Cognitive Behavioral Therapy (CBT)

What is CBT?

Cognitive Behavioral Therapy (CBT) is a skill-based approach to talk therapy. When you start CBT, you and your therapist will work together to identify your individual problems and concerns. You’ll also learn to integrate strategic techniques in response to these issues.

CBT is based on the understanding that our emotional experiences are directly related to our thoughts, beliefs, and actions – and therefore, it is possible to change our emotional experiences by examining and altering our thoughts and behaviors.

The duration of CBT treatment varies, typically ranging from six sessions to several months. You will typically meet with your therapist once a week.

Over time, CBT will help you gain self-awareness of:

• Your unique thinking and behavioral patterns
• The impact your beliefs and actions have on your overall mental health
• How you can incorporate techniques and skills to improve your mental health

 

How does CBT work?

Together with your therapist, you will work collaboratively to identify which patterns of thinking and behavior contribute to negative moods.

CBT offers specific techniques to examine and adjust these unhelpful beliefs and thoughts – called cognitive distortions – through the processes of cognitive restructuring.

An example of a cognitive distortion might be a mental filter (e.g., only focusing on one negative comment your partner made) or personalizing (e.g., “My friend must be in a bad mood because of something I did”).

You will learn behavioral techniques, which help support the process of changing your thoughts and emotional experiences. There are many CBT techniques, including:

• Rational problem solving: A six-step process to identifying the most effective solution to a clearly defined problem after considering important alternatives.
• Relaxation training: A variety of techniques used to calm the nervous system. Examples include breathing exercises, mindfulness skills, visualization, and progressive muscle relaxation.
• Guided imagery: Using words, music, or images to elicit positive and calming imagined scenarios.
• Social perspective taking: Consider how others may interpret a situation differently.
• Exposure and avoidance hierarchy worksheets: A tool used to assess anxiety levels about certain situations.

These are just a few approaches to CBT. You and your therapist will determine the right one for your needs.

Does CBT work?

Studies have found CBT to be effective as a standalone treatment for:

• Anxiety and depression (in mild to less severe forms)
• PTSD
• Tics
• Substance abuse (excepting opioid use disorder)
• Eating disorders
• Borderline personality disorder

Additionally, CBT is often recommended in conjunction with medication for:

• OCD
• Opioid use disorder
• Bipolar disorder
• Psychotic disorders  

Often therapists will suggest returning for a “tune-up,” should symptoms re-emerge at any point after a full course of treatment is completed.

Structure of CBT sessions

A typical session of CBT begins with an objective measure of your mood and symptoms. Your therapist may use a designated checklist, based on what protocol they’re following.

Next, you share any problems you’re currently, or have recently, experienced related to your mental health. You will use that information to prioritize an agenda for the therapy session.

During the session, you and your therapist will review previous sessions and the time between sessions. You’ll discuss how you utilized learned skills, and what (if any) effects these had on your mood.

Your therapist will act as a coach or trainer to help you break down the current problem you’ve identified, and apply a CBT skill or technique to address that problem.

Finally, each session usually ends with a plan for you to practice a CBT technique or skill on your own after the session, and report back at the next meeting.  This typically includes homework-style activities, like tracking your behavior patterns and/or thoughts in a journal or app specifically built for CBT.  

What can CBT help with?

CBT is proven to be effective at improving outcomes for several emotional and mental health challenges, including:

• Depression
• Anxiety
• Panic
• Phobias
• Stress
• Obsessive-Compulsive Disorders
• Addictions
• Eating Disorders
• PTSD
• Bipolar Disorder
• Sleep Disorders

How does CBT help depression?

CBT treats the thoughts and behaviors that have led to your depression, and those that continue to perpetuate depressed mood and feelings. For example, if you’ve been in your room for multiple days, a CBT technique called “behavioral activation” might encourage you to leave your house and go for a walk – simply to get you taking healthy steps.

You might try to also identify negative thought patterns, such as comparing yourself negatively to other people, or negatively filtering life events.

A therapist will help you to identify the negative thought patterns common in people with depression, and work with you to identify alternative thoughts that are more helpful or adaptive.

Changing even one behavior or thought pattern can have ripple effects on one’s mood and depression in ways that create meaningful relief from low mood and sadness.

How does CBT help anxiety?

Research shows that CBT is the most effective psychotherapy for treating anxiety disorders. Utilizing CBT requires identifying unhelpful behaviors and ways of thinking, and replacing them with more adaptive thoughts and behaviors that can reduce and manage anxiety.

One of the most common principles of CBT for anxiety is that approaching the things that causes anxiety, rather than avoiding them, can actually help relieve anxiety symptoms in the long run. In the process of facing anxiety, CBT examines specific thoughts related to anxiety, replacing those that contribute to anxiety with more helpful and reality-based thoughts.

CBT also teaches relaxation skills, such as progressive muscle relaxation, to calm the body and mind in moments of increased stress or anxiety.