Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy technique that can help people to cope with various mental health conditions by changing the way they think and behave. Numerous studies have found CBT to be highly effective.

Table Of Contents

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a type of psychosocial intervention that helps to change disturbing thought patterns that can negatively impact our behavior. By focusing on improving impulsive and instinctive negative thoughts, CBT aims to improve mood, emotions and mental health. This therapy technique encourages the patient to identify, challenge and change dysfunctional cognitive distortions into more positive & realistic thoughts, behaviors, attitudes & beliefs improving emotional regulation 1 . It also involves numerous strategies, such as relaxation techniques, journaling & role-playing, that can help people overcome such destructive thoughts.

According to the experts at Mind Journal, “CBT is a type of psychological therapy or talking therapy which has proved more effective in treating various psychiatric conditions than other types of therapies or medications.” Although CBT was initially developed for treating depression, it is now widely used in the treatment of different psychiatric conditions such as anxiety disorders, depression, eating disorders, drug abuse and other severe mental illnesses. Studies 2 have found that CBT can significantly improve the quality of life 3 and functioning of a person.

CBT can be recommended to individuals of all ages, even children and older adults. A scientific analysis 4 explains “Cognitive behavior therapy is a structured, didactic, and goal-oriented form of therapy.” It adds “CBT has been adapted and studied for children, adolescents, adults, couples, and families.” This treatment approach has shown to be helpful in a short period of time. Although there is no established time frame, typically 5 to 20 CBT sessions can be effective.

Origins Of Cognitive Behavioral Therapy

CBT was originally developed by psychiatrist Aaron Beck in the 1960s. While working with depression patients, Beck observed that the patients often had “cognitive distortions” in their thoughts and their words lacked validity. His observations made him believe that depression is more of a cognitive disorder than a mood disorder as certain thoughts led to emotional distress. He identified these thoughts as “automatic negative thoughts.” This eventually led him to develop Cognitive Therapy for Depression. “Beck pioneered a model for what psychologists many years later defined as an “empirically validated psychological treatment,” explains a scientific review. As other researchers and clinicians found the concept interesting, they eventually developed different treatment protocols for CBT and analyzed their efficacy. Later, behavioral strategies were integrated into cognitive therapy and the term was modified to cognitive behavior therapy. “Today CBT is the most extensively researched of all psychotherapies with several evidence-based treatment protocols,” adds the review.

However, CBT is also based on Rational Emotive Behavioral Therapy (REBT), which was developed by psychologist Albert Ellis in the late 1950s. Ellis developed REBT as he found out that being aware of our thoughts and beliefs did not necessarily help to change them. REBT is based on the basic philosophy that emotional and behavioral problems are typically caused by our own illogical beliefs about it & how we may approach it. However, if we change such beliefs, we can improve our emotions and behaviors. A 2018 study 5 explains “Rational emotive behavior therapy (REBT) is the original form and one of the main pillars of cognitive‐behavioral therapies (CBT). Alongside with the cognitive therapy (CT) created by Aaron Beck (1976), it served as the basis for the development of CBT.”

Understanding Cognitive Behavioral Therapy

CBT is considered as one of the best studied and most effective forms of psychotherapy. It is even considered as the current “gold standard” of psychotherapy by most experts. According to a recent scientific review 6 “Cognitive behavioral therapy is a problem-oriented strategy. It focuses on current problems and finding solutions for them.” Instead of dealing with past issues, CBT focuses on the current problems. This approach believes in helping patients to help themselves so that they can improve their quality of life without any further psychological intervention. “This does not mean that cognitive behavioral therapy completely ignores the influence of past events. But it mainly deals with identifying and changing current distressing thought and behavioral patterns,” adds the scientific review.

