Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs. Considered a "solutions-oriented" form of talk therapy, CBT rests on the idea that thoughts and perceptions influence behavior.
Feeling distressed, in some cases, may distort one’s perception of reality. CBT aims to identify harmful thoughts, assess whether they are an accurate depiction of reality, and, if they are not, employ strategies to challenge and overcome them.
CBT is appropriate for people of all ages, including children, adolescents, and adults. Evidence has mounted that CBT can address numerous conditions, such as major depressive disorder, anxiety disorders, post-traumatic stress disorder, eating disorders, obsessive-compulsive disorders, and many others.
CBT is a preferred modality of therapy among practitioners and insurance companies alike as it can be effective in a brief period of time, generally 5 to 20 sessions, though there is no set time frame. Research indicates that CBT can be delivered effectively online, in addition to face-to-face therapy sessions.
CBT in Practice
CBT focuses on present circumstances and emotions in real time, as opposed to childhood events. A clinician who practices CBT will likely ask about family history to get a better sense of the entire person, but will not spend inordinate time on past events. The emphasis is on what a person is telling themselves that might result in anxiety or disturbance. A person is then encouraged to address rational concerns practically, and to challenge irrational beliefs, rumination or catastrophizing.
For example, a person who is upset about being single will be encouraged to take concrete measures but also question any undue negativity or unwarranted premise ("I will be alone forever") that they attach to this present-day fact.
A typical course of CBT is around 5 to 20 weekly sessions of about 45 minutes each. Treatment may continue for additional sessions that are spaced further apart, while the person keeps practicing skills on their own. The full course of treatment may last from 3 to 6 months, and longer in some cases if needed.
In therapy, patients will learn to identify and challenge harmful thoughts, and replace them with a more realistic, healthy perspective. Patients may receive assignments between sessions, such as exercises to observe and recognize their thought patterns, and apply the skills they learn to real situations in their life.
CBT programs tend to be structured and systematic, which makes it more likely that a person gets an adequate “dose” of healthy thinking and behaviors. For example, a patient with depression may be asked to write down the thoughts he has when something upsetting happens, and then to work with the therapist to test how helpful and accurate the thoughts are. Repeated and focused practice is an integral part of CBT. CBT centers around building new habits—which we may know but need to remember and implement successfully.
Additionally, CBT programs can be standardized and tested so that the mental health field can identify which programs are effective, how long they take, and the benefits that patients can expect.
Research has found the CBT delivered virtually is often equally as effective, and sometimes more effective, than CBT delivered in person. For example, one review study found that online CBT reduced symptoms of anxiety and depression to the same extent or more than in person CBT. Online CBT was also effective in treating post-traumatic stress disorder, panic disorder, and specific phobia. Given that online therapy removes certain barriers, such as travel time or childcare, it’s a strong option to consider.
For more, see Online Therapy.
Almost everyone deals with distracting or destructive thoughts at times, but cognitive and behavioral principles can help you overcome them. The first goal is to restructure exaggerations. You can cultivate cognitive flexibility by asking questions like, “What’s the evidence for and against this idea?” “Is it possible that another perspective is more accurate?”
The second approach is to problem solve. If your beliefs are rooted in reality, fix the problem or make it more manageable, such as outlining the steps to complete a project that feels overwhelming. The third is to accept what you can’t change. You can then move forward and engage in activities that matter, without allowing your thoughts to control you.
Many people pursue therapy because their relationships are suffering. A course of CBT can lead to marked benefits not only for the person in therapy but for those close to him or her. One is less anxiety in the relationship; chronic worry in generalized anxiety disorder frequently leads to tension and irritability, causing conflict between partners. Another is greater presence, because a CBT framework can help translate one's intention to be present into a plan of action to make it happen. Positive mood, better sleep, happier children, and healthier thought patterns, are also ways in which CBT can improve a relationship.
What Conditions Can CBT Treat?
CBT originally evolved to treat depression, but research now shows that it can address a wide array of conditions, such as anxiety, post-traumatic stress disorder, substance use disorder, and phobias. Versions have also been created to treat insomnia and eating disorders. But beyond treating clinical challenges, CBT can also provide the skills people need to improve their relationships, happiness, and overall fulfillment in life.
