What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy (CBT) is a type of psychotherapy. This form of therapy modifies thought patterns in order to change moods and behaviors. It’s based on the idea that negative actions or feelings 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. Cognitive therapy focuses on your moods and thoughts. Behavioral therapy specifically targets actions and behaviors. A therapist practicing the combined approach of CBT works with you in a structured setting. You and your therapist work to identify specific negative thought patterns and behavioral responses to challenging or stressful situations.
Treatment involves developing more balanced and constructive ways to respond to stressors. Ideally these new responses will help minimize or eliminate the troubling behavior or disorder.
The principles of CBT can also be applied outside of the therapist's office. Online cognitive behavioral therapy is one example. It uses the principles of CBT to help you track and manage your depression and anxiety symptoms online.
How CBT works
CBT is a more short-term approach than psychoanalysis and psychodynamic therapies. Other types of therapies may require several years for discovery and treatment. CBT often requires only 10 to 20 sessions.
The sessions provide opportunities to identify current life situations that may be causing or contributing to your depression. You and your therapist identify current patterns of thinking or distorted perceptions that lead to depression.
This is different from psychoanalysis. That type of therapy involves working backward through your life history to discover an unconscious source of the problems you’re facing.
You may be asked to keep a journal as part of CBT. The journal provides a place for you to record life events and your reactions. The therapist can help you break down 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
- magnifying or minimizing the importance of an event: making a bigger deal about a specific event or moment
- 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
You and your therapist can use the journal to help replace negative thought patterns or perceptions with more constructive ones. This can be done through a series of well-practiced techniques, such as:
- learning to control and modify distorted thoughts and reactions
- learning to accurately and comprehensively assess external situations and reactions or emotional behavior
- practicing self-talk that is accurate and balanced
- using self-evaluation to reflect and respond appropriately
You can practice these coping methods on your own or with your therapist. Alternately you can practice them in controlled settings in which you’re confronted with challenges. You can use these settings to build on your ability to respond successfully. Another option is online CBT. This allows you to practice these methods in the comfort of your home or office.
What disorders can CBT
Cognitive behavioral therapy is widely used to treat several disorders and conditions in children, adolescents, and adults. These disorders and conditions include:
- antisocial behaviors (including lying, stealing, and hurting animals or other people)
- anxiety disorders
- attention deficit hyperactivity disorder
- bipolar disorder
- conduct disorder
- eating disorders such as 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 to help with depression.
Are there any risks?
There is little long-term emotional risk associated with CBT. But exploring painful feelings and experiences can be stressful. Treatment may involve facing situations you’d otherwise avoid. For instance, you may be asked to spend time in public places if you have a fear of crowds. Alternately you may need to confront the death of a loved one that is causing your depression.
These scenarios can provide opportunities to practice altered responses to stressful or adverse situations. The eventual goal of therapy is to teach you how to deal with anxiety and stress in a safe and constructive manner.
What the expert
“There is a massive tidal wave of evidence for cognitive behavioral therapy that suggests it is very effective at treating certain problems,” Simon Rego, Psy.D. of Montefiore Medical Center in New York told Healthline. “The breadth of evidence isn’t as extensive for other forms of psychotherapy.”
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,” Rego says. “More evidence-based studies have been conducted on the results of cognitive-behavioral therapy than any other kind.”