Cognitive behavioral therapy (CBT) is a treatment approach that helps you recognize negative or unhelpful thought and behavior patterns. Many experts consider it to be the gold standard of psychotherapy.

CBT aims to help you identify and explore the ways your emotions and thoughts can affect your actions. Once you notice these patterns, you can begin learning to reframe your thoughts in a more positive and helpful way.

Unlike many other therapy approaches, CBT doesn’t focus much on talking about your past.

Read on to learn more about CBT, including core concepts, what it can help treat, and what to expect during a session.

CBT is largely based on the idea that your thoughts, emotions, and actions are connected. In other words, the way you think and feel about something can affect what you do.

If you’re under a lot of stress at work, for example, you might see situations differently and make choices you wouldn’t ordinarily make. But another key concept of CBT is that these thought and behavior patterns can be changed.

According to the American Psychological Association, the core concepts of CBT include:

  • that psychological issues are partly based on unhelpful ways of thinking
  • that psychological issues are partly based on learned patterns of behavior
  • that those living with these issues can improve with better coping mechanisms and management to help relieve their symptoms
the cycle of thoughts and behaviors

Here’s a closer look at how thoughts and emotions can influence behavior — for better or worse:

  • Inaccurate or negative perceptions or thoughts contribute to emotional distress and mental health concerns.
  • These thoughts and the resulting distress sometimes lead to unhelpful or harmful behaviors.
  • Eventually, these thoughts and resulting behaviors can become a pattern that repeats itself.
  • Learning how to address and change these patterns can help you deal with problems as they arise, which can help reduce future distress.

So, how does one go about reworking these patterns? CBT involves the use of many varied techniques. Your therapist will work with you to find the ones that work best for you.

Typical treatment often involves the following:

  • recognizing how problems can be made worse by inaccurate thinking
  • learning to better understanding the thinking and motivations of others
  • learning new problem-solving skills
  • gaining confidence and self-worth
  • learning how to face fears and challenges
  • using role play and calming techniques when faced with potentially challenging situations

The goal of these techniques is to replace unhelpful or self-defeating thoughts with more encouraging and realistic ones.

For example, “I’ll never have a lasting relationship” might become, “None of my previous relationships have lasted very long. Reconsidering what I really need from a partner could help me find someone I’ll be compatible with long term.”

These are some of the most popular techniques used in CBT:

  • SMART goals. SMART goals are specific, measurable, achievable, realistic, and time-limited.
  • Guided discovery and questioning. By questioning the assumptions you have about yourself or your current situation, your therapist can help you learn to challenge these and consider different viewpoints.
  • Journaling. You might be asked to jot down negative beliefs that come up during the week and the positive ones you can replace them with.
  • Self-talk. Your therapist may ask what you tell yourself about a certain situation or experience and challenge you to replace negative or critical self-talk with compassionate, constructive self-talk.
  • Cognitive restructuring. This involves looking at any cognitive distortions affecting your thoughts — such as black-and-white thinking, jumping to conclusions, or catastrophizing — and beginning to unravel them.
  • Thought recording. In this technique, you’ll come up with unbiased evidence supporting your negative belief and evidence against it. Then, you’ll use this evidence to develop a more realistic thought.
  • Positive activities. Scheduling a rewarding activity each day can help increase overall positivity and improve your mood. Some examples might be buying yourself fresh flowers or fruit, watching your favorite movie, or taking a picnic lunch to the park.
  • Situation exposure. This involves listing situations or things that cause distress, in order of the level of distress they cause, and slowly exposing yourself to these things until they lead to fewer negative feelings. Systematic desensitization is a similar technique where you’ll learn relaxation techniques to help you cope with your feelings in a difficult situation.

Homework is another important part of CBT, regardless of the techniques you use. Just as school assignments helped you practice and develop the skills you learned in class, therapy assignments can help you become more familiar with the skills you’re developing.