Yes, many studies have documented the benefits of CBT for treating depression. Research shows that CBT is often equally as effective as antidepressants; patients who receive CBT may also be less likely to relapse after treatment than those who receive medication. CBT can provide patients with the inner resources they need to heal—and to prevent a depressive episode from recurring in the future.
CBT is an effective and lasting treatment for anxiety disorders, research shows. CBT provides the tools to alter the thoughts and behaviors that exacerbate anxiety. For example, someone with social anxiety might think, “I feel so awkward at parties. Everyone must think I’m a loser.” This thought may lead to feelings of sadness, shame, and fear, when then lead to behaviors like isolation and avoidance. CBT can help people learn to identify and challenge distorted thoughts, and then replace them with realistic thoughts, changing the cycle of anxiety.
Cognitive Behavioral Therapy for Insomnia, or CBT-I, is a short-term treatment for chronic insomnia. The therapy aims to reframe people’s thoughts, feelings, and behaviors around sleep. People with insomnia often enter a cycle of trying to make up the sleep they lost, sleeping poorly the subsequent night, and then becoming anxious about sleeping. These behaviors can include going to bed too early, taking naps, or relying on alcohol to fall asleep. The role of CBT-i is to change those patterns, through techniques such as challenging anxious thoughts and adhering to a set sleep schedule.
Enhanced Cognitive Behavioral Therapy, or CBT-E, is a form of CBT designed to treat eating disorders including anorexia, bulimia, and binge-eating disorder. CBT-E focuses on exploring the reasons the patient fears gaining weight with the goal of allowing the patient to decide for themselves to make a change. CBT-E stands in contrast to Family-Based Therapy, a leading treatment in which the patient’s family takes on an important role in addressing the disorder and the person’s eating patterns at home.
The Origins of CBT
CBT was founded by psychiatrist Aaron Beck in the 1960s, following his disillusionment with Freudian psychoanalysis and a desire to explore more empirical forms of therapy. CBT also has roots in Rational Emotive Behavioral Therapy (REBT), the brainchild of psychologist Albert Ellis. The two were pioneers in changing the therapeutic landscape to offer patients a new treatment option—one that is short-term, goal-oriented, and scientifically validated.
The creator of cognitive behavioral therapy is Aaron Beck, a psychiatrist at the University of Pennsylvania. In the 1960s, Beck was practicing psychoanalysis. But he came to realize that the approach was failing to treat his depressed patients—entrenched negative thoughts prevented them from overcoming the disorder. So he developed cognitive behavior therapy, rooted in the philosophy of Albert Ellis’s rational emotive behavior therapy, to change these harmful patterns of “emotional reasoning” and spark genuine change.
In the 1950s, the psychologist Albert Ellis became discouraged by psychoanalysis. When treating his patients, he discovered that becoming aware of one’s beliefs and challenges didn’t necessarily change them. Ellis developed what is now called "rational emotive behavior therapy" (REBT). The groundbreaking therapy is based on his core philosophy: that most of our behavioral and emotional problems—from getting over a breakup to handling child abuse—stem from our own irrational beliefs about our situations and how we should be treated. By changing those beliefs, we can change our emotions and behaviors for the better.
Rational emotive behavior therapy later sparked the creation of cognitive behavior therapy. Both encompass the notion that emotions and behavior are predominantly generated by ideas, beliefs, attitudes, and thinking, so changing one’s thinking can lead to emotion and behavior change. Yet there are also a few differences between REBT and CBT. Unlike CBT, REBT explores the philosophic roots of emotional disturbances, encourages unconditional self-acceptance, and distinguishes between self-destructive negative emotions and appropriate negative emotions.
Psychoanalytic and psychodynamic therapy, as well as many other approaches, center around exploring the past to gather understanding and insight. CBT is distinct because it focuses on the present. What are you thinking right now? What were you thinking when you began to feel anxious? Are there any harmful patterns that emerge? The goal is to understand what happens in your mind and body in the present to change how you respond.