Some people find it easier to write about what they are going through than to say it out loud. You might have plenty to say but struggle to find the words on a video call. Or you might simply prefer to take a moment and put your thoughts into a message.
There is another way to have a CBT conversation. Text-based CBT, sometimes called CBT by text or CBT by SMS, uses written messages between you and your therapist during an agreed appointment.
What is text-based CBT?
Cognitive behavioural therapy (CBT) helps you understand links between situations, thoughts, feelings, physical sensations and the things you do in response. Together, you and your therapist make sense of patterns that may be keeping a difficulty going, and work out what you could try differently.
In a written session, the principles stay the same. The conversation happens through messages rather than spoken words. It is therapy with a qualified person, not an automated chatbot or a self-help text alert.
How does CBT by SMS work?
At Calm Breathing Therapies, an SMS CBT appointment is a scheduled 50-minute session. We communicate in writing for the agreed time, just as we would set aside time for a video appointment. Sessions are not an unlimited or around-the-clock messaging service.
Depending on what you want help with, we might explore a recent situation, notice a familiar worry pattern, look at how a behaviour affects your anxiety, or plan a manageable step to try between appointments. You can ask questions and we can review what you are learning together.
The session costs £50 for 50 minutes. You can find the options on my fees page.
Who might prefer CBT by text?
Writing may appeal to you if talking openly feels uncomfortable, you prefer to organise your thoughts on screen, or you do not want a video appointment. It can also be helpful to have written prompts to refer back to, depending on how we agree to use them.
That does not automatically mean SMS is the best format for everyone. Some situations need more immediate conversation, more detailed assessment or a different type of support. We would consider your needs and preferences before agreeing to work this way.
What can you work on in written CBT?
The focus would be individual to you. CBT can support people experiencing anxiety, panic, worry and other difficulties, but we would first talk about what you have been finding hard and whether a text-based format would allow us to do the work properly. Certain exercises, particularly where exposure or close observation is needed, may be better suited to a different format or additional support.
We still want to understand what keeps a problem going, agree useful changes and review what happens when you practise them.
What about confidentiality and safety?
Privacy matters with written therapy as much as it does with spoken sessions. Ordinary SMS should not be assumed to offer the same security as an encrypted clinical messaging platform. Before starting, we would explain the communication arrangements, confidentiality and data handling, including the practical limitations of texting.
SMS CBT is scheduled therapy, not an emergency or crisis service. If you need urgent help, please see the urgent support information.
Considering text-based CBT?
If this is how you would prefer to have therapy, you can read more about text-based CBT sessions or get in touch to ask whether it may suit your needs. You do not need to explain everything in your first message.