This might involve more practice with skills you learn in therapy, such as replacing self-criticizing thoughts with self-compassionate ones or keeping track of unhelpful thoughts in a journal.

CBT can help with a range of things, including the following mental health conditions:

But you don’t need to have a specific mental health condition to benefit from CBT. It can also help with:

These examples can give you a better idea of how CBT might realistically play out in different scenarios.

Relationship issues

You and your partner have recently been struggling with effective communication. Your partner seems distant, and they often forget to do their share of household chores. You begin to worry that they’re planning on breaking up with you, but you’re afraid to ask what’s on their mind.

You mention this in therapy, and your therapist helps you come up with a plan to deal with the situation. You set a goal of talking to your partner when you’re both home on the weekend.

Your therapist asks about other possible interpretations. You admit it’s possible something at work is bothering your partner, and you decide to ask what’s on their mind the next time they seem distracted.

But this makes you feel anxious, so your therapist teaches you a few relaxation techniques to help you stay calm.

Finally, you and your therapist role-play a conversation with your partner. To help you prepare, you practice conversations with two different outcomes.

In one, your partner says they feel unsatisfied with their job and have been considering other options. In the other, they say they might have developed romantic feelings for a close friend and have been considering breaking up with you.

Anxiety

You’ve lived with mild anxiety for several years, but recently it’s gotten worse. Your anxious thoughts center on things that happen at work.

Even though your co-workers continue to be friendly and your manager seems happy with your performance, you can’t stop worrying that others dislike you and that you’ll suddenly lose your job.

Your therapist helps you list evidence supporting your belief you’ll be fired and evidence against it. They ask you to keep track of negative thoughts that come up at work, such as specific times you begin worrying about losing your job.

You also explore your relationships with your co-workers to help identify reasons why you feel like they dislike you.

Your therapist challenges you to continue these strategies each day at work, noting your feelings about interactions with co-workers and your boss to help identify why you feel like they don’t like you.

In time, you begin to realize your thoughts are linked to a fear of not being good enough at your job, so your therapist begins helping you challenge these fears by practicing positive self-talk and journaling about your work successes.

PTSD

A year ago, you survived a car crash. A close friend who was in the car with you didn’t survive the crash. Since the accident, you haven’t been able to get into a car without extreme fear and post-trauma stress.

You feel panicked when getting into a car and often have flashbacks about the accident. You also have trouble sleeping since you often dream about the accident. You feel guilty you were the one who survived, even though you weren’t driving and the accident wasn’t your fault.

In therapy, you begin working through the panic and fear you feel when riding in a car. Your therapist agrees your fear is OK and expected, but they also help you realize that these fears aren’t doing you any favors.

Together, you and your therapist find that looking up statistics about car accidents helps you counter these thoughts.

You also list driving-related activities that cause anxiety, such as sitting in a car, getting gas, riding in a car, and driving a car.

Slowly, you start getting used to doing these things again. Your therapist teaches you relaxation techniques to use when you feel overwhelmed. You also learn about grounding techniques that can help prevent flashbacks from taking over.

CBT is one of the most studied therapy approaches. In fact, many experts consider it to be the best treatment available for a number of mental health conditions.

Here’s some research behind it:

  • A 2018 review of 41 studies looking at CBT in the treatment of anxiety disorders, PTSD, and OCD found evidence to suggest that it could help improve symptoms in all of these situations. The approach was most effective, however, for OCD, anxiety, and stress.
  • A 2018 study looking at CBT for anxiety in young people found that the approach appeared to have good long-term results. More than half of the participants in the study no longer met criteria for anxiety at follow-up, which took place 2 or more years after they completed therapy.
  • Research published in 2011 suggests that CBT can not only help treat depression, but it may also help reduce the chances of relapse after treatment. It may also help improve symptoms of bipolar disorder when paired with medication, but more research is needed to help support this finding.
  • One 2017 study looking at 43 people with OCD found evidence to suggest brain function appeared to improve after CBT, particularly with regard to resisting compulsions.
  • A 2018 study looking at 104 people found evidence to suggest CBT can also help improve cognitive function for people with major depression and PTSD.
  • Research from 2010 shows that CBT can also be an effective tool when dealing with substance misuse. According to The National Institute on Drug Abuse, CBT can also be used to help people cope with addiction and avoid relapse after treatment.
  • Newer research from 2020 and 2021 even show that virtual and internet-based CBT also holds promise for effective treatment. More research is needed to see how to best treat people virtually and if blended techniques could also be beneficial.

Beginning therapy can seem overwhelming. It’s OK to feel nervous about your first session. You might wonder what the therapist will ask. You may even feel anxious about sharing your difficulties with a stranger.

CBT sessions tend to be very structured, but your first appointment may look a bit different.

Here’s a high-level look at what to expect during that first visit:

  • Your therapist will ask about symptoms, emotions, and feelings you experience. Emotional distress often manifests physically, too. Symptoms such as headaches, body aches, or stomach upset may be relevant, so it’s a good idea to mention them.
  • They’ll also ask about the specific difficulties you’re experiencing. Feel free to share anything that comes to mind, even if it doesn’t bother you too much. Therapy can help you deal with any challenges you experience, large or small.
  • You’ll go over general therapy policies, such as confidentiality, and talk about therapy costs, session length, and the number of sessions your therapist recommends.
  • You’ll talk about your goals for therapy, or what you want from treatment.

Feel free to ask any questions you have as they come up. You might consider asking:

  • about trying medication along with therapy, if you’re interested in combining the two
  • how your therapist can help if you’re having thoughts of suicide or find yourself in a crisis
  • if your therapist has experience helping others with similar concerns
  • how you’ll know therapy is helping
  • what will happen in the other sessions

In general, you’ll get more out of therapy when seeing a therapist you can communicate and work well with. If something doesn’t feel right about one therapist, it’s perfectly OK to see someone else. Not every therapist will be a good fit for you or your situation.

CBT can be incredibly helpful. But if you decide to try it, there are a few things to keep in mind.

It’s not a cure

Therapy can help improve concerns you’re experiencing, but it won’t necessarily eliminate them. Mental health issues and emotional distress could persist, even after therapy ends.

The goal of CBT is to help you develop the skills to deal with difficulties on your own, in the moment when they come up. Some people view the approach as training to provide their own therapy.

Results take time

CBT can last for weeks or months, usually with one session each week. In your first few sessions, you and your therapist will likely talk about how long therapy might last.

That being said, it’ll take some time before you see results. If you don’t feel better after a few sessions, you might worry therapy isn’t working. But give it time, and keep doing your homework and practicing your skills between sessions.

Undoing deep-set patterns is major work, so go easy on yourself.

It isn’t always fun

Therapy can challenge you emotionally. It often helps you get better over time, but the process can be difficult. You’ll need to talk about things that might be painful or distressing. Don’t worry if you cry during a session — that box of tissues is there for a reason.

It’s just one of many options

While CBT can be helpful for many people, it doesn’t work for everyone. If you don’t see any results after a few sessions, don’t feel discouraged. Check in with your therapist.

A good therapist can help you recognize when one approach isn’t working. They can usually recommend other approaches that might help more.

How to find a therapist

Finding a therapist can feel daunting, but it doesn’t have to be. Start by asking yourself a few basic questions:

  • What issues do you want to address? These can be specific or vague.
  • Are there any specific traits you’d like in a therapist? For example, are you more comfortable with someone who shares your gender?
  • How much can you realistically afford to spend per session? Do you want someone who offers sliding-scale prices or payment plans?
  • Where will therapy fit into your schedule? Do you need a therapist who can see you on a specific day of the week? Or someone who has sessions at night?
  • Next, start making a list of therapists in your area. If you live in the United States, head over to the American Psychological Association’s therapist locator.

Concerned about the cost? Our guide to affordable therapy can help.