What is Cognitive Behavioral Therapy?

Today, cognitive behavioral therapy (CBT) is one of the most common and best studied forms of psychotherapy.

Originally developed in the 1960s, it combines two therapeutic approaches, known separately as cognitive therapy and behavioral therapy.

CBT is an approach that has been shown to be effective at treating many disorders and behaviors, including anxiety, depression, addiction, and obsessive compulsive disorder. 

In this article, I’ll describe different types of CBT and what they can be used to treat. I’ll also discuss the effectiveness, benefits, and techniques of CBT and what you can expect from your first session.

Types of Cognitive Behavioral Therapy

CBT is a short-term, problem-oriented therapy approach that focuses on helping people understand the thoughts and feelings that influence their behaviors.

Unlike psychoanalysis, the goal of CBT is to help people deal with their current problems as efficiently as possible, rather than focusing on deeper causes of someone’s behavior and history.

The length of treatment can vary from person to person, with some people only needing a few sessions while others may require months to years of treatment.

Because of the introspective nature of CBT, it’s often best suited for people who are comfortable with self-analysis and willing to commit time and mental effort toward achieving their goals.

There are several types of cognitive behavioral therapy, each with their specific aims and use-cases.

Here are a few of the most common forms of CBT used today:

Dialectical Behavior Therapy (DBT)

DBT is a comprehensive, cognitive-behavioral treatment program developed by Dr. Marsha Linehan.

Though originally developed for the treatment of non-fatal, self-injurious behavior in women with borderline personality disorder (BPD), it is now used to treat patients with multiple disorders, including BPD, depression, eating disorders, and substance use disorders.

DBT emphasizes behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance. In most applications, therapists who practice DBT follow strict, procedural guidelines.

Rational Emotive Behavioral Therapy (REBT)

While REBT also relies on behavioral principles, it stands apart from other cognitive-behavioral approaches by focusing on irrational and rational beliefs.

The main goal of REBT is to reduce irrational beliefs in favor of rational beliefs, which helps to decrease the occurrence and frequency of unhealthy negative emotions.

Part of this process involves encouraging the patient to challenge specific irrational beliefs.

REBT is often used to treat people with depression, anxiety, addiction or addictive behaviors, phobias, procrastination, disordered sleeping habits, and sleeping disorders.

Computerized CBT (iCBT)

Computerized CBT, sometimes referred to as iCBT, employs the same strategies as CBT but is delivered virtually through phones, apps, and other electronic devices instead of in-person. K Health offers K Therapy, a text-based therapy program that includes unlimited messaging with a licensed therapist, many of whom practice CBT.

It has been found to be just as effective as CBT in treating conditions like depression, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and bipolar disorder.

iCBT has also been shown to be more cost-effective for some patients, helping more people gain access to helpful and supportive therapy.

What Can CBT Be Used to Treat?

CBT has been shown to be an effective form of psychological therapy for a range of mental health disorders and some physical conditions, including:

• Depression
• Anxiety
• Somatoform disorders (having excessive thoughts, feelings, and behaviors relating to physical symptoms, including hypochondria and body dysmorphia)
• Obsessive-compulsive disorders
• Addiction and substance use disorder
• Insomnia
• Stress management
• Phobias
• Maladaptive behaviors
• Schizophrenia
• Attention deficit hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)
• Sexual dysfunction
• Eating disorders
• Anger control
• Chronic pain
• Distress due to pregnancy complications and hormonal conditions
• Tinnitus
• Rheumatism

In addition to treating conditions in adults, CBT has been shown to be effective in addressing many issues experienced by children. 

Benefits of CBT

There are over 200 meta-analytic studies that examine the effectiveness of CBT for a range of conditions, and a recent review of over 100 of those meta-analyses found that CBT is most effective at treating anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress.

The review also measured the effectiveness of CBT in treating other conditions:

• Addiction and substance use disorder: The effectiveness of CBT was found to be small to medium when treating these conditions, depending on the type of substance use disorder.  When treating cannabis and nicotine dependence, CBT was found to be highly effective, but when treating opioid and alcohol dependence it was found to be less effective.

• Schizophrenia and other psychotic disorders: CBT was not found to be as effective as family intervention or psychopharmacology for chronic symptoms of these psychotic disorders, but somewhat effective in treating their secondary outcomes.

• Depression: The studies on the effectiveness of CBT in treating depression were mixed, with many reports showing CBT to be highly effective.

• Bipolar disorder: CBT was found to be mildly effective at treating bipolar disorder, but more effective in treating depressive symptoms in bipolar disorder.

• Stress management: CBT was found to be more effective than organization-focused and other therapies at stress management intervention, but more research is needed to determine the effectiveness of CBT on occupational stress.

• Conditions in children: There is significant evidence showing that CBT can be very effective in treating children with internalizing disorders, including depressive tendencies, loneliness, anxiety, and somatic complaints.

Techniques

CBT places responsibility in the hands of the patient.

In addition to learning tools to help solve problems, the focus of CBT is working on issues and concerns in the present, rather than the past.  

Here are some of the stages and techniques used in CBT:

• Functional analysis: Helping an individual identify problematic beliefs. This is important in learning how thoughts, feelings, and situations can lead to maladaptive behaviors.

• Data log: Keeping a daily log of observations, feelings, and negative automatic thoughts.

• Learning new behaviors: Practicing problem-solving skills that can be employed in real-life situations. In some cases, this may include learning how to face one’s fears instead of avoiding them.

• Setting goals: An important component of CBT is goal setting: Once an individual identifies which thoughts or feelings are harmful and which new behaviors may be helpful, a CBT therapist may encourage setting small milestones between each session to help the patient mark progress on the path to behavior change. 

• Activity scheduling: Planning each day in advance, which can help remove the need for repeated decision making.

• Graded task assignments: Creating manageable steps to help overcome procrastination and anxiety-provoking scenarios.

• Role play: Some therapists may use role play to help a patient prepare for upcoming problematic interactions. 

• Relaxation training: Learning how to manage panic, anxiety, and stress through a variety of stress management techniques.

Keep in mind that each person’s experience with CBT will vary, as most therapists will tailor the experience based on the patient’s needs and level of comfort.

In every case, building a trusting and collaborative relationship with one’s therapist is crucial to the success of the approach.

What to Expect From the First Session

Starting CBT with an open mind and a willingness to do the work will help you to make the most out of each session.

But it’s also normal if you’re feeling nervous or anxious ahead of your initial session, especially if it’s your first time working with a therapist. 

During your first session, your therapist may ask you to fill out certain forms to assess your mood and goals.

These may be referred to as depression, anxiety, or hopelessness inventories.

The more honest with your answers the better your therapist can tailor your sessions ahead to help achieve your goals. 

Many therapists will also use the first session to outline general therapy policies, including confidentiality, costs, and how many sessions your therapist recommends according to your goals.

Things to Consider

Self-introspection can take time.

Though some people may need just a few sessions of CBT to accomplish their goals, each person is unique and there’s no shame if your therapist recommends more ongoing sessions. 

To make the most out of your work, your therapist may recommend keeping a daily or weekly journal where you can write down your thoughts and observations about your week-to-week progress.

Additionally, some therapists may assign weekly homework tasks, which will encourage you to practice the new behaviors you and your therapist may discuss during your sessions.

It’s also normal for a therapist to ask for feedback, including what was helpful or not helpful about a particular session or exercise.

Again, remaining open and honest is the best way to make each session productive.

CBT can be an effective tool for many people, but it won’t work for everyone.

If you’re not seeing results, talk with your therapist about your options.

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.