What is Cognitive Behavioral Therapy (CBT)?
Cognitive behavioral therapy (CBT) is a blend of two existing forms of therapy: Cognitive Therapy and Behaviorism. This psychotherapeutic approach was developed in the early 1960’s by a psychiatrist named Dr. Aaron Beck, and is now one of the most widely used and well-researched therapy approaches. CBT has been extensively studied, and is proven to be effective in treating a wide range of conditions including depression, anxiety disorders, and substance use disorders.
Cognitive behavioral therapy is a form of psychotherapy that is used by counselors, social workers, and psychologists to treat a variety of emotional and behavioral issues. CBT recognizes that thoughts, emotions, and behaviors are all connected. The main goal of CBT is to improve a person’s mental and emotional wellbeing by making positive changes in the way people think and behave. This is usually done in 1:1 sessions with a trained therapist who works with a client to set and achieve specific goals for treatment.
As an example, anxiety disorders often involve a combination of worried “what if…” thoughts that create feelings of anxiety. A common way people cope with these thoughts and feelings is to avoid situations that scare them. While this can temporarily make someone feel less worried and anxious, avoidance tends to worsen anxiety in the long term.
Some of the techniques commonly used in CBT focus on changing the way people think about situations.
For example, a CBT therapist working with someone who has anxiety about getting bloodwork done might encourage the person to turn their ‘what if’ thoughts into ‘even if’ thoughts. This technique is called reframing, and can help people think more rationally during times when they feel anxious. Another aspect of CBT focuses on behavioral change. In this example, a CBT therapist may encourage the person to weigh the pros and cons of canceling their appointment, and then identify other choices where the pros outweigh the cons.
As you can see, CBT can be an effective way to help people make changes to the way they think and react during times when they feel emotional. CBT can also be used to treat other types of mental health and substance use disorders. It’s often used in conjunction with other psychotherapy approaches as well as other forms of treatment like psychiatric medication. Unlike other psychotherapy approaches, CBT deals with your current problems rather than focusing solely on issues from the past. Using CBT, a client can begin to break problematic patterns of behavior or change unhelpful thought patterns fueling these behaviors.
Is CBT a Good Option for Me?
Cognitive behavioral therapy is used to treat a number of common mental health issues. In recent years, it has become the go-to form of psychotherapy due to its ability to improve the current mental state and improve day-to-day life in a relatively short amount of time. Often, CBT is provided on a weekly basis for a period of a few months at which point a person has often developed the CBT “skills” needed to manage their problems on their own. On average, people in CBT usually receive 8-20 sessions.
CBT is one of the therapeutic approaches with the most research supporting its effectiveness. Some of the issues CBT has had the most documented success in treating include anxiety disorders, anger issues, depression, and specific types of substance use disorders. There’s less evidence that CBT is helpful for marriage or family problems, eating disorders, or posttraumatic stress disorder.
Some people who prefer a less directive approach or just want to “vent” might find that CBT is too structured of an approach for them. Generally, CBT is a good fit for people who: want a more structured approach, want a therapist who is more direct, want to work on specific issues and problems happening in their lives now, and want to develop new ways to cope or respond to these problems.
What Can I Expect During CBT Treatment?
CBT is often held in weekly or bi-weekly sessions consisting of 45-60 minute conversations between you and your therapist. Early on, your therapist will work with you to set specific goals for your therapy, which will be reviewed frequently. After setting goals, the therapist will likely provide some education on the specific issue, diagnosis or problem bringing you to therapy, and may also introduce some CBT specific information. Often, this will include an explanation about how thoughts, feelings, and behaviors are linked and some exploration of your patterns.
From there, a CBT therapist will usually introduce some key skills to try outside of sessions. These skills might include ways to interrupt or “reframe” unhelpful thoughts, cope more effectively with difficult emotions, or learn new ways to approach problem solving or decision making. The eventual aim of cognitive behavioral therapy is to apply the lessons you learn in your CBT sessions to your daily life. That’s why CBT often includes doing “homework” outside of your therapy sessions which may include worksheets, mood or thought trackers, and/or utilization of specific CBT skills.
The more you are able to implement what you learn in CBT therapy into your daily life, the more you’ll get out of treatment and the faster your recovery will be. As progress is made, it is common for a CBT therapist to recommend meeting less frequently or even terminating therapy because you have achieved your goals. While this can be a difficult transition, it also is a marker of progress you have made in treatment. Also, many people find that coming in periodically for sessions helps them to refresh their skills and maintain the progress they have made in treatment.
During the COVID-19 pandemic, rates of anxiety and depression tripled and more Americans reported struggling with stress, substance abuse, and mental illness. This led to an increased demand for therapies like CBT, which are highly effective in treating anxiety disorders, mood disorders, and addictions. Online therapy also became more widely available during the pandemic, and most insurance companies expanded their coverage for telehealth. This means that most people with insurance now have the option to see a CBT counselor in person or do their sessions online.
Questions to Ask a Therapist During Consultations
Finding a therapist who is a good fit for you is important, so plan on speaking to more than one person before making a decision to book the first appointment. Most therapists offer free phone consultations and will be happy to answer any questions you have for them about treatment. Some questions that people find helpful in making a decision about what therapist to choose include:
- What days/times would you be available to meet with me?
- What is your style of counseling? (example: Do you use CBT?)
- Have you worked with other people with the issues I have (ie: anxiety, depression, etc.)?
- How long does treatment typically last?
- What could I expect to gain from treatment?
- How would a typical session go?
Asking questions like this can be helpful in finding a therapist who you are comfortable with. There are no right/wrong answers to these questions, but you will find that some therapists will answer the questions in ways that sound like they would match your needs better than others. The most important thing to gain from these initial conversations is a sense of how the therapist operates and whether you would feel comfortable with them. After all, many people go to counseling to discuss very personal and private details about themselves and their lives, so it is important to find a therapist who makes you feel comfortable about taking this step.
CBT is a popular type of psychotherapy that can help people struggling with mood problems, anxiety disorders, impulse control and substance use disorders. CBT therapists tend to use more structured approaches in therapy that focus on teaching skills to help clients reach their goals. Most CBT skills attempt to help people change thought and behavior patterns that are contributing to their issue or problem. You can find a CBT therapist by using a therapist directory or even researching and calling different therapists near you to find one that’s trained in CBT.
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- Substance Abuse and Mental Health Services Administration. 2015. Evidence Based Practices Resource Center. Retrieved from: https://www.samhsa.gov/sites/default/files/20190719-samhsa-finding_evidence-based-programs-practices.pdf.
- Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. (2020). Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic – United States, June 24-30, 2020. MMWR. Morbidity and mortality weekly report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1