Cognitive Behavioral Therapy

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What is cognitive behavioral therapy?

Cognitive therapy—or cognitive behavioral therapy (CBT)—is a type of psychotherapy or talk therapy. It focuses on how a person’s thoughts and beliefs affect their actions, emotions and behaviors. By addressing unhealthy or dysfunctional thinking, people can change their feelings and actions. Oftentimes, these unhelpful thought patterns and behaviors are learned over the course of a person’s life.

Learning how to identify and change beliefs and behaviors can help people better cope with situations in their lives. This is true even if external situations do not change. It helps them respond more effectively to their circumstances and can relieve symptoms, such as anxiety. This, in turn, improves a person’s ability to function and their quality of life. CBT for anxiety, depression, and other mental health conditions can be very effective, helping to prevent relapses of depressive episodes for some people with major depressive disorder.

Why is cognitive behavioral therapy performed?

Cognitive behavioral therapy can help manage a wide variety of emotional and mental health problems. Situations and conditions that may benefit from cognitive behavioral therapy include:

  • Abuse or violence recovery including physical, emotional or sexual abuse

  • Eating disorders including anorexia nervosa, bulimia, and binge-eating disorder

  • Mental health disorders including anxiety, depression, bipolar disorder, obsessive-compulsive disorder (OCD), phobias, schizophrenia, and sleep disorders

  • Relationship problems including family or marital conflicts and problems with self-esteem or self-confidence

  • Substance abuse or addiction including alcohol, drug, gambling, internet or sex addictions

  • Trauma and stressful life situations including post-traumatic stress disorder (PTSD) and stress from medical illnesses, physical symptoms, divorce, grief or loss

Sometimes, cognitive behavioral therapy works best in combination with other treatments, such as medications. Examples include cognitive therapy for depression or cognitive therapy for anxiety in combination with antidepressants or anti-anxiety medicines.

Who performs cognitive behavioral therapy?

A psychotherapist uses cognitive behavioral therapy to address the mental and emotional needs of people of all ages. Several types of healthcare providers can fulfill the role of psychotherapist including:

  • Psychiatrists

  • Psychologists

  • Clinical social workers

  • Counselors

  • Marriage and family therapists

How does cognitive behavioral therapy work?

CBT takes place in sessions. Sessions can be in a group, couple or one-on-one setting. During a session, your therapist will work with you to identify problems and develop goals for managing them. Your therapist will need to know some things about your life’s history. This helps the therapist gain an understanding of what has led to your difficulties. However, the goal of therapy is to foster strategies for moving forward with your life.

Your therapist will lead you through the following steps throughout your CBT sessions:

  • Identifying problems or troubling situations

  • Becoming aware of your current thoughts, beliefs and emotions about these problems or situations

  • Recognizing thoughts, beliefs or behaviors that are negative, unhelpful or inaccurate

  • Changing or reshaping these thoughts, beliefs or behaviors into helpful and effective ones

 

There are several cognitive therapy techniques your therapist may use including:

  • Developing confidence in your abilities

  • Facing your fears

  • Role-playing interactions with others

  • Learning stress management techniques

  • Understanding behaviors and motivations of others

  • Using problem-solving skills

 

Your therapist may also ask you to do homework between sessions. This may include reading, journaling, and completing other activities to build upon what you learn in your sessions. The goal is to help you learn to identify and change thoughts and behaviors on your own. In a sense, it helps you become your own therapist.

What are the risks and potential complications of cognitive behavioral therapy?

Cognitive behavioral therapy offers potential lifelong benefits and with little risk. At times, you may feel uncomfortable or even stressed because it can be difficult to confront your problems. Your therapist is there to guide you through the process. The key is finding the right therapist for you.

Look for a certified and licensed therapist with plenty of experience dealing with your particular issues. Those aspects mean the therapist has the skills necessary to practice CBT, but it is a good idea to go to an initial session and see if the therapist’s style is a good fit for you. Do not feel like you must continue with a therapist that isn’t a good match.

How do I prepare for cognitive behavioral therapy?

Not much preparation is necessary for cognitive behavioral therapy. It helps to think about the overall problem you need to address. Maybe even make some notes about it. Bring a notepad with you to your appointment as well.

You also need to think about the cost of CBT. Check with your health insurance company to understand your coverage. Some plans offer coverage for specific problems. However, you may have a limit on the number of sessions. If you do not have coverage, talk with the therapist about their fees. Many therapists offer sliding-scale fees and payment plans to help people afford their services.

What can I expect with cognitive behavioral therapy?

Cognitive behavioral therapy is a relatively short form of therapy. It is meant to address specific goals. It can last anywhere from 5 to 20 sessions. This is different from more lengthy forms of therapy, such as psychoanalysis.

Together, you and your therapist will decide when it’s time to end your therapy. Ending therapy may not mean your problems are solved. But it may signal that you are ready and able to cope with your issues. You should leave therapy feeling healthier and better about your situation.

You may find you need therapy again in the future. However, there are things you can do to make therapy successful including:

  • Be an active participant in your sessions. Therapy is a partnership that requires you to work with your therapist to get positive results. If therapy does not seem to be working, tell your therapist. A different approach or a different therapist may be the answer.

  • Be honest and do not hold back. Your therapist can’t help you unless you are completely open about your thoughts and feelings. It can be very difficult or embarrassing to talk about certain things. If you feel uncomfortable, tell your therapist up front. Together, you can work through the process.

  • Be diligent about your treatment. Don’t be tempted to skip sessions or homework. Progress toward healthy thinking, behaviors and emotions relies on your consistent participation.

 

It can take time to overcome unhelpful thought or behavior patterns. This is especially true if they have been with you for a long time. It can also be painful to go through the process of changing them. But, patience and perseverance will be worth the pay-off of healthier living. The CBT skills you learn will always be with you!  

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 5
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Cognitive Behavioral Therapy. Mayo Foundation for Medical Education and Research.  https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
  2. Psychotherapies. National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml
  3. What Is Cognitive Behavioral Therapy? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
  4. What Is Cognitive-Behavioral Therapy (CBT)? Association for Behavioral and Cognitive Therapies. http://www.abct.org/Information/?fa=_WhatIsCBTpublic
  5. What Is Cognitive-Behavioral Therapy (CBT)? National Association of Cognitive-Behavior Therapists. http://www.nacbt.org/whatiscbt-htm/