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When people hear the words “therapy” or “psychology,” they might think of laying on a couch and speaking to a quiet man in a tweed jacket and bow tie. Over the last couple decades, though, another form of therapy has risen to the forefront. Cognitive behavioral therapy, or CBT, is now one of the first types of treatment mental health providers bring up when talking to clients.
As a certified CBT therapist, I’ve seen firsthand this treatment alleviate distress and improve the lives of countless people.
But what the heck is Cognitive Behavioral Therapy? Great question. There are many incredible and in-depth explanations about CBT scattered throughout the internet, but it can be overwhelming sifting through all that information.
Here are the basics of what you need to know.
Cognitive Behavioral Therapy’s Goal
Cognitive behavioral therapy focuses on reducing emotional distress and behavioral problems through changing dysfunctional thinking.
This is a goal-oriented, problems-focused treatment. While many other therapies focus on resolving the past, CBT focuses on how to change the present. Generally speaking, CBT is fairly structured and aims to be more time-limited than other treatment options.
The Theory Behind CBT
It’s hard enough making sense of the world around us, let alone our reactions to it. Sometimes we feel badly or act out and have no idea why.
Cognitive behavioral theory breaks down what’s going on in our heads in an easy-to-understand model. It goes like this: a situation happens. We have an automatic thought. From that thought, we have an emotion. Our body has some sort physical reaction—like tightness in the chest, a jolt of energy, or nausea. Then, based on our thoughts and feelings, we take action. What we do has some sort of consequence, which affects our situation and starts this loop all over again.
Here’s a visual:
The chain reaction occurs constantly without our conscious noticing. It’s like a ping pong match between us and our environment.
I’ll give you an example. Meet Bill. Bill walks into the gym, stretches, and sees an old friend by the treadmills. He waves wildly, but that friend struts on by without so much looking him in the eye. Upset, Bill steps onto the treadmill and runs for only a couple of minutes before leaving early.
What happened? This probably all felt like it happened very quickly for Bill, but let’s analyze what happened using the fancy lens of cognitive behavioral theory.
Situation/Trigger: Bill’s friend did not acknowledge his wave.
Automatic thought: Bill thought, “I thought we were close, but he doesn’t even recognize me.”
Emotion: Bill felt sad and ashamed.
Physical response: Bill’s stomach churned, and his heartrate sped up.
Behavior: Feeling unwell, Bill skipped the rest of his work-out and went home early.
This is a logical sequence of events, right? One of my favorite parts of cognitive behavioral therapy is how well it organizes information. It breaks a chaotic moment into a linear story.
Looking at this model, which piece do you think we have the most control over? Firstly, we can’t control every situation that gets thrown our direction. Life happens, and we have to find ways to deal with it. Our emotions and bodily responses often feel like they happen instantly once we’re in those situations. And, as emotional creatures, the way we behave is intrinsically different based on whether we’re happy, sad, or angry.
In terms of change, thoughts are where we get the most bang for our buck. If we can change our perspective, a whole other chain reaction could unfold.
Let’s jump back to poor Bill in our example. What if, after that automatic thought that his old friend didn’t recognize him, he had practiced a different thought? Let’s go through one example and see what might’ve changed. Again, I’m trying to guesstimate how each step of this might go.
Situation: Bill’s friend did not acknowledge his wave.
Thought: Bill thought, “I guess he didn’t see me.” Or “he’s got his headphones in, maybe he’s distracted.”
Emotion: Bill felt fairly neutral, maybe even encouraged that he’d run into an old friend.
Physical response: Bill kept up his energy he walked into the gym with.
Behavior: Bill moved on with his workout. Or, Bill possibly caught up to his friend to say hi again.
Big difference, right? This is a simple example of what cognitive behavioral therapy tries to do. There’s a lot of power in changing one’s automatic thoughts and setting ourselves up for feeling better and taking healthful action.
Does Cognitive Behavioral Therapy Work?
Yup. Cognitive behavioral therapy is a highly effective treatment. There have been lots of studies over the years that have shown it can be helpful in reducing mental health symptoms. Results can come more quickly than a lot of therapies. Furthermore, one of the goals of CBT is to teach people to practice these exercises on their own. Truly, with this treatment, you typically get what you put in. With practice, you can become your own cognitive behavioral therapist. This means the effects of this therapy can be long-lasting. Occasional booster sessions after completion of the main portion of CBT can help prevent relapse, too!
One drawback to cognitive behavioral therapy is that you might feel upset during treatment. Us therapists always prefer that clients leave session feeling better, but change doesn’t always feel good. Discussing difficult subjects and experimenting with other perspectives can trigger all sorts of emotions. That’s very common in CBT. Still, clients heading into this therapy should expect to go through highs and lows. Sometimes, people feel worse before they feel better.
