Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a short-term form of psychotherapy based on the idea that the way someone thinks and feels affects the way he or she behaves. CBT aims to help clients resolve present-day challenges like depression or anxiety, relationship problems, anger issues, stress, or other common concerns that negatively affect mental health and quality of life. The goal of treatment is to help clients identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.
Originally called simply “cognitive therapy,” what is now CBT was developed in the 1960s and 1970s by psychiatrist Aaron Beck, who found that helping depressed patients recognize and challenge their automatic negative thoughts had a positive impact on their symptoms. Beck drew on theories developed by psychologist Albert Ellis, the creator of rational emotive behavior therapy (REBT), among others, to develop an approach that was short-term and goal-oriented, in contrast to the dominant modalities of the time. Though it was originally designed to treat depression, since its inception CBT has been found to be effective for a wide range of mental health conditions and day-to-day psychological challenges, and is recommended as the first-line treatment for disorders including depression, anxiety, and insomnia.
CBT is appropriate for children, adolescents, and adults and for individuals, families, and couples. A large body of research has found it to be either highly or moderately effective in the treatment of depression, generalized anxiety disorder, post-traumatic stress disorder, general stress, anger issues, panic disorders, agoraphobia, social phobia, eating disorders, marital difficulties, obsessive-compulsive disorder, and childhood anxiety and depressive disorders. CBT may also be effective as an intervention for chronic pain conditions and associated distress. CBT can be used alone or in conjunction with psychiatric medication. Some studies have found that CBT and medication are equally effective in treating depression.
Specialized forms of CBT may also be used to treat specific conditions. For example, cognitive behavioral therapy for insomnia, or CBT-I, has been found to be a highly effective short-term treatment for chronic insomnia; it is now the recommended first-line treatment for individuals struggling with insomnia. Another example is enhanced cognitive behavioral therapy, or CBT-E, a form of CBT specifically designed to treat eating disorders. Brief cognitive behavioral therapy, or BCBT, is a shortened form of CBT used in situations where the client is not able to undergo a longer course of therapy.
CBT is a structured form of psychotherapy that can occur in a relatively short period of time—often between 5 and 20 weekly sessions, generally around 45 to 50 minutes each. CBT usually starts with one or two sessions focused on assessment, during which the therapist will help the client identify the symptoms or behavior patterns that are causing them the most problems and set goals for treatment. In subsequent sessions, the client will identify the negative or maladaptive thoughts they have about their current problems and determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, the client will learn skills that help them challenge and ultimately change their thinking patterns so they are more accurate with respect to a given situation. Once the client’s perspective is more realistic, the therapist can help them determine an appropriate course of action.
CBT usually concludes with a session or two of recapping, reassessing, and reinforcing what was learned. If necessary, someone may return to therapy for periodic maintenance sessions. Along the way, clients will most likely be given “homework” to do between sessions. That work will typically include exercises that will help them learn to apply the skills and solutions they came up with in therapy to real-world situations in their day-to-day life.
While cognitive behavioral therapy may sound simple—CBT therapist Seth Gillihan writes that he tells clients that the things he’ll ask them to do are “stupidly obvious”—it can be quite challenging in practice. Our patterns of thinking are often deeply entrenched and habitual—and as with any long-standing habit, it can be an arduous process to replace one thought pattern with a new, healthier one. And while clients undergoing CBT will likely not spend a large amount of time exploring their childhood or past, they may still be asked to examine thoughts and behavior patterns that they may find embarrassing or shameful. As in all types of therapy, it is important to work with a therapist with whom one can be open and candid.
CBT integrates behavioral theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of an experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances.
CBT often targets cognitive distortions, or irrational patterns of thought that can negatively affect behavior. Common cognitive distortions include all-or-nothing thinking (seeing everything in black-and-white terms and ignoring nuance), catastrophizing (always assuming the worst will happen), and personalization (believing that the individual is responsible for everything that happens around them, whether good or bad).
For example, someone who is prone to catastrophizing may assume that a friend who doesn't text them back right away is angry at them, potentially leading them to withdraw socially, lash out at the friend, ruminate, or otherwise behave in a non-productive way. Using CBT, they may learn to recognize their tendency to jump to the worst possible conclusion—and the next time their friend does not return their text, they can remind themselves that the friend has always returned texts in the past and may simply be busy. Such reframing can help someone refrain from engaging in counterproductive behavior.
CBT is rooted in the present, so the therapist will initially ask clients to identify life situations, thoughts, and feelings that cause acute or chronic distress. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so that they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.
CBT is among the most widely-utilized therapeutic approaches, so many people are able to locate a therapist in their area who practices it, but CBT has also been found to be effective when delivered online. There is no particular certification or license required to practice CBT, but clients are advised to look for a credentialed mental health professional with specialized training and experience in cognitive behavioral therapy. In addition to confirming these credentials, it is important to find a therapist with whom one feels comfortable, as CBT is a collaborative process and a strong therapeutic alliance is critical to its success.