Cognitive behavioral therapy is an integration of two separate psychotherapy techniques – cognitive therapy & behavioral therapy. Cognitive therapy helps to build clarity about our own thought & behavior patterns, expectations and attitudes with the objective of changing distressing and false beliefs. With cognitive therapy one can learn how to replace harmful thoughts with realistic ones. Behavioral therapy, on the other hand, is based on behavioral psychology or behaviorism. According to this theory, behaviors are learned through conditioning and hence can be unlearned and relearned. Behavioral therapy focuses on how specific behavioral habits can lead to problems in our lives and how to change such behavioral patterns. CBT combines both these therapeutic approaches to improve mental and emotional health. It is based on the principle that our thoughts, emotions and behavior are closely connected and these factors contribute to our overall well being.

How CBT Works?

Cognitive behavioral therapy focuses on finding practical strategies to improve the mindset of the patient on a regular basis. According to a 2017 study 7 , the crux of the CBT model is that our thoughts, behaviors & emotions are interconnected & these elements can lead to distress. As it is difficult to change emotions directly, the CBT model challenges maladaptive and damaging thoughts 8 & behaviors to bring about a necessary change in emotional distress. The researchers of the study state “Utilizing an evidence-based approach, CBT is a time-limited, present-oriented psychotherapy to help people modify dysfunctional thinking and behavior, as a way to help solve current problems. Contemporary CBT refers to a family of interventions that blend an assortment of behavioral, emotion-focused, and cognitive techniques.”

Our thoughts, emotions, behaviors and beliefs influence our perception of the world. With the help of CBT, we can become aware of how our thought patterns determine our behavior and our reality. Once we are aware of such thoughts, CBT can help us learn to alter them with more positive thoughts to change our behavior and attitude. This can help to reduce their emotional distress, risk of negative moods and enable them to function more productively, benefiting others around them as well. However, one may need a number of sessions over various weeks or months to experience the positive effects of CBT.

As cognitive behavioral therapy is an action-oriented, problem-focused type of psychotherapy, it differs from conventional therapy approaches. The therapist helps the patient overcome a diagnosed psychiatric disorder by helping them learn new information-processing skills and implement effective coping strategies. This helps to relieve symptoms of the conditions and achieve identified goals set by the patient and the therapist together. CBT strategies also enable people to build a more aware, mindful and open approach towards cognitive distortions which helps to reduce their impact.

Basic Principles In Cognitive Behavioral Therapy

Cognitive behavioral therapy is based on the notion that our thoughts, emotions, behaviors and actions are interrelated. Thus, negative thoughts and overwhelming emotions can affect us adversely. CBT shows us how to change negative thought patterns and deal with challenges in a positive way. The primary aim is to change our mental state on a daily basis. According to the American Psychological Association (APA), this form of psychotherapy is based on certain core principles, such as –

  • Distorted or “unhelpful” patterns of thought can often cause mental health problems.
  • “Learned patterns of unhelpful behavior” can also lead to certain mental health problems.
  • Individuals affected by psychological problems can learn to cope with them better by changing the way they think and behave.
  • New thought and behavior patterns can help to relieve symptoms & help them to live better lives.

Importance Of Thoughts & Behaviors In CBT

The cycle of thoughts and behaviors of an individual also play a vital role in developing the strategy of the therapy. Negative and distorted thoughts and perceptions often lead to mental health issues and emotional distress. This can contribute to harmful or unhelpful behaviors. If unaddressed, such thoughts and behaviors can become negative patterns and may occur repeatedly. Distorted perceptions can make an individual vulnerable to –

  • Developing a negative or pessimistic state of mind
  • Being judgmental or judge prematurely
  • Considering everything as either good or bad/evil, and nothing in between
  • Mistaking certain situations as disastrous even though it is normal or common


CBT helps us to identify, address and change these destructive thought and behavior patterns and overcome the resultant problems to reduce further distress in future. Here are certain core concepts associated with thought and behavior patterns in CBT:

1. Thought patterns

As CBT primarily focuses on improving thoughts, the process may involve the following strategies:

  • Learning how to identify distorted thoughts leading to psychological and emotional problems.
  • Analyzing these disturbing thoughts in a more positive and realistic manner.
  • Developing a clearer understanding about the motivation & behavior of other people.
  • Coping with challenging situations with problem-solving skills.
  • Building a stronger sense of self-worth and self-confidence in our own abilities.

