What does 2025 hold for CBT and its practitioners?

In this article, Professor Patrick McGhee reviews the CBT landscape and examines what 2025 might hold in store for us all as CBT practitioners

If we mark the birth of CBT as the publication of Aaron Beck’s book Depression in 1967, the model has been around for 58 years in 2025. CBT has gone through many transformations not only in terms of expanding into areas such as mindfulness, compassion, acceptance and metacognitive perspectives, but also in terms institutional, cultural and professional developments in the organisation, acceptance and training.   

But what might 2025 hold for CBT, particularly in the UK and Ireland? Let’s wipe our crystal ball of prediction and see what we can see.  We will try to avoid black-and-white thinking, emotional reasoning and generalization – and certainly no catastrophizing. In any event, here are our 6 predictions for CBT in 2025.

1 – Growth of AI in the delivery of CBT.   

The most recent generation of AI has impacted hugely on almost every aspect of society in terms of information, communication and knowledge management since the launch of Chat GPT in 2022.  Alongside of this, everyday apps are now able to carry out tasks which previously would have required substantial human expertise and input.   For example, the app Limbic Access can now classify common mental health disorders with 93% accuracy. Debate rages as to just how expansive a role AI can have in actually delivering therapy. While there seems to be evidence that AI can help individuals with clear cut presentations of common disorders such as depression and GAD, there is less evidence that AI can cope with real-world messy presentations of comorbid depression and anxiety, substance abuse and complicating contextual factors such as relationship issues.  Worse, the tendency of some AI systems to ‘hallucinate’ ie present invented facts as truth, can be downright damaging. Another phenomenon is the expansion of AI with a CBT angle in apps that are not explicitly presented as being about CBT at all but actually have CBT as the engine under the bonnet. An example of this is the hugely popular Noom app for weight loss.  A further phenomenon is that of people, including clients, using systems like Chat GPT to get advise on everyday life decisions such as dating, investments, managing arguments and parenting. These are increasingly lived experiences for clients and will therefore need space to be made for them in the therapeutic conversation. Overall, in 2025 will see even greater growth in AI apps seeking to replace specialist advice, apps providing access to support while on a waiting list and apps designed to help clients manage their lives post-therapy. CBT therapists will need to become aware of the power – and limitations – of AI and do so quickly.

Another huge development in the area of AI which will start to have an impact of CBT in 2025 is the area of what is called ‘agentic ai’. This where systems like Chat GPT does not just respond to a query but rather takes action in the real world regarding that query. For example, the AI will not just give you suggestions for a nice one-week holiday in France, it will if requested, book your flight, your accommodation and your insurance – it will even block out your calendar for the week in question! In CBT this might be reflected in AI not just advising on a 5-point plan to help a client be more assertive, it would buy a book on Amazon about assertiveness, have it posted to the client and then perhaps send the client an invite to an assertiveness workshop. It could also, conceivably, set up an additional session with you and the client to discuss the plan on assertiveness. An interesting model which could lead to unpredictable outcomes (“Why are sending me this assertiveness book – I told you I didn’t like self-help books”) or extraordinary improvements in targetted support. (“Oh that’s great that webinar looks just right for me, I never seem to get my act together to book in for these things, though I know I should…”). Either way therapists are going to have to develop a better understanding of the possibilities of agentic AI and the advantages and disadvantages. This is a key area for all CBT therapists and that is why we are running a special series of workshops in 2025 on this crucial topic including our new app Flutura. There is no doubt that the whole area of digital therapeutics will be a major trend in 2025 and has been named as key trend by the American Psychological Association

2 – Growing focus on Trauma-Informed Care (TIC) in CBT.   

Trauma-informed care is, amongst other things,  a model of the delivery of mental health care and support based on a recognition of the high incidence of trauma in the lives of clients engaging with mental health services. The focus is on the legacy of trauma experiences and, crucially,  the potential for trauma or re-traumatization to occur in the context of care itself.  In this area CBT has an important role in linking the trauma legacy to immediate psychological challenges. Trauma-informed care (TIC) is a holistic approach that focuses which recognises the experiences and symptoms of trauma and their impact on health. TIC prioritizes client  safety through the development of trust in a way that supports patient choice and empowerment. In 2025 key research findings and reviews will continue to inform service delivery in NHS, HSE and charitable providers. The financial constraints in providing a safe and inclusive healing environment that considers specific challenges while promoting a greater sense of well-being and patient partnership are not cheap however. Therefore, underfunded institutional and individual practices will increasingly come into conflict with TIC values and priorities.  More generally the ‘here and now’ focus on CBT will increasingly need to find effective ways of incorporating the historical legacies of trauma. Central to these developments will be in recognising that the majority of individuals respond and recover from trauma experiences entirely by themselves and that while it is easy to overlook the impact of trauma it is also possible to focus on its impact too narrowly to the detriment of other psychologically significant factors maintaining the client distress.  Those working on the front line of public health are increasingly uneasy about the casual use of the term ‘trauma’ in the popular press, social media and celebrities. “It is arguable that the word “trauma” has recently been over-used to the extent that it has become devalued as a descriptor, with even relatively low level adverse experiences sometimes being described as traumatic.” (Cox, 2024). In 2025 we predict greater visibility of the debate about what TIC means in practice particularly in NHS and, in Ireland,  HSE settings. In this area, as in many others, a focus on evidenced-based practice is essential.