Some caveats. To be clear, no one type of psychotherapy will work for everyone. CBT does not have a perfect record. For example, in 2013, researchers looking across studies found that cognitive behavioral therapy reducing anger and aggression in close to 70% of patients. Given how complex and diverse human beings are, 70% is actually a great success rate. Lastly, I’d like to point out that recovery is going to look different for each person. Notice that I’ve talked about CBT reducing symptoms. That may mean the symptoms disappear entirely. Maybe CBT will muzzle the symptoms so much that they’re manageable. Or, perhaps CBT helps take the edge off distress that will continue to challenge the individual throughout their life.
No one therapy is going to work for everyone. Everybody responds differently.
Who Can Benefit from CBT?
Cognitive behavioral therapy can be powerful for anybody who is capable of holding a therapeutic discussion. If that sounds broad, good. CBT can be effective for competent children, adults, and older adults. This therapy has also proven helpful with folks from all kinds of cultural, religious, racial, gender, and socioeconomic identities. According to the Academy of Cognitive Therapy, over 60 countries use CBT!
Cognitive behavioral therapy can work with a wide variety of mental health symptoms and disorders. It is commonly used to alleviate anxiety, depression, and trauma-related symptoms, but can also work with eating disorders, addiction, and more.
Certain conditions don’t fit great for this treatment, though. Individuals with severe developmental delays or intellectual disability may not be able to participate well in cognitive behavioral therapy. These individuals may benefit more from other treatments, such as behavioral therapy. I know, it sounds similar, but trust me, it’s a little different. People experiencing mania will be unable to engage in CBT, but would likely benefit once they stabilize from medication. Finally, cognitive behavioral therapy can’t cure hallucinations or delusions. These are biologically driven and, like mania, need to be treated through medication. That said, CBT can still help treat other issues individuals with psychosis experience.
CBT is not just for people with a mental disorder either. Interventions in this therapy can be helpful in more general issues like reducing stress and improving relationships.
What Does Cognitive Behavioral Therapy Look Like?
In this therapy, there is no Freudian-style sitting on the couch for an hour and talking with little to no input from the provider. Cognitive Behavioral Therapy is a highly interactive treatment, where both the therapist and client are expected to collaborate in problem-solving.
Appointments tend to follow a similar general structure. At the start of session, clients are typically asked to check in and rate how they’ve been feeling. Both the client and the clinician set the agenda together. Major topics are addressed and reviewed. Then, at the end, some kind of homework is assigned.
While some other therapies largely exist within dialogue with the provider, Cognitive Behavioral Therapy takes many types of forms. Seriously, I could spend the rest of my life writing about all the different types of therapy spun off from CBT, including Dialectical Behavioral Therapy (DBT) and Exposure and Response Prevention (ERP). However, on top of therapeutic dialogue, CBT often uses worksheets and exercises.
Cognitive Behavioral Therapy is most likely to be successful when client does homework between sessions. Think of it like physical training. Yeah, weekly personal sessions with a trainer are great, but results will be limited unless you go to the gym and grind on your own. The more these CBT exercises are practiced, the stronger your “muscles” will be in managing mental health symptoms. With time, you will hopefully transform into your own cognitive behavioral therapist.
How Long Does CBT Take?
It depends. Typically, sessions last around fifty minutes and occur once per week. That said, I’ve seen intensive programs that go for multiple hours several days a week. As symptoms improve, therapists and clients may agree to space out sessions to every couple of weeks, every month, or even every couple of months.
As I mentioned above, Cognitive Behavioral Therapy tries to provide relief and change more quickly than some other types of psychotherapy. This treatment may last for 5-20 sessions, though this is by no means a definite number. Length can be influenced by factors like the symptoms’ intensity, how long these symptoms have been around, having a support system, the connection with the provider, and how much work the client does between sessions.
Real world factors come into play, too. Some agencies and programs will only approve therapy for a limited time, plus clients and providers’ availability might change. Private insurances in the United States may also set a hard limit that they will pay for, although that can be appealed by your therapist.
Remember, there are little to no instant fixes in treatment. Cognitive behavioral therapy—and psychotherapy in general—is about creating change. Thought patterns usually build up over years, so it takes time to create new habits. Please be kind to yourself and give yourself permission to take that time.
Get the Treatment You Need
One of the hardest things to do is to reach out for help. It’s scary and intimidating. We may feel tempted to keep the status quo running, even if the status quo sucks. Even so, you are important. If things are hard, think about connecting with a mental health provider. Cognitive behavioral therapy is a great option if you want to change your perspective and behaviors.
If you live in California and want to try this type of therapy, maybe you and I would be a great fit. You can find my therapy profile page here. Also, here’s an easy “How To” guide on finding a mental health provider.
What do you think? Are you considering cognitive behavioral therapy? Have you done CBT before? Please share your thoughts and questions in the comments below.
