reach the Suicide and Crisis Lifeline, free and available around the clock. Elsewhere, contact your local emergency number or crisis line.
• Substances. Experiments done while drinking or using drugs to cope teach very little, because the safety behavior is still in place.
• It keeps not working. If you have repeated an experiment several times and the belief has not moved at all, something is being missed, often a hidden safety behavior or a different belief underneath. That is a good problem to bring to a professional.

Finding a therapist

Look for someone who describes their work as cognitive behavioral therapy and is licensed in your area. In the United States, the ADAA and the Association for Behavioral and Cognitive Therapies maintain directories. In England, NHS Talking Therapies accepts self-referrals without a doctor's appointment. Many countries have similar public routes.

References

• Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40(12), 1943–1957. doi.org/10.1017/S0033291710000772
• Andrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders, 55, 70–78. doi.org/10.1016/j.janxdis.2018.01.001
• Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1–18. doi.org/10.1080/16506073.2017.1401115
• Karyotaki, E., Efthimiou, O., Miguel, C., et al. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371. doi.org/10.1001/jamapsychiatry.2020.4364
• Furukawa, T. A., Suganuma, A., Ostinelli, E. G., et al. (2021). Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: A systematic review and component network meta-analysis using individual participant data. The Lancet Psychiatry, 8(6), 500–511. doi.org/10.1016/S2215-0366(21)00077-800077-8)
• Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. doi.org/10.1016/S0005-7967(99)00123-000123-0)

Helpful links

• 988 Suicide and Crisis Lifeline (United States)
• ADAA: Find a therapist
• NHS Talking Therapies (England)
• NAMI: Anxiety disorders
• Mind (UK): Anxiety and panic attacks

Educational content, not medical advice or a substitute for professional care. Ready to try it? Open the online worksheet or get the app.