Cognitive Behavioral Therapy

What is CBT?

If you think of yourself as uninteresting, unintelligent, and unworthy of anything good, you’re probably not going to put yourself out there very much. In fact, you’re likely going to miss out on a lot of connections and opportunities throughout your life.

But what if these negative thoughts are just like any other bad habit that can be broken? According to cognitive behavioral therapy (CBT), that’s just what they are.

True to its name, Cognitive behavioral therapy (CBT) is a combination of cognitive and behavioral therapies that explores how your thoughts (cognitive) and actions (behavioral) intertwine to impact the way you feel and experience your life.

In other words, negative thoughts cause self-destructive feelings and behaviors. So if you think you don’t deserve to be happy or you’ll never amount to anything, you’re not going to even try to reach your goals. On the flip side, unhealthy and self-destructive behaviors also lead to negative thoughts and feelings. So when you don’t change out of your pajamas or get out of bed most days, you may start to feel sluggish, incapable, and useless.

CBT is the most researched form of psychotherapy. It takes a practical, structured, skills-based approach that’s often short-term and focused.

As the client, you’ll be actively engaged in the process both during the session and between sessions, with homework assignments, real-world practice, and self-reflection.

CBT is based on a few core principles which include

  • Negative and self-critical ways of thinking contribute to psychological problems
  • Your actions and behavioral patterns also contribute to psychological problems
  • Psychological problems can be relieved by learning healthier ways of coping

How does CBT work?

The idea behind CBT is that it is possible to have some control over your thoughts, feelings, and behaviors.

What follows is that as you unlearn negative automatic thoughts and deeply held core beliefs and replace them with helpful or productive thoughts and beliefs, you can radically change your experience of life. And as you replace harmful coping behaviors with healthier activities, you’ll feel better and be more equipped to cope with life’s challenges.

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As you unlearn negative automatic thoughts and deeply held core beliefs and replace them with helpful or productive thoughts and beliefs, you can radically change your experience of life.

One of the first steps in CBT usually involves developing an awareness of this thought-feeling-behavior interconnection so you can identify new ways of responding that better support your goals.

In therapy, you’ll focus on changing both thoughts and behaviors using multiple skill-based strategies including

  • Journaling
  • Role-playing
  • Relaxation techniques
  • Completing workbook exercises
  • Filling out thought records, rating scales, and questionnaires

Not every CBT therapist will use all of these strategies. It’s a collaborative process that depends on your treatment goals, preferences, and specific situation.

The aim of these practices is to

  • Set achievable goals
  • Identify negative thoughts
  • Recognize how your negative self-talk creates problems in your life
  • Re-evaluate the truth behind your self-criticism and negative core beliefs
  • Replace negative thoughts with healthy alternatives
  • Develop problem-solving skills and healthy coping strategies
  • Improve your self-confidence and belief in your own abilities
  • Face your fears rather than avoiding them (exposure)
  • Problem-solve around challenging interactions with others
  • Use role-playing to practice managing difficult situations
  • Engage in positive or pleasurable activities
  • Tap into community support
  • Cultivate your capacity to ground yourself and relax your body
  • Develop an ability to self-monitor
  • Learn about your condition

What is a thought record?

Thought records are a common CBT technique that allows you to take a closer look at the messaging you’re giving yourself, notice when you’re ruminating, and practice making impactful shifts in your perspective.

Completing a thought record typically includes five steps

  • Identifying the “event” that triggers a negative thought
  • Marking down what the negative thought is
  • Taking note of how that thought is making you feel
  • Challenging the thought by offering alternative evidence, plans of action, and self-compassion
  • Taking note of how the replacement thought is making you feel

For example, if you’re terrified that you’re going to fail an upcoming exam, you might notice the automatic thought, “I’m a failure” that’s attached to a deeply held core belief, “I’ll never amount to anything.”

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Using a thought record, you can begin to notice how these thoughts make you feel and challenge them by listing evidence to the contrary and exploring potential alternative positive thoughts.

As you challenge the “failure” thought, you might say, “this is a really tough test (self-compassion). My plan is to study for 30 minutes every morning and evening (plan of action). I’ll learn the materials as much as I can, and I’ll do my best. When my fear of failing overcomes me, it doesn’t help me pass the exam. In fact, it gets in the way of me doing what I need to do to succeed. I’m going to stop listening to that thought today.”