3 – Increase in CBT therapists setting up in private practice.

The large and growing demand for mental health services in general, and for high-intensity CBT, in particular will increase the appetite for qualified practitioners to set up in private practice. Increasingly poor working environments in the NHS and HSE in some areas will push practitioners to either go part-time to create space of private practice or make a full transition.  Similarly, reduction in public funding for charities will make contraction in those areas unfortunately, inevitable. Since Covid, the acceptability by clients, therapists and insurers of online therapy has made entry costs to private practice even lower.  And yet the challenges to setting up in private practice remain considerable: keeping on top of paper work, managing tax returns, self-care and the basic challenge of letting potential clients know you are there and open for business. However, some software packages previously focusing only on appointment bookings and video calls, have evolved into full private practice in a box solutions.  In 2025 we predict a significant increase in the number of CBT therapist going straight from training into private practice and experienced practitioners moving into private practice on a ‘balanced portfolio’ basis. (Our annual workshop on Running a Succesful Private Counselling Practice takes place in January).

4 – Increase in the number of lower-quality CBT and pseudo-CBT books on self-help and client advice.

With the increase in self-publishing, driven by simplification of manuscript production, ease of access to market places and integrated sales and revenue systems, it has become very significantly easier for anyone to publish a book on almost anything. Mental health and CBT are no exception. Lacking the traditional peer review or clinical editorial process, the growth in publications with little or no clinical value will grow. It will be increasingly important for CBT therapists to build in more guidance on books as part of psychoeducation. Some books can emphasise a simplistic replacing of negative thoughts rather than a balanced, realistic perspective or emphasise a checklist for behavioural change with addressing activity scheduling, barrier or generalisation issues. In 2025 we expect to see more therapists actively engaging with clients on helpful and unhelpful reading lists.

5 – Growth in couples counselling through CBT in the UK and Ireland.

Couples counselling is much less common in the UK than in the US, Canada or Australia. CBT has been shown to be highly effective in supporting couples address conflict and communication issues.  Cognitive Behavioural Couples Therapy (CBCT) is   one of the most widely recognised  therapeutic approaches for working with couples. Scores of clinical trials have shown CBT for couples to be effective, with 70% of the couples improved and 50% show stable effects over a period of five years. Interestingly, historically, IAPT systems tend to track only the impact of couples counselling on individuals rather than the pair themselves. One of the key drivers for increasing use of CBT services by couples is likely to be the fact that one or other of the couple will have already been in individual therapy of some kind. Royal College of Psychiatrists reported a record number of annual appointments for those accessing cognitive behavioural therapy (CBT) across England in 2021. In fact, there were more CBT appointments taken than any previous year on record, as findings showed 1,961,096 appointments registered overall for the calendar year 2021.  However, there is still a lack of training opportunities for therapists in CBT for Couples  and there is still a job to be done on bringing these services to public attention. This is also an area where cost-conscious clients are concerned not so much about the cost of individual sessions but rather the number of sessions that will be required and the impact on the overall outlay required. In 2025 we expect to see modest growth in demand for private practice relationship counseling laying a foundation for significant growth in subsequent years. Practical CBT will be running courses in early 2025 on relationship conflict and navigating divorce.

6 – Increasing engagement in NHS and HSE policy by CBT practitioners.  

The NHS Ten-Year Plan Consultation provides an opportunity for CBT therapists and representative bodies such as the BABCP, to shape aspects of NHS mental service delivery.  The BABCP has highlighted a number of key priorities raised by members:

• Increase protection for patients and the public by ensuring interventions delivered only by qualified and registered/accredited practitioners – particularly in psychological therapies
• Only evidence-based interventions e.g.CBT – implementing NICE guidance – psychological therapies emphasis on equity of access for minoritised populations; dose, intensity, frequency and modality
• Prioritise staff wellbeing -in resources available, caseload size and complexity, clinical supervision and leadership
• Public health education–understanding of evidence-based mental health care, accessible prevention/early intervention.
• Equity of esteem, rapid access, across age groups and individual differences -– tackling barriers for people with protected characteristics; financial hardship and lack of community and social resources; in different geographical locations with specific differences – particularly intersections of these.

In 2025 as the NHS Ten Year Plan starts to take shape, and reviews of CBT in Ireland the long-standing recognition of poor access to mental health services and the need for more evidence-based interventions such as CBT will have a higher profile within Government, across the NHS and in the public debate.

And so we draw our review of potential developments in CBT to a close, and once more wrap up our crystal ball in the dark cloak of patience. 2025 will be a year of change for CBT – technological, policy, institutional and practice changes. What does 2025 hold for all of us? Well, in the end, the main thing is that we make the best of what it throws at us.

Professor Patrick McGhee is a CBT therapist, psychologist and UK National Teaching Fellow. Educated at the universities of Glasgow and Oxford, he has completed CPD programmes at Harvard Business School and Ashridge. In 2017 he was a Visiting Fellow/Scholar at the universities of Cornell, Yale and MIT in the USA. He has taught, researched or practised in psychology and therapy for 30 years. His first post was a Research Fellow in Psychiatry and Psychology at St George’s Hospital Medical School, University of London. He is the author of Thinking Psychologically (Palgrave) and co-editor of Accounting for Relationships (Methuen). He is an occasional columnist for the Guardian, the BBC and the Times Higher. He currently works in private practice in Greater Manchester. He has full accreditation from the British Association for Behavioural and Cognitive Psychotherapies.

References and further reading

• Beck, A.T. (1967). Depression. Harper and Row: New York.
• Blease, C., & Torous, J. (2023). ChatGPT and mental healthcare: Balancing benefits with risks of harms. BMJ Mental Health, 26(1), e300884. https://doi.org/10.1136/bmjment-2023-300884Link
• Cunha, C., & Gomes, M. (2024). The imperative of trauma-informed care: A comprehensive review and strategies for implementation in health services. European Psychiatry, 67(S1), S815-S815. https://doi.org/10.1192/j.eurpsy.2024.1699

• Ehlers, A., Wiedemann, M., Murray, H., Beierl, E., & Clark, D. M. (2021). Processes of change in trauma-focused CBT. European Journal of Psychotraumatology, 12(sup1)https://doi.org/10.1080/20008198.2020.1866421Link
• Farrand, P., Dawes, A., Doughty, M., Phull, S., Saines, S., Winter, S., & Roth, A. (2022). Development and application of criteria to evaluate written CBT self-help interventions adopted by improving access to psychological therapies services. Cognitive Behaviour Therapist, 15https://doi.org/10.1017/S1754470X22000241Link
• Hazell, C. M., Kelly, O., O’Brien, S., Strauss, C., Cavanagh, K., & Hayward, M. (2020). Patient experience of guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial. Cognitive Behaviour Therapist, 13https://doi.org/10.1017/S1754470X20000458Link
• Isobel S, Wilson A, Gill K, Howe D. ‘What would a trauma-informed mental health service look like?’ Perspectives of people who access services. Int J Ment Health Nurs. 2021 Apr;30(2):495-505. doi: 10.1111/inm.12813. Epub 2020 Nov 21. PMID: 33219725.

• Kalam, K. T., Rahman, J. M., Islam, M. R., & Dewan, S. M. R. (2024). ChatGPT and mental health: Friends or foes? Health Science Reports, 7(2), e1912-n/a. https://doi.org/10.1002/hsr2.1912Link
• Murray, H., Grey, N., Warnock-Parkes, E., Kerr, A., Wild, J., Clark, D. M., & Ehlers, A. (2022). Ten misconceptions about trauma-focused CBT for PTSD. Cognitive Behaviour Therapist, 15, s1754470x22000307. https://doi.org/10.1017/S1754470X22000307Link
• Novilla, M. L. B., Bird, K. T., Hanson, C. L., Crandall, A., Cook, E. G., Obalana, O., Brady, L. A., & Frierichs, H. (2024). U.S. physicians’ training and experience in providing trauma-informed care in clinical settings. International Journal of Environmental Research and Public Health, 21(2), 232. https://doi.org/10.3390/ijerph21020232

• Novilla, M. L. B., Bird, K. T., Hanson, C. L., Crandall, A., Cook, E. G., Obalana, O., Brady, L. A., & Frierichs, H. (2024). U.S. physicians’ training and experience in providing trauma-informed care in clinical settings. International Journal of Environmental Research and Public Health, 21(2), 232. https://doi.org/10.3390/ijerph21020232Link
• Singh, O. (2023). Artificial intelligence in the era of ChatGPT – opportunities and challenges in mental health care. Indian Journal of Psychiatry, 65(3), 297-298. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_112_23Link
• Skean, K. R., & Brown, E. (2024). Emotionally focused couple therapy with a late-life couple: From despair to integrity. Pragmatic Case Studies in Psychotherapy, 20(1)https://doi.org/10.55818/pcsp.v20i1.2151Link
• Yıldızhan, C., Kafescioğlu, N., Zeytinoğlu‐Saydam, S., Erdem, G., Söylemez, Y., & Yumbul, Ç. (2024). Emotion regulation in emotionally focused therapists working with high‐conflict couples. Journal of Marital and Family Therapy, 50(4), 840-866. https://doi.org/10.1111/jmft.12725Link