Cognitive Behavioral Therapy

CBT 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.

What is CBT? Cognitive behavioral therapy (CBT)

The goal of CBT is to change problematic behavior by teaching people to think and respond differently when they are upset.

What is CBT?

Cognitive behavioral therapy (CBT) is a blend of two existing forms of therapy: Cognitive Therapy and Behaviorism. This psycho-therapeutic approach was developed in the early 1960s by Dr. Aaron Beck, a psychiatrist who also developed Cognitive Therapy, and is now one of the most widely used and well-researched therapy approaches. Traditional Behaviorism focused on changing behaviors by conditioning people using rewards and consequences to encourage certain behaviors and discourage others. Cognitive Therapy focuses on the way that our thoughts influence our feelings and our behaviors and works to change thought patterns in order to create changes to a person’s emotions and behaviors. Being a blend of these two approaches, CBT recognizes that thoughts, emotions, and behaviors are all connected and works to help people make changes to the way they think, feel, and behave using a variety of techniques. Some of the techniques commonly used in CBT focus on changing the way people think about situations, other people, and themselves and other techniques in CBT focus on changing specific patterns of behavior that are causing problems and consequences in people’s lives.

In a nutshell, the goal of CBT is to help change problematic behaviors by teaching people to think and respond differently when they are upset. In CBT, it is common that clients are taught to “self-monitor” their feelings, thoughts, and behaviors to help build awareness of their patterns. Once they begin to notice these patterns, the CBT therapist will often help the client evaluate whether these patterns are “working” to get them what they want, or whether these patterns are “not working” or keeping them from getting what they want. In cases where certain patterns of thinking, feeling and responding are not working and are causing problems for the person, the goal of CBT would be to replace those patterns with more helpful patterns.

As an example, a person who struggles with anger issues might keep track of the times when they become angry over the course of the week. Using a log or journal, the person would record what they were thinking and feeling right before and during times when they became angry, what was happening during these times, and what they did in response. A person’s log might show that they tend to become angry at work and notice when they are angry they start having thoughts about what their coworkers have not done and how this often leads to them having more work assigned to them. They might notice that when they get angry about this, they tend to be short with their coworkers, interrupting them and sometimes even lashing out and yelling at them. It is likely that this person would identify that this pattern is “not working” for them, and probably even causing problems for them at work.

After a problematic pattern has been identified, a person would likely begin to work on trying out alternative ways to think about their coworkers or the tasks they are assigned and to identify new ways to respond to their coworkers during times when they feel angry. In the example given above, a person might make an effort to interrupt the angry thoughts about their coworkers not doing their work and instead focus on a more neutral thought like, “Maybe my coworkers are not aware that their work is being assigned to me” which might lead them to go and talk with their coworkers about this issue instead of yelling at them without addressing the real issue.

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. 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, and specific types of substance use disorders. Despite this evidence, CBT might not be the right treatment for every single person.

When considering treatment options, it is important to think about what you want to address in therapy and what you want to get out of it. Specifically, you can ask yourself, “what would be different about me or my daily life if therapy was successful?”. For some, success would mean that they are able to get their work done, for others success might mean they are fighting less with their significant other or not drinking alcohol each night. Depending on what success looks like for you, CBT might or might not be the right form of treatment for you. For example, the person who fights a lot with their significant other might find that couples or marriage therapy is a better fit for them and the person who drinks every night might benefit more from participating in group therapy with others who are working to stop drinking.

In addition to considering what a successful outcome would look like, a person could also consider their preferences about how they imagine sessions with their counselor should be. 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. Others who may have a lot of unresolved issues from childhood or other traumatic events that have happened might find that they benefit more from therapy that includes processing through these past events more than typical CBT treatment includes. Generally, CBT is a good fit for people who want a more structured approach, want a therapist who is more directive, 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 information 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. Once you begin to apply these lessons, change is often imminent, and your overall sense of wellbeing begins to improve. 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 less you may need to come in for therapy sessions. When 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.

How Do I Find a CBT Therapist?

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.

A great place to start your search for a therapist is using an online directory like TherapyTribe to find a therapist in your area who meets your needs. You can customize your search by using filters that only show you therapists who specialize in your concern, who use a certain style of therapy (like CBT), or who offer sliding scales for patients who pay out-of-pocket. It can be helpful to reach out to a few therapists before deciding to book your first appointment.

References

  • Beck AT. Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy. 1970;1:184–200. [Google Scholar]
  • Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440. doi:10.1007/s10608-012-9476-1
  • Substance Abuse and Mental Health Services Administration. 2015. Evidence-Based Practices Resource Center. Retrieved from: https://www.samhsa.gov/capt/tools-learning-resources/finding-evidence-based-programs.