How Cognitive-Behavioral Therapy (CBT) May Improve Your Life

Cognitive-behavioral therapy is an effective tool used in clinical psychology to develop problem solving skills and examine your way of thinking.If your therapist has mentioned cognitive-behavioral therapy (CBT) as a treatment option, you may be eager to learn more about this popular and effective therapeutic approach. Depending on your mental health needs, CBT counseling can be the starting point for lifestyle changes toward healthier patterns, thoughts, and relationships.

CBT has been shown to be effective at treating a wide array of disorders and conditions, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), eating disorders, and substance use disorders. In addition to treating specific disorders, CBT can also improve stress management and other forms of emotional challenges that a person may be facing.

Learning about the purpose of CBT, the critical characteristics of the treatment, and the effectiveness of CBT in online settings may help you make an informed choice when selecting a treatment plan.

What is CBT?

Cognitive-behavioral therapy (CBT) is a type of therapy recognized by the APA as a talk therapy addressing various mental health concerns, including anxiety disorders, depression, and eating disorders. During therapy sessions, CBT therapists may encourage clients to focus on how their thoughts, beliefs, and attitudes impact their behaviors and relationships. 

CBT combines two types of therapy to help people assess and retrain their thoughts and behaviors, including the following: 

• Cognitive therapy, in which you examine your thoughts
• Behavior therapy, in which you examine your behaviors and behavioral responses

In some studies, CBT has been shown to be as effective, if not more so, than other therapies such as exposure therapy, or psychiatric medications in treating mental illness.

What are the core principles of CBT?

According to the APA, the delivery of CBT is based psychologically on several core principles, including:

• Unhelpful or faulty thinking patterns can contribute to psychological problems.
• Unhelpful learned behavior patterns can contribute to psychological problems.
• Adopting healthy coping skills can reduce the symptoms of psychological problems and improve a person's daily functioning. 

In alignment with these principles, CBT therapists employ various strategies during a therapy session that challenge their patients to recognize, understand, and effectively respond to unhealthy thinking patterns. 

How do CBT sessions work?

Compared to other types of psychological therapy, CBT is often highly structured and focused on your current concerns and particular situation. While it involves talking, CBT may be more targeted than traditional talk therapy. Each 30 to 60 minute-session may be spent discussing specific issues rather than freely discussing life and past events.

As an individual, you might expect to meet with a CBT therapist for around six to 20 weekly sessions, making it a relatively short-term therapy. However, some clients might attend therapy for longer and how many sessions you attend depends on your specific situation. Below is an outline of how treatment might progress, starting with your first session. However, treatment is personal, so discuss your treatment plan with your therapist. 

First sessions

In your first few sessions, your therapist may confirm that CBT is effective for you and that you're comfortable with the plan and process. These sessions may flow more freely than later meetings as your therapist learns about you and your background. The CBT therapist can also outline what to expect from the full-length treatment and recommend alternative therapies if needed.

Later sessions

Your remaining CBT sessions may be dedicated to confronting fears, symptoms, stress, and unhelpful thought patterns. The goal may be overcoming these concerns. When you and your therapist have established your history and goals, you may break them down into more minor parts. 

At its core, CBT helps individuals identify and make sense of significant concerns by dividing them into more manageable pieces. CBT therapists often help clients break down their concerns into five areas:

• Situations
• Thoughts
• Emotions
• Physical feelings
• Actions and behaviors

You might see how each category connects by categorizing your concerns into these five categories. For example, you may notice that your worried thoughts about your job often correlate with an upset stomach or a desire to walk away from the office physically. With time, a CBT therapist may help you slow down and halt these negative thought cycles before further distress occurs. This form of self-talk is designed to be self-sustaining and used outside of therapy.

Common goals of CBT

Recognizing cognitive distortions

Cognitive distortions are methods of thinking or "cognitive constructs" that develop when individuals process information ineffectively. A person may not necessarily be diagnosed with a mental health or medical condition to engage in faulty or inaccurate thinking. Many people experience distortions throughout their lives. Psychologists recognize numerous cognitive distortions, including the following examples. 

Black-and-white thinking

Black-and-white thinking as a cognitive distortion may occur in several mental health conditions, although others can experience it. By thinking in "black and white," people may think in extremes and experience difficulties finding nuance, compromise, or any "grey area" in emotional issues. 

"Should" statements

When individuals impose "should" statements on themselves and others, they may be implying a belief that a situation must occur a certain way. These statements may take the form of strict rules, such as:

• "I should always be the funny one in social situations."
• "I should avoid that food at all costs."
• "My family members shouldn't act that way in public." 

Thought patterns rooted in "should" statements may limit an individual's ability to show up authentically to themselves and in relationships. 

CBT therapists often help patients recognize any cognitive distortions contributing to their psychological problems. If you're working with a CBT-trained counselor, they might challenge you to re-evaluate your distortions using facts. 

For example, if you think another person "should" be a "better parent," a therapist can help you outline factual reasons why these thought patterns may harm you and others. 

Challenging negative thoughts with cognitive restructuring

Cognitive restructuring allows someone to examine their thoughts when upset or distressed. By closely evaluating our thoughts, we may determine if they are accurate and intentionally shift to more accurate, uplifting thought patterns if not. 

Cognitive restructuring can be broken down into five steps, including the following: 

1. Describe the situation
2. Identify the feeling
3. Identify the thought
4. Evaluate the thought
5. Make a decision

Ask yourself if your evidence supports a thought. If so, it may be a beneficial thought. If not, it may be valuable to change it. 

Applying CBT skills outside of therapy 

While a trained, licensed CBT therapist can help a client find success, a client's commitment to participating actively in their treatment may also be beneficial. Commitment may include completing "homework" outside of CBT, asking for further support or clarity when necessary, accepting opportunities to face fears, or engaging in roleplay to prepare for potentially stressful interactions.

Journaling is another common CBT exercise used during and outside sessions to track progress and goals. In a 2018 study, researchers found that positive affect journaling (PAJ), an emotion-focused form of reflective writing, can improve well-being physical functioning and emotional health, while reducing mental distress among people in CBT treatment. 

Counseling options

CBT can be a beneficial therapy for many individuals and is one of the most popular types practiced in the US. Despite its popularity, people may face barriers to receiving CBT in person. For example, many people cannot pay session fees, commute to an office, or take time off work or school to meet a therapist. In these cases, online therapy may be beneficial. 

Research indicates that online CBT (also called CBT-I) can be as effective as in-person treatments. In 2019, researchers found that CBT-I significantly improved patients' sleep quality, functional health, and psychological well-being, based on the results of 1,711 people with self-reported insomnia symptoms. Other studies suggest that CBT-I effectively treats symptoms of anxiety, depression, and related mental health concerns.

Online CBT may be an option for you if you're experiencing negative thought patterns or responding to stressful situations in unhealthy ways. Often, online therapy is a resource for people who want to incorporate psychotherapy into their lives at their convenience. Therapists cannot prescribe medications directly, however, they may refer you to a therapist. If you want to improve your mental health but can't commit to in-person therapy, a platform like BetterHelp may align with your busy lifestyle and goals.  While BetterHelp does not accept health insurance, it is similar in cost or less than insurance co-pays.