2. Behavioral patterns

Strategies for improving behavior using CBT may involve the following efforts:

  • Focusing on overcoming fears and anxieties instead of avoiding them
  • Preparing for interactions with other people that may be complicated or problematic with the help of role playing
  • Learning ways to relax the body and calm the mind to reduce stress and anxiety

CBT Learning Tools

Some of the most common CBT learning tools may include the following:

  • One-to-one sessions and/or group discussion sessions regularly
  • Constant feedback
  • Techniques to relax the mind and body
  • Exposure to the object of fear or anxiety in gradually increasing manner
  • Role-playing activities
  • Maintaining a CBT diary
  • Homework assignments
  • Practicing coping skills learned during sessions for positive change in thought & behavior patterns


However, these strategies may not be utilized by all types of cognitive behavioral therapy. The treatment strategy is typically developed by the psychiatrist/psychologist by working closely with the patient to understand the condition(s) better and for more effective treatment. This form of therapy is focused on enabling the patient to help themselves by developing certain coping skills to change their negative thoughts, emotions and behaviors. This is typically done through certain exercises during the therapy sessions and even at home, outside of sessions. Although the therapist may look into the medical and family history of the patient, the focus is primarily on the current situations in the patient’s life and how to move forward in life effectively.

What Cognitive Behavioral Therapy Can Help With?

CBT has been found to be substantially effective in depressive and anxiety disorders 9 . However, it can also help with a range of other conditions as well. According to a recent 2020 study 10 , “Cognitive behavioral therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder.” The researchers add that the application of this type of therapy has recently been extended to “psychotic disorders, behavioral medicine, marital discord, stressful life situations, and many other clinical conditions.”

CBT can successfully help in the treatment of the following psychiatric conditions:

  • Major depressive disorder 11
  • Anxiety disorders 12 , such as phobia and panic
  • Post-traumatic stress disorder (PTSD 13 )
  • Obsessive-compulsive disorder (OCD 14 )
  • Eating disorders 15
  • Dysthymia 16
  • Schizophrenia
  • Bipolar disorder 17
  • Substance use disorder 18
  • Somatoform disorders 19
  • Personality disorders 20
  • Anger 21 & aggression 22
  • Antisocial 23 & criminal behaviors


Apart from these, CBT can also be applied effectively in the following situations, even in the absence of a particular mental health condition:

  • Grief or loss 24
  • Relationship or marital problems 25
  • Breakup or divorce
  • Insomnia 26
  • Low self-esteem 27
  • General life stress 27
  • Fibromyalgia 28
  • Migraines 29
  • Irritable bowel syndrome 30
  • Chronic pain 31 and chronic fatigue syndrome 32
  • Distress related to general medical conditions
  • Distress due to pregnancy complications 33
  • Female hormonal conditions 34

Types Of Cognitive Behavioral Therapy

Cognitive behavioral therapy involves a wide range of approaches and techniques which focus on improving our thoughts, behaviors and actions. These approaches can include self-help strategies and different types of structured psychotherapies. Some of the most common types CBT approaches include the following:

1. Cognitive therapy (CT)

This form of therapy is based on the cognitive model of psychopathology and focuses on recognizing and improving distorted & unhelpful thoughts, behaviors and emotional responses.

2. Dialectical behavior therapy (DBT)

DBT primarily focuses on changing thought and behavior patterns and involves helpful strategies to promote emotional regulation as well as mindfulness. “Dialectical behavior therapy is a modular and hierarchical treatment consisting of a combination of individual psychotherapy, group skills, training, telephone coaching, and a therapist consultation team,” explains a 2015 study 35 .

3. Multimodal therapy

In this form of therapy, the core concept suggests that mental health problems can be treated when certain interconnected yet separate modalities are addressed, which include – affect, behavior, cognition, drug/biological considerations, interpersonal factors, imagery and sensation. A scientific review 36 describes multimodal therapy “as a broad category that involves combining two or more modalities that target different aspects of a disease.”

4. Rational emotive behavior therapy (REBT)

REBT mainly focuses on enabling patients to recognize irrational and unjustifiable beliefs, challenge such beliefs actively and learn to identify and replace these negative thought patterns with more positive ones. According to a 2016 study 37 , “REBT is considered to be the original cognitive-behavior therapy (CBT) by many scholars, and was developed by Dr. Albert Ellis in the 1950s and was driven in part by Ellis’ desire to conceive of a more effective psychotherapy that addressed some of the shortcomings of psychoanalysis.”

Apart from these, there are some other common types of CBT which may include –

  • Cognitive Processing Therapy (CPT 38 )
  • Self-Instructional Training
  • Stress Inoculation Training
  • Others


Even though the different forms of cognitive behavioral therapy may take unique different approaches, all the types focus on addressing and improving thought & behavior patterns that lead to psychiatric disorders and psychological distress.

Phases In Cognitive Behavioral Therapy

According to a 2008 study 39 , CBT is believed to have six distinctive phases which include:

1. Assessment

This stage mainly involves open communication and interaction between the therapist and the patient and their families. It also includes certain self-reported measures to recognize the severity of psychosocial impairment so the most effective course of action can be determined. This phase can further include the following steps:

  • Identifying undesirable or negative behaviors
  • Deciding if undesirable behaviors tend to be deficits or excesses
  • Assessing such behaviors to get a baseline for intensity, frequency and duration
  • Reducing intensity, frequency and duration, if behavior is excess; increasing behaviors in case of deficits

2. Reconceptualization

This stage is considered as one of the most crucial phases of therapy as it comprises most of the cognitive aspect of CBT. “The reconceptualization phase of CBT seeks to help patients to challenge and question the rationality of such maladaptive thoughts,” explains the study.

3. Skills acquisition

In this phase, the patient learns skills and strategies to cope with daily challenges and stressors with the help of the therapist. The doctor may also teach the individual ways to avoid sinking back into the negative thought and behavior patterns.

4. Skills consolidation and application training

The researchers explain that in this phase, “patients are given homework in an attempt to help them reinforce the skills that they have acquired during the skill acquisition phase, one of the hallmark methods in CBT.”

5. Generalization and maintenance

During this phase, the patient and the therapist communicate and share their thoughts about the future to determine how the patient can cope with challenges after the treatment is over.

6. Post-treatment assessment follow-up

The final phase involves post-treatment assessments and follow-up and requires complete participation and co-operation from the patient. This can help the therapist “to monitor and evaluate patients’ application of CBT skills to their lives,” adds the study.

Once the treatment is deemed complete and post-treatment assessments have been made, the therapist needs to determine whether cognitive behavioral therapy was successful or not and then decide the next course of action accordingly.

Is Cognitive Behavioral Therapy Effective?

Studies show that CBT is an effective psychotherapy approach that can help to relieve symptoms and improve overall patient satisfaction. One 2018 study considers CBT as the gold-standard of psychological treatment, that is the best standard currently available in the field, due to the following reasons –

  • CBT is believed to be the most widely researched and studied form of psychotherapy.
  • Other types of psychotherapy have not been found to be systematically more effective or better than CBT. “If there are systematic differences between psychotherapies, they typically favor CBT,” explains the study.
  • The mechanisms and models of change used in CBT are perhaps the most studied. They are in compliance with established “mainstream paradigms of human mind and behavior,” such as information processing.


The study explains “Cognitive behavioral therapy was the first form of psychotherapy tested with the most stringent criteria of evidence-based framework used in the health field. Therefore, it was the first psychotherapy largely identified as evidence-based in most clinical guidelines.” However, the researchers believe that there is still scope for further improvement as in certain situations patients may not respond to this treatment approach or may relapse.

Read more to know about: Effectiveness Of Cognitive Behavioral Therapy

What To Expect From CBT?

Cognitive behavioral therapy is typically provided by a licensed therapist, psychologist, licensed counselor, or other mental health professionals. The CBT sessions can be individual or in a group. It may also include self-help materials under the supervision of a therapist. Usually, you may need to attend a session once a week or every 2 weeks. On average, the course of treatment may involve 5 to 20 sessions with each session lasting between 30 to 60 minutes, depending on the condition. Although the duration of the treatment is usually short-term, some patients may need to attend sessions for over a year.

The therapist will work closely with you to establish practical treatment goals, identify and break down issues into different parts and provide you tasks to be accomplished on your own. As the treatment does not focus on your personality traits or your past issues & experiences, the therapist will encourage you to focus on your current thoughts and feelings. Your therapist will then help you work through unrealistic or unhelpful thoughts and behaviors & understand how you may change them in your daily life. Your progress will then be discussed in the next therapy session.

The objective of CBT is to help you learn and apply necessary coping skills in your daily life & prevent your thoughts from affecting you negatively. You should also feel free to ask any questions or concerns that you may have during the treatment. By openly communicating with your therapist and working with them in a co-operative way you will be able to get the most out of your session. If for some reason you think your therapist is not right for you, you can opt to see another mental health professional.

How To Find A Therapist

As not every therapist or counselor may be the best fit for your condition, you should only work with licensed and trained mental health professionals who are experienced with cognitive behavioral therapy. The titles of the professional may be different based on their qualifications and role but they should be able to help you in the best way possible. However, it is often best to work with psychologists, psychiatrists or psychotherapists. You should also check for their license, certification, years of experience, field of expertise and if they specialize in certain conditions like depression 10 , PTSD, eating disorders etc.

Things To Remember

CBT has been proven to be highly effective for most people, however, it may be possible that it may not work for your specific condition due to different factors. This is why it is important to keep a few things in mind to get the most of your cognitive behavioral therapy, such as:

1. CBT isn’t a cure

This form of therapy focuses on enabling the patient to learn new coping skills to deal with issues that they are experiencing. However, emotional distress and psychological problems may still continue as CBT may not necessarily remove them, even if it relieves the symptoms. It is a form of training that empowers you to be your own therapist.

2. Patience is necessary

Depending on your condition, you may require 5 to 20 CBT sessions, with each session every week. This is why you need to be patient and work with your therapist persistently to see favorable results. Instead of worrying about the effectiveness of the treatment, focus on attending sessions regularly, developing the skills your therapist teaches you, doing your homework and applying what you learn in the therapy sessions. Changing your thought and behavior patterns can be highly challenging. So make sure to take one step at a time and don’t expect any instant or magical results.

3. Be an active participant

Therapy proves to be effective when you approach it as a partnership and actively participate in making decisions with your therapist. Work through issues, address major concerns, set goals and analyze problems together with the therapist.

4. Communicate honestly & openly

Make sure to share your genuine thoughts, emotions and experiences with your therapist honestly. It is also important that you keep an open mind and accept the suggestions of your therapist. Openly inform them about any reservations that you may have.

5. Follow the treatment plan

Do not skip a session or be irregular in your treatment just because you lack motivation or do not see the results you expected. This can adversely affect your progress. Make sure to attend sessions regularly and share everything you want to with your therapist.

6. It is not the only solution

As mentioned earlier, CBT may not work for everyone. If you think that this therapy is not beneficial for you, then let your therapist know about it. They can help you develop a new approach or try other forms of therapy and treatment that can help you better.

Takeaway

Cognitive behavioral therapy is one of the most studied and effective forms of psychotherapy that can enable someone to alter their beliefs & perceptions and replace negative thoughts with more positive ones. CBT can also help to improve our mood & behavior and cope with different mental health conditions, like, anxiety & depression.

One should only work with qualified & licensed professionals to make the most out of the CBT sessions. One can even opt for online self-help CBT intervention as research indicates this can have significant “positive effects.” CBT is undoubtedly one of the most helpful and effective tools for improving your mental and emotional well being.

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