A note about CBT and medication

CBT can be used on its own or in combination with medication, which sometimes produces the strongest results. There is not enough research to say whether cognitive behavioral therapy, medication, or another form of treatment works better for many mental health disorders. Much of it depends on your specific situation and preferences.

What to expect during a CBT session

The focus of CBT is on the present so you typically won’t dive into early childhood experiences, analyze dreams, or go deep into the issues that lead up to your current situation.

CBT is usually broken up into phases including assessment, the middle phase, and the ending phase.

In general, your therapist will

  • Develop an understanding of the main things that you’re struggling with
  • Ask you clarifying questions and have you fill out questionnaires to track your symptoms and progress
  • Set achievable treatment goals in a collaborative process that clarifies what you want to get out of therapy
  • Help you to identify harmful or problematic thoughts and behaviors
  • Work with you to unlearn and replace these thoughts and behaviors
  • Practice new strategies using role-play and other techniques
  • Provide you with information and written materials to learn more about your health and mental health conditions
  • Provide you with homework that allows you to continue to engage with the therapy process between sessions

What conditions does CBT treat

CBT can be used to treat a range of mental health issues for children and adults including:

When not to use CBT

While each person and set of circumstances is unique, there are a few cases where CBT generally is not considered an appropriate treatment including

  • If you have a brain disease or injury that gets in the way of rational thinking
  • If you’re not interested in, able to, or willing to complete between session assignments (including filling out thought records, keeping a journal, completing questionnaires, or testing out certain action plans)
  • If you require another treatment before engaging in psychotherapy
  • If you’re otherwise not ready to start psychotherapy and consistently attend sessions
  • If you’re looking for a rapid fix

Potential benefits and disadvantages of CBT

Cognitive behavioral therapy has the potential to change the way you think, feel, and act in response to the particular struggles that you’re facing, which can be profoundly impactful.

While it can’t change the world around you, it can support you in changing the ways that you experience it. In cognitive-behavioral therapy, your therapist will work with you to become more aware of your harmful patterns and support you in replacing them with healthier and more positive habits and ways of thinking.

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While CBT can’t change the world around you, it can support you in changing the ways that you experience it.

Potential benefits include the opportunity to

  • Develop healthier and more positive patterns in your life
  • Create shorter-term, achievable goals with the possibility for improvement in five to 20 sessions
  • Treat a variety of conditions
  • Limit the number of costly sessions

Disadvantages

While CBT has been shown to be effective for many mental health disorders, it’s not for everyone.

In general, psychotherapy can cause you to feel more upset or uncomfortable during the process. If this happens to you, it’s important to discuss your experience with your therapist.

Additional drawbacks of CBT may include:

  • The time it takes for you to notice improvements
  • The need for you to be actively involved in the therapy process, including fitting homework into your schedule between visits
  • The highly structured nature of CBT may not be the right fit for you
  • The lack of opportunity to explore your past and your unconscious drives

How long does CBT take to work?

Cognitive behavioral therapy tends to be one of the shorter forms of therapy that generally takes place over 10 to 20 sessions.

This doesn’t mean that you’ll experience results immediately. Changing your long-standing thinking patterns and deeply-rooted habitual responses will usually take time. The good news is, many people notice incremental positive changes with CBT which can happen in a relatively short period of time.

CBT can be done online

If you’re leaning towards trying CBT after considering some of the different forms of psychotherapy, you can connect with a therapist from the comfort of your own private space.

CBT can be done in person or via teletherapy (online), and more research over the last year and a half of the pandemic is telling us that online therapy is a powerful and effective pathway for more people to connect to mental health services and support that they need.

Kate Dubé

Licensed Clinical Social Worker (LCSW) | Berkeley

Kate Dubé is a Licensed Clinical Social Worker (LCSW) and mental health writer trained at UC Berkeley and UCSF in Cognitive Behavioral Therapy, Motivational Interviewing, mindfulness, psychodynamic and psychoanalytic approaches. She specializes in creating a therapeutic space to work through daily stressors, anxiety, depression, trauma, relationship issues and life transitions, including parenthood. Kate incorporates her clinical expertise to create well-researched, accessible content on topics ranging… Read more