Cognitive Behavioral Therapy (CBT)

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The psychological basis for cognitive behavioral therapy is the relationship between thoughts (cognition), feelings (emotions), and behavior. Specifically, CBT postulates that distorted thoughts often drive distressing emotions and unhelpful behaviors. When left unaddressed, the cycle of distorted thoughts and emotional/behavioral challenges can worsen and contribute to the development of mood disorders. Techniques utilized in CBT can interrupt unhealthy thoughts to break this cycle. 

For example, someone who thinks that they’ll embarrass themselves at a dinner party may begin changing their behavior by avoiding social situations. Over time, this avoidance may become worse and spread to other areas of life, such as school or work, eventually affecting quality of life. During CBT sessions, a therapist may help reframe distorted thoughts, such as “No one will want to talk to me,” to more realistic thoughts, such as “I don’t know what I want to talk about, but I can ask people questions about themselves.”  

Some of the most common techniques cognitive behavioral therapists use to help clients reframe unhelpful thought patterns and cope with stress include the following: 

• Cognitive reframing: Many people’s thoughts are often over-generalized, all-or-nothing, and more negative than reality. A therapist may utilize cognitive reframing to change thoughts like “I got a D on this test because I’m stupid” to “I didn’t prepare as well for this test as I should have, but I’ll talk to my teacher about how I can do better next time.” 
• Exposure therapy: If you have a phobia, a therapist specialized in cognitive behavioral therapy can help gradually guide you through exposure to it, which can reduce fear and avoidant behaviors. For example, if you’re afraid of spiders, a therapist may help by having you look at a picture of a spider, before looking at a toy spider, holding a toy spider, and eventually being in the same room as a real spider. Throughout the process, they may provide strategies to help you cope with fear. 
• Stress reduction: Cognitive behavioral therapists can help you learn to reduce stress through practices like deep breathing and mindfulness. 
• Successive approximation: Using this technique, therapists can break overwhelming tasks down into smaller, more manageable steps.  
• Guided discovery: In guided discovery, the therapist typically asks the client questions that challenge distorted thoughts. This practice can provide insight into the difference between distorted thoughts and reality by providing a broader, unbiased perspective.  
• Role-playing: Role-playing can be an effective way to prepare for potentially problematic interactions that the client may run into. 

Cognitive behavioral therapy (CBT) is usually a short-term therapy that includes around 6 to 20 sessions aimed at providing clients with tools to manage thoughts on their own. Sessions may be conducted one-on-one or with couples, family members, or groups of people with similar challenges. CBT may be incorporated into in-person therapy, online therapy, or self-guided programs. 

During the first few sessions, most cognitive behavioral therapists ask questions and allow clients to share any details they feel comfortable discussing. If CBT is a good fit and the clients feel comfortable with their therapist, the therapist may begin working with their clients to develop specific, measurable, achievable, realistic, time-limited (SMART) goals and a plan to achieve them. 

After learning more about your thought processes, a therapist may utilize a combination of psychoeducation (including some homework) and CBT techniques to reframe distorted thoughts. After a course of CBT sessions has been completed, many people find that they can better manage their thoughts and feelings on their own. 

Cognitive behavioral therapy (CBT) can benefit many people with psychiatric disorders, people with non-psychiatric disorders, and people without any diagnoses. The following are cases where CBT may be effective, when used alone or in combination with pharmacotherapy or other interventions: 

Psychiatric disorders: 

• Anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, and panic disorder
• Depressive disorders 
• Eating disorders 
• Body dysmorphic disorder³
• Bipolar disorder
• Substance use disorders 
• Obsessive-compulsive disorder⁴ 
• Post-traumatic stress disorder 
• Schizophrenia
• Phobias
• Sleep disorders

Non-psychiatric disorders or physical health challenges: 

• Multiple sclerosis 
• Fibromyalgia
• Chronic pain
• Diabetes
• Breast cancer
• Irritable bowel syndrome
• Chronic fatigue syndrome

Non-medical instances: 

• Anger management
• Conflict resolution
• Communication skills 
• Insomnia  
• Grief
• General stress
• Smoking cessation relapse reduction
• Marital problems 

For the best possible outcomes, it’s important that therapists be licensed and trained to practice CBT, that clients feel comfortable working with their therapist (it’s okay to change therapists at any time), and that clients be motivated and committed to doing the work in between CBT sessions. 

Cognitive-behavioral therapy (CBT) is the most researched form of psychotherapy with the highest degree of systematic effectiveness and empirical support. Cognitive behavioral therapy (CBT) is generally considered the gold standard of psychological treatment, especially for mental health conditions like depression, anxiety, and eating disorders.

Over time, CBT has evolved from the first-wave form utilized by Aaron Beck and Albert Ellis in the 1950s, to the second-wave form of CBT established in the 1960s, and recently to a third-wave form. The third-wave form has developed new CBT approaches, including mindfulness-based CBT, acceptance and commitment therapy, and dialectical behavior therapy. Platforms for CBT delivery have also adapted, now including both online CBT and personal computer-based CBT programs. 

Online therapy is a central focus of many current research studies for its potential to enable more cost-effective, convenient care. A 2017 review article published in the Cureus Journal of Medical Science evaluated 373 peer-reviewed articles, concluding that online CBT is effective for a wide variety of psychiatric disorders and non-psychiatric disorders with comorbid mental health challenges. Another review, published in 2022, evaluated 12 randomized controlled trials with a total of 13,334 participants with either depression or anxiety during the COVID-19 pandemic, finding that online CBT significantly decreased symptom severity. 

If you’re searching for a cognitive behavioral therapist, you may want to consider the following tips: 

• Look for in-network providers: If you have health insurance, it may cover cognitive behavioral therapy sessions. However, some insurance providers require a diagnosis for coverage. You might consider exploring your insurer’s directory to find a therapist who is in-network. If a therapist you want to see is out-of-network, it will likely cost you more to see them, but you can ask if they offer payment on a sliding scale. 
• Evaluate a therapist’s credentials and background: Therapists should provide information such as their license number, educational background, years of experience, focus population(s), and any special credentialing they have. You can always ask for more information to evaluate whether a therapist may be a good fit. 
• Ask yourself if the therapist is someone you feel comfortable with: Are you comfortable talking to the therapist? Do they feel like someone you can confide in? Do they actively listen when you’re speaking? Do they validate your feelings? 

If you do not have health insurance, cannot afford out-of-pocket costs, or otherwise do not wish to start in-person therapy, you may find the following resources helpful: 

• Online therapy: Many platforms, such as BetterHelp, offer online CBT from licensed therapists. The cost is often comparable to an insurance copay, and most people are matched with a therapist within 24-48 hours. You can choose to communicate with your therapist via audio, videoconferencing, or live chat. 
• Worksheets: Therapist Aid offers free downloadable CBT worksheets that are available in English or Spanish. Worksheets include exercises in topics like cognitive restructuring, examination of core beliefs, cost/benefit analysis, and evaluation of facts vs. opinions. 
• Mental health apps: Free mental health apps include MindShift, BellyBio, Take a Break!, and Bearable. While apps may be a helpful complement to therapy, they’re often not studied for their effectiveness, unlike cognitive behavioral therapy.