Cognitive-Behavioral Therapy (CBT) is a type of psychotherapy that modifies thought patterns in order to change moods and behaviors. Therapy is based on the idea that negative actions or feelings—such as those associated with depression—are the result of current distorted beliefs or thoughts, not unconscious forces from the past.
CBT is a blend of cognitive therapy and behavioral therapy. While cognitive therapy focuses on a person’s moods and thoughts, behavioral therapy specifically targets actions and behaviors. In the combined approach, a patient works with a therapist in a structured setting to identify specific negative thought patterns and behavioral responses to challenging or stressful situations. Treatment involves developing more balanced, constructive ways to respond to the stressors, ideally minimizing or eliminating the troubling behavior or disorder in the process.
The principles of CBT can also be applied outside of the therapist's office. For example, online cognitive behavioral therapy uses the principles of CBT to help patients track and manage the symptoms of depression and anxiety online.
How It Works
Unlike psychoanalysis and psychodynamic therapies (which might require several years for discovery and treatment), CBT is a more short-term approach that often requires only 10 to 20 sessions. During these sessions, a patient and therapist identify current situations in the patient’s life that may be causing or contributing to their depression. Then, instead of working backward to discover an unconscious source for the problem in the patient’s history (as is done in psychoanalysis), the therapist and patient identify the current patterns of thinking or distorted perceptions that lead to depression.
As part of this discovery, patients are often asked to keep a journal in which they record events and their reactions to them. The therapist can then break down their reactions and thought patterns into several categories of self-defeating thought. These include:
- all-or-nothing thinking: viewing the world in absolute, black-and-white terms
- disqualifying the positive: rejecting positive experiences by insisting they “don’t count” for some reason
- automatic negative reactions: having habitual, scolding thoughts such as, “This is all my fault.”
- magnifying or minimizing the importance of an event
- overgeneralization: drawing overly broad conclusions from a single event
- personalization: taking things too personally or feeling actions are specifically directed at you
- mental filter: picking out a single negative detail and dwelling on it exclusively so that the vision of reality becomes darkened
Using the journal, the therapist and patient can work on replacing negative thought patterns or perceptions with more constructive ones through a series of well-practiced techniques. These include:
- learning to control and modify distorted thoughts and reactions
- learning to accurately and comprehensively assess both external situations and reactions or emotional behavior
- practicing self-talk that is accurate and balanced
- using self-evaluation to reflect and respond appropriately
Patients can practice these methods on their own, with a therapist, or in controlled settings in which they’re confronted with challenges and then allowed to build on their ability to respond successfully. Another option is online CBT, which allows patients to practice these methods in the comfort of their own home or office.
Disorders CBT Treats
Cognitive-behavioral therapy is widely used to treat several disorders and conditions in children, adolescents, and adults. These disorders and conditions include:
- anti-social behaviors (including lying, stealing, and hurting animals or other people)
- anxiety disorders
- attention deficit hyperactivity disorder
- bipolar disorder
- conduct disorder
- eating disorders (binge eating, anorexia, and bulimia)
- general stress
- personality disorders
- sexual disorders
- sleep disorders
- social skill problems
- substance abuse
Cognitive-behavioral therapy may be combined with other treatments, including antidepressants, to help patients with depression.
Are There Any Risks?
There is little long-term emotional risk from CBT. However, patients may find that exploring painful feelings and experiences can produce a great deal of emotional discomfort. As part of the process of practicing altered responses to stressful or adverse situations, some patients will have to face situations they’d otherwise avoid — such as public places if they have a fear of crowds, or a death of a loved one that is causing their depression. In these situations, patients may feel a good deal of anxiety or stress, but the eventual goal of therapy is to teach the patient how to deal with this stress safely and constructively.
What the Expert Says
“There is a massive tidal wave of evidence for cognitive-behavioral therapy that suggests it is very effective at treating certain problems,” says Simon Rego, Psy.D., director of the Cognitive Behavior Therapy Program at Montefiore Medical Center in New York. “The breadth of evidence isn’t as extensive for other forms of psychotherapy.” Although, he adds, that’s not to say other therapies aren’t equally effective and beneficial. “They just don’t fit as neatly into anything that can be studied, so more evidence-based studies have been conducted on the results of cognitive-behavioral therapy than any other kind,” he says.