Cognitive Behavioral Therapy (CBT): What You Need to Know

A form of talk therapy, CBT is effective for managing mental health disorders like depression, as well as emotional issues like stress or anger, research shows.

Cognitive behavioral therapy (CBT) is one of the best tested and most widely used forms of psychological treatment today.

It helps you learn how to change unhelpful thoughts and behavior patterns into healthier ones.

CBT has been evaluated in more than 2,000 research studies, which confirm that it can be an effective treatment for a variety of mental health disorders, psychological issues, and other medical conditions with psychological components.

One of the core principles of CBT is that how a person initially interprets various situations can have a more powerful effect on their emotional, behavioral, and physiological reactions than whatever actually happened — and that people with mental health disorders often interpret situations in unhelpful or inaccurate ways.

Those initial interpretations (which CBT therapists call “automatic thoughts”) can lead a person to develop problematic underlying beliefs about themselves and others, as well as about the world around them or the future. Those beliefs then can negatively influence a person’s behavior.

The goal of CBT treatment is for people to learn to identify and reevaluate any distorted, unhelpful, or inaccurate thought patterns that are negatively impacting their emotions or behavior, explains Karol Darsa, PsyD, a licensed psychologist who practices CBT and is the founder and executive director of Reconnect Integrative Trauma Treatment Centers in Los Angeles. “One may not be able to control a specific situation but controlling how they interpret the situation can help them cope with it better,” Dr. Darsa says.

Though several key figures in psychology and psychiatry contributed to the development of CBT, psychiatrist Aaron T. Beck, MD, is widely acknowledged as the most prominent contributor. Dr. Beck discovered that just helping his patients identify and change distorted thinking patterns and underlying beliefs often led to long-lasting psychological improvement and behavioral changes.

CBT also helps people to develop and practice new behaviors that make it easier to manage and prevent problems. These new behaviors might include:

Making time for activities that you enjoy and give you a sense of accomplishment
Breaking big tasks down into little, more manageable ones
Gradually facing down fears until they no longer stop you from doing things that are important to you

CBT is beneficial not only for people diagnosed with a mental health disorder but also people who just have trouble managing emotions caused or worsened by negative thought patterns, Darsa says.

Mental health professionals commonly use CBT to treat:

Anger issues
Anxiety disorders, such as panic disorder or specific phobias
Depression
Eating disorders
Post-traumatic stress disorder (PTSD)
Stress
Substance use disorders

Ample studies have demonstrated the effectiveness of CBT over time. In fact, CBT is the most well-studied form of psychotherapy.

Research has also shed light on how to maximize CBT’s benefits when treating certain mental health conditions. For example, some research suggests CBT may be most effective for treating moderate to severe depression when combined with antidepressant medication compared with CBT treatment alone. In contrast, research shows research shows that for anxiety disorders, adding medication to CBT is generally not more effective than CBT alone.

How soon you can expect to notice the benefits from CBT varies from person to person, but CBT typically requires 5 to 20 sessions — far fewer than other kinds of therapy — with the benefits often emerging well before the end of the treatment.

And the positive effects appear to be long-lasting. For example, in one study review of 69 clinical trials for anxiety-related disorders, CBT was associated with fewer symptoms within a year of completing treatment compared with placebo or other interventions, such as supportive therapy or relaxation.

In an initial CBT session, the therapist will ask you several background questions about yourself, your overall health, and the mental health concerns you’re currently experiencing, says Sarah Gleason, who is a licensed professional counselor and licensed chemical dependency counselor at the Taylor Counseling Group in The Woodlands, Texas. They’ll also ask what your goals for therapy are and explain what you can expect to achieve over time.

Every therapist is somewhat different in how they conduct their sessions, but with a CBT therapist, Gleason explains, you will be learning tools that you can utilize when not in the therapy room.

One of the most common CBT tools is called the cognitive model, which involves identifying a situation that triggers an automatic thought that is then followed by an emotional, physiological, and/or behavioral reaction. Applying this model to one’s own experiences helps patients evaluate those patterns on a deep level, Gleason says.

Gleason offers an example of how to apply the cognitive model: “Susie” was not invited to “Jackie’s” party with her other friends, a situation she found hurtful. Susie’s automatic thought was, “They must not want to be my friend anymore.” This caused Susie to feel sad and have a stomachache — examples of emotional and physiological reactions to a situation. As a result, Susie decides not to talk to her friends next time she sees them — an example of a behavioral reaction.

Using the cognitive model to assess the situation could help Susie learn to recognize and interrupt similar negative automatic thoughts in the future and to practice replacing them with more constructive thoughts, says Gleason. “Instead of Susie thinking her friends don’t want to be friends anymore, she might instead think something like, ‘Jackie knew that I was busy with my family on the night of her party, which must be why I wasn’t invited.’”

And instead of deciding she’ll no longer talk to her friends, Susie could reach out to Jackie and calmly communicate how not being invited to the party made her feel. Then Jackie, upon learning she inadvertently hurt Susie’s feelings, could explain why it happened and together they could agree on how to avoid future misunderstandings.

Over the years, CBT has evolved to include distinct subsets targeted at treating specific mental health disorders, such as:

Dialectical Behavioral Therapy (DBT) This form of CBT was first designed to treat people with borderline personality disorder and chronic suicidal thoughts or behaviors. It’s now used for other conditions, too, like depression, PTSD, and eating disorders. In DBT sessions, participants practice skills like mindfulness, distress tolerance, and emotional regulation.
Cognitive Processing Therapy (CPT) This type of CBT is commonly used to treat people with PTSD by helping them learn to assess and change distressing thoughts that have been affecting them since their traumatic experiences first happened.
Rational Emotive Behavior Therapy (REBT) Developed by psychologist and CBT pioneer Albert Ellis, PhD, this form of CBT employs a technique called “disputing” to help reframe maladaptive beliefs into helpful ones.

Most licensed therapists have websites that list the therapeutic techniques (aka modalities) in which they’re trained. If you’d like to connect with a mental health professional who offers CBT, you might want to first browse the professional’s website and then email or call them to ask them more about their experience with CBT.

Both Darsa and Gleason recommend using Psychology Today’s “Find a Therapist” tool to help pinpoint CBT therapists in your area. Other helpful tools include:

Anxiety & Depression Association of America’s “Find Your Therapist” directory
American Psychiatric Association’s “Find a Psychiatrist” tool
Association for Behavioral and Cognitive Therapies “Find a CBT Therapist” directory

CBT and other types of talk therapy can be expensive, but there are ways to ease the financial burden. Before seeking treatment, ask your insurance provider which mental health services they cover and if they have a directory of therapists who accept your insurance. You can also ask therapists you reach out to which health insurances they accept.

In addition, many therapists offer lower rates for shorter sessions, sliding-scale pricing based on one’s income, or lower fee therapy trainees who are closely supervised by a licensed clinician to help make therapy more affordable and accessible.

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