Cognitive Behavioral Therapy (CBT): What It Is and How It Works

It would be rhetorical to ask if you’ve ever had a negative thought, feeling, or behavior. We’ve all experienced the psychological impact of passing through valleys in life. 

While all this is a part of the human experience, it’s not normal when negativity becomes second nature and interferes with your quality of life, leading to mental health challenges like depression and anxiety. So, what should you do when you’re trapped in a vicious cycle of negativity?

Many people turn to cognitive behavioral therapy (CBT). Often called “the gold standard” of psychotherapy, CBT is one of the most effective treatments available for changing dysfunctional thoughts, behaviors, and emotions that impact one’s mood and ability to function.

Below, we explore what CBT talk therapy entails, how it works, and who can benefit from it. We’ll also share how you can get started with CBT if it sounds like a good option for you.

What is CBT? Cognitive behavioral therapy is a structured, time-limited form of psychotherapy. It was developed in the 1960s by Aaron Beck.

Psychotherapy is a therapeutic process that involves talking with a trained mental health professional to address emotional, psychological, and behavioral issues that are interfering with your quality of life. 

It aims to help people understand and manage their problems, improve well-being, and develop healthier coping mechanisms for when we inevitably stumble on hard things again. 

CBT is commonly used to treat a range of mental health conditions, including depression, anxiety disorders, and phobias. 

The premise is that your psychological and emotional problems are caused by unhelpful ways of thinking or behaving. These problems feed into negative thoughts, which feed back into destructive emotions and behaviors. 

CBT aims to interrupt this cycle and build new patterns. It does this first by teaching you to recognize dysfunctional thoughts and behaviors. It then teaches you how to redirect these negative thoughts in a healthier way.

CBT is effective both alone and when used with other treatment options, medications, or other complementary forms of therapy. 

With CBT, you learn healthy problem-solving skills and more positive ways of speaking to yourself. It empowers you to manage your symptoms and improve your overall quality of life.

First and foremost, CBT is done with a licensed professional who will assist with your cognitive behavioral therapy interventions. Together, you’ll tackle your dysregulated thought patterns and how they impact your mental health — then, you’ll start making changes. 

As with any type of therapy, CBT experiences can vary from person to person. A CBT plan will ultimately be tailored to your specific problems and goals, but it usually follows some general guidelines. 

Here’s what you can expect when preparing for your first session: 

• You and your therapist will identify specific issues you’re having and set clear, achievable goals.

• Your therapist will help you understand how your thoughts, emotions, and behaviors are interconnected.

• You’ll start recognizing distorted or unhelpful thoughts that are triggering your emotional challenges. 

• As you identify patterns causing your current problems, you’ll develop coping skills to address cognitive distortions in real time, stop catastrophizing, and rebuild your self-esteem. This generally involves taking an introspective look at what’s bothering you and formulating rational answers to address triggers. 

• CBT techniques often include self-help activities outside of therapy, as it places an emphasis on helping you learn to be your own therapist. 

• Your therapist will help track your progress and make necessary adjustments.

• Your conversations are confidential, except in specific circumstances where there is an immediate threat to safety or when your therapist is required by law to report concerns to authorities.

Cognitive Behavioral Therapy Examples

Here are some CBT therapy examples to help illustrate how various forms of CBT might work:

Role-playing

A person with social anxiety might role-play different social scenarios to practice and improve their social skills and reduce anxiety in real-life difficult situations.

Exposure therapy

For someone with a phobia of dogs, for example, exposure therapy might involve gradually exposing the person to dogs in a controlled and safe manner. It might start with looking at pictures of dogs, then being in the same room as a dog, and eventually petting a dog.

Graded exposure

For someone with panic disorder, graded exposure might involve exposing themselves to the physical sensations of panic (like increased heart rate) in a controlled way, like with mild exercise, to reduce their fear of these sensations.

Mindfulness meditation

A person struggling with intrusive thoughts might use mindfulness meditation to stay present and observe their thoughts without judgment.

Problem-solving

Someone who feels overwhelmed by work might break down their tasks into smaller, manageable steps, prioritize them, and develop a plan to tackle them systematically.

Behavioral activation

A person with depression may feel unmotivated to engage in activities they once enjoyed. A therapist might help them schedule and reintroduce these activities, like going for a walk or meeting a friend for coffee, to help lift their mood.

Reframing thinking patterns

An anxious person might think, "I’m going to fail at everything." In therapy, they would challenge this thought by considering the evidence for and against it and then create a more balanced thought like, "I may not be perfect at everything, but I’ve been successful before."

What to Expect When CBT Ends

CBT is time-limited and focused. With this type of short-term treatment, you might be looking at 10 to 20 sessions to start out. This can, of course, be adjusted depending on your individual progress. 

“Graduating” from CBT doesn’t mean you’ll no longer struggle with obstacles in life (these never go away!). But you will develop strategies to maintain your progress and prevent relapse after your regular therapy sessions end.

CBT treatment is a process. Changing behavior patterns takes time, and exactly how long it takes varies. You can’t unlearn destructive behaviors in a day, and there’s no real definitive time frame for how long CBT takes to work.

Still, you could see some initial results faster than you might think. For some people, feeling better in the short term can take just a few weeks of therapy sessions (typically a one-hour session with your therapist once a week). For others, it can take longer.

CBT is widely researched and has more evidence supporting its effectiveness than any other form of therapy. 

It’s used for a wide range of mental health problems, helping adults and adolescents cope with numerous emotional issues, including:

• Depression

• Phobias

• Post-traumatic stress disorder (PTSD)

• Anxiety disorders like generalized anxiety disorder (GAD) and panic disorder

• Eating, sleep, and sexual disorders

• Obsessive-compulsive disorder (OCD) and substance use disorders

• Bipolar disorders

• Schizophrenia

Cognitive behavioral therapy is also sometimes used in marital counseling, insomnia treatment, and substance abuse counseling. If flawed or destructive thoughts could be at the root of your problem — or you’re just having difficulty coping — CBT can be a potential solution.

CBT may also be help:

• Manage symptoms or prevent relapses of mental illnesses

• Identify better ways to manage emotions and expectations

• Treat a mental illness when medications aren’t effective or an ideal treatment option

• Learn healthier techniques for coping with stressful life situations

• Cope with grief or loss

• Cope with chronic pain and the negative thinking that can result from it

• Resolve relationship conflicts and learn better ways to communicate

• Overcome emotional trauma related to violence or abuse

• Manage stress

Of course, CBT isn’t the only option out there — but there’s a reason it’s known as the gold standard in mental health. Next, we’ll examine what makes CBT stand out from other psychotherapies.

When you Google the types of psychotherapies, you’ll likely stumble across a long list of options and providers specializing in them. A few commonly used types of behavior therapies include:

• Group therapy: As the name suggests, this is done in a group setting where members can provide support and feedback to each other. It leans on shared experiences, which can be helpful for a wide range of issues, like substance abuse, depression, and anxiety.

• Eye movement desensitization and reprocessing: Better known as EMDR, this type of therapy aims to help you process traumatic memories. It uses guided eye movements or other bilateral stimulation while recalling traumatic events.

• Mindfulness-based therapies: This generally incorporates mindfulness meditation practices to help you address underlying psychological issues and emphasize being more present and aware in the moment. 

• Interpersonal therapy (IPT): IPT focuses on social functioning and relationships with others to help address relational issues that may play a role in mental health problems. It’s often used for depression, eating disorders, and other mood disorders. 

• Dialectical behavior therapy (DBT): This focuses on emotional regulation, tolerating stressful situations, and becoming more effective in relationships with others. It often combines CBT techniques with mindfulness practices and is used for mental health conditions like borderline personality disorder, self-harm, and chronic suicidal ideation.

So, how does CBT stack up against these other types of therapy? One plus of the treatment is that it evolved from older ways of looking at mental health. 

CBT brought a new emphasis on cognition — the role of thought — in our behaviors and emotions. The idea that human thought could be responsible for maladaptive human emotions — depression or anxiety — was further developed in the decades to come. 

One thing that makes CBT superior is the volume of research behind it. It’s the first type of therapy that could be considered evidence-based. It’s supported by research rather than anecdote, and it has been studied in scientifically stringent conditions like randomized trials.

Overall, no other form of psychotherapy has been shown to be systematically superior to CBT. In most cases, when it comes to therapy for mental health, CBT is king. Nevertheless, CBT isn’t for everyone and it’s not always the best treatment for every condition. Other therapies also have strong evidence for their effectiveness. CBT may be an excellent tool, but it’s not the only one that’s been shown to work well.

If you’ve gotten this far and think CBT may be right for you, we support your decision to invest in your mental health in this way. 

There are a few ways you can pursue getting therapy set up.

First, you could ask your primary care provider for personal recommendations just as you would for other specialist referrals. 

Note that not all therapists accept insurance. If it’s important to you not to pay in full out-of-pocket, you’ll want to search for therapists that are covered by your insurance provider. Then, you can start researching the options and calling their offices to check if they’re taking new patients. 

The quickest way to get started may be online therapy. 

Hers partners with fantastic licensed mental healthcare professionals who are ready to help. Learn more about our affordable and effective mental health resources here and get connected with a provider by taking our free online assessment.

Cognitive behavioral therapy is considered a very effective form of psychotherapy that can be used to treat a wide range of mental health challenges. 

If you’re struggling to find joy, break free from a negative cycle, or otherwise climb out of a rut, CBT treatment can help.

• CBT is a well-researched form of psychotherapy, with numerous studies demonstrating its effectiveness. 

• It helps people identify the unhealthy and disordered thoughts that fuel negative emotions and behaviors. 

• You’ll need a licensed CBT therapist to help you work through problems like social anxiety, depression, and other disordered ways of thinking that are preventing you from living your best life. 

• Other therapies have also been shown to be effective, and your mental health provider may recommend something different for your individual needs.

Want to get started with CBT but aren’t sure where to start? Hers can help. Check out our online psychiatry and other virtual mental health services.