How does cognitive behavioral therapy work?

Cognitive behavioral therapy (CBT) is often considered the gold standard of psychotherapy. This collaborative, goal-oriented therapeutic approach can help people manage and overcome various mental health challenges.

What is CBT?

Cognitive behavioral therapy is a type of talk therapy that focuses on the connection between feelings, thoughts, and behaviors. The goal is to help people identify negative thought patterns and behaviors so they can replace them with healthier and more helpful alternatives. CBT also aims to help people develop practical coping skills, improve emotional regulation, and solve problems more effectively in daily life.

CBT is based on the following core concepts:

• Psychological issues are based on unhelpful ways of thinking.

• Psychological issues are based on learned patterns of unhelpful behaviors.

• Psychological issues are based on problematic core beliefs, including thoughts about yourself and the world.

• Access to better coping methods can help alleviate symptoms and improve overall mental and emotional well-being.

Common CBT techniques

CBT teaches practical, evidence-based strategies to help people reach their mental health goals. Although it focuses on addressing current problems, you can use these tools to challenge negative thoughts and create positive change throughout the rest of your life. These strategies are often referred to as CBT methods and CBT exercises.

Here are some leading CBT techniques:

• Cognitive restructuring: CBT teaches people to recognize cognitive distortions, meaning irrational thoughts that shape how you see yourself and the world. Then, it helps you replace them with more positive and encouraging thoughts.

• Behavioral activation: Behavioral activation helps people understand how their behaviors influence their emotions. The goal is to encourage people to engage in activities that generate positive feelings, like joy, satisfaction, and fulfillment.

• Problem solving: CBT empowers people to take an active role in identifying and overcoming mental health challenges and difficult situations. With the support of your therapist, you’ll learn to break down problems into smaller, more manageable situations. This approach can help you find a straightforward and sustainable solution.

• Exposure therapy: Exposure therapy allows people to confront their fears in a safe and controlled environment so they learn to feel less vulnerable and more confident in their ability to cope.

• Relaxation and stress-reduction techniques: CBT teaches relaxation techniques, like guided imagery and deep breathing exercises, to reduce stress and tension during difficult moments.

Dig deeper:

• Discover mindfulness-based cognitive therapy

• How metacognitive therapy (MCT) compares to CBT

What conditions can CBT treat?

CBT can help people manage difficult situations, like dealing with grief, anger, chronic pain, and interpersonal conflict. It’s also effective for a wide range of mental and behavioral health conditions.

Depression

Research shows that CBT is an effective treatment for depression. And combining CBT and medication is significantly more effective than medication alone. For someone with depression, cognitive interventions can address negative thoughts that contribute to depression, while behavioral activation can encourage activities that reduce depressive symptoms.

Anxiety

According to a large analysis, CBT improves symptoms of anxiety disorders, like generalized anxiety disorder, panic disorder, and social anxiety disorder. Through practices like cognitive restructuring, CBT teaches people how unhealthy thinking can affect their mood, beliefs, and outlook on life.

Dig deeper:

• How CBT helps with anxiety

Post-traumatic stress disorder (PTSD)

Research shows that CBT can reduce PTSD symptoms, as well as feelings of depression and anxiety in people with PTSD. Exposure therapy, cognitive restructuring, and other CBT techniques are considered safe and appropriate for reducing symptoms and improving overall functioning.

Eating disorders

CBT is considered an effective treatment for eating disorders, including bulimia, anorexia, and binge eating disorder. It addresses negative thought patterns related to food, body image, and self-esteem. It also focuses on behavioral changes to create better coping methods and a healthier attitude and habits around food.

Substance use disorders

CBT can help people with substance use disorders identify harmful behavior patterns, find motivation for change, and develop healthier coping skills. Learning to recognize cognitive and environmental triggers may also help people avoid relapse after treatment.

What to expect in a CBT session

CBT is a short-term therapy, with most people requiring 5-20 sessions to effectively manage their symptoms or concerns. Throughout the process, you’ll work with your therapist to set goals, challenge negative thought patterns, and develop coping skills. Sessions often involve discussing current challenges, reviewing patterns in your thoughts and behaviors, and learning practical CBT exercises you can use in everyday life.

1. Initial assessment and goal setting

Similar to most types of talk therapy, the first CBT session is an opportunity to introduce yourself to your therapist and learn more about their therapeutic approach. You’ll review your personal and family health histories, as well as any symptoms, emotions, or feelings that brought you to therapy. You may also talk about current stressors, work or school challenges, and situations in which your thoughts or emotions feel overwhelming.

You might even ask your therapist questions, like:

• How long have you been practicing CBT?

• Do you have experience treating other people with similar concerns?

• How will I know if the CBT is working?

The first session is also an opportunity to set treatment goals. CBT goals should be specific, measurable, achievable, relevant, and time-bound (S.M.A.R.T.). They should also be focused on your unique needs and desired outcomes.

2. Identify and challenge negative thought patterns

During CBT sessions, you’ll learn to identify unhelpful or self-defeating thoughts so you can replace them with more encouraging ones. Once you create a treatment goal, you’ll work with your therapist to challenge cognitive distortions, like black-and-white thinking, that may impact your success. You might explore recent situations that triggered stress, anxiety, or self-doubt and examine how your thoughts influenced your emotional reactions and behaviors.

For example, instead of saying “I’ll never get a promotion,” you might replace the thought with “I didn’t get a promotion when I applied two years ago, but this is a different role with a different company. I’ve had time to grow my skill set and I’m now better prepared for additional responsibilities.”

As you work to overcome negative thoughts, your therapist may pose a few questions to offer a fresh perspective on the issue:

• Is there substantial evidence for this thought?

• Is there evidence contrary to my thought?

• What would a friend think of the situation?

• Will this matter a year from now or five years from now?

3. Develop and practice new skills

CBT teaches skills and strategies to manage your thoughts, emotions, and behaviors. During sessions, you’ll discover techniques like problem-solving skills, relaxation exercises, assertiveness training, and communication skills to help you achieve your goals. You may also practice these skills during sessions through role-playing conversations, planning responses to stressful situations, or learning ways to calm your body during moments of anxiety.

And with CBT, you’ll learn to practice your new skills both in and out of therapy sessions. Homework is an important component of CBT, so therapists will often assign work, like journaling or calming exercises, to reinforce the skills you’ve learned during your time together.

How to get started with CBT

If you’re interested in CBT, the first step is finding a mental health provider who uses this approach. Many psychologists, licensed therapists, and counselors are trained in CBT. You can search online therapy directories, explore teletherapy platforms, or ask your doctor for a referral.

Before scheduling an appointment, check whether your insurance plan covers therapy. Many plans include mental health benefits, though the number of sessions or out-of-pocket costs may vary. You can review your benefits online or contact your insurance provider to ask about coverage for outpatient therapy.

You may also want to decide whether online or in-person therapy works best for you. In-person sessions allow you to meet face-to-face with a therapist, while virtual therapy offers more flexibility and convenience. Both formats can be effective for CBT so the best option often depends on your schedule, comfort level, and access to providers.

Once you begin CBT, progress may take time. As you practice CBT exercises and apply new skills, many people start to feel more confident managing stress and challenging negative thoughts.

Clinician’s take

One of the strengths of CBT is it helps clients understand how their thoughts influence their emotions and behaviors. When those patterns shift, people often experience real improvements in how they cope with stress and relationships.

Brandy Chalmers, LPC

Clinical reviewer

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