Cognitive-behavioral therapy is particularly effective for anxiety disorders, depