Cognitive Behavioural Therapy | Christian K Hughes

CBT has a larger and more robust evidence base than almost any other psychological therapy. For anxiety, depression, OCD, trauma, and a range of related difficulties, it is what the research consistently points to — and what NICE recommends as a first-line treatment for most of the conditions I work with.

But the evidence base is for CBT done well. What makes the difference is not the model itself but how it is applied: whether the treatment is built around a careful understanding of your specific difficulties, or whether it follows a generic protocol that treats your presentation as a category rather than a person.

My approach starts with formulation.

Formulation-Led Treatment
Before any intervention begins, we develop a shared understanding of what is keeping your difficulties going. This is not a diagnostic label or a standard description of your condition. It is a precise, individualised account of the specific patterns — the interactions between thoughts, feelings, physical sensations, and behaviour — that are maintaining your problem and preventing change.
This formulation draws on extensive clinical experience across complex and specialist presentations in NHS mental health services, military mental health settings, and private practice. It shapes everything that follows: which targets we focus on, which techniques are most likely to be useful, and how we sequence the work.
Getting this right at the start is what makes the treatment genuinely effective rather than generically applied. It is also what allows the work to be outcome-focused — because once we understand the mechanism clearly, we can track whether the intervention is actually addressing it.

What the Work Involves

CBT is structured, but structure is not the same as rigidity. The framework provides direction and allows us to track progress clearly. Within that, the treatment is built around your specific difficulties, your circumstances, and what the evidence shows works for your particular presentation.

Sessions typically involve reviewing what has shifted since we last met, working on the specific targets identified in the formulation, and agreeing what you will take away and practice before the next session. Between-session practice is important: it is how insight becomes change, and how change becomes lasting.

You will always know where we are in the treatment, what we are working toward, and how we will know when we have got there. Progress is reviewed regularly, and I will be direct with you about what is and isn't moving.

What CBT Can Help With

I offer CBT in Stourbridge and online across the UK for a range of presentations.  Common issues include, but not limited to the following...

• Anxiety including generalised anxiety disorder, health anxiety, social anxiety, panic disorder, and agoraphobia.

• OCD using exposure and response prevention and, where appropriate, ACT-informed approaches that address the values and acceptance dimensions of recovery.

• Depression and low mood with a focus on the behavioural patterns, avoidance, and cognitive habits that maintain low mood and disconnection from meaning.

• PTSD and trauma using trauma-focused CBT, often alongside EMDR where a combined approach offers more than either alone.

• Chronic worry working with the specific mechanisms that make worry self-sustaining, rather than simply managing it in the moment.

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Why Work With Me

I am Christian Hughes, a BABCP-accredited cognitive behavioural psychotherapist. BABCP accreditation is the lead professional standard for cognitive behavioural psychotherapy in the UK, requiring both a qualifying training and a supervised practice requirement assessed against an external standard.

My clinical background spans NHS specialist mental health services, military mental health environments, and private practice. Across those settings, I have worked with complex, treatment-resistant, and high-acuity presentations where getting the formulation right was not optional. That experience informs how I work with every client, whatever the complexity of their presentation.
I am also a member of the Association for Contextual Behavioural Science (ACBS), reflecting a sustained commitment to ACT and the contextual behavioural science framework alongside my CBT practice.
 

Practical Information

• Sessions are 60 minutes. Fee: £125 per session.

• In-person appointments are available at my practice in Stourbridge, West Midlands, accessible for clients across Dudley, Halesowen, Kidderminster, the Black Country, and the wider West Midlands. Online appointments via Zoom are available for clients anywhere across the UK.

• Weekday daytime appointments are available, with limited evening slots.

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Frequently Asked Questions

• How many sessions will I need?
  It depends on the nature and complexity of your difficulties. A focused presentation treated promptly often responds well within 12 sessions. More complex or longstanding difficulties typically take longer. We review progress regularly and I will always be honest with you about where we are and what further work is likely to involve.

• Is CBT effective?
  It has one of the most extensively researched evidence bases in psychological therapy. The reason it is often described as the gold standard is not that other approaches are ineffective, but that CBT has been subjected to more rigorous testing across more presentations than most. For many of the difficulties I work with, NICE recommends it as the first-line treatment.

• Do you offer ERP for OCD?
  Yes. Exposure and response prevention is central to CBT for OCD, and I offer it within a carefully formulated, collaboratively agreed treatment plan. I also work with ACT-informed approaches for OCD, which some people find more accessible or which complement the ERP work at different stages of treatment.

• What does between-session practice involve?
  It varies depending on the stage of treatment and what we are working on. It might involve behavioural experiments, thought records, exposure tasks, mindfulness or defusion practices, or values-based activities. Whatever it involves, it is agreed in session, kept realistic, and reviewed at the start of the next appointment.

• Is online CBT as effective as in-person?
  Yes, for most presentations. The evidence for online CBT is well-established and consistent with the broader evidence for online therapy. Many clients find the flexibility of online working makes it easier to maintain regular appointments, which itself supports better outcomes.

• What if I have tried CBT before and it did not fully work?
  It is worth thinking carefully about what that experience involved and why it may not have produced the change you hoped for. CBT varies considerably in depth and quality, and a previous course that felt insufficient does not mean CBT is the wrong approach. It may also be worth considering whether an ACT-informed framework would offer something different, particularly if the previous work focused primarily on cognitive restructuring.

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Next Steps

A free 15-minute call is available if you would like to talk through your situation before committing to anything. There is no obligation, and it is often the most useful way to work out whether we are a good fit.​

[Book a free 15-minute chat] | [Book a session] | [Contact me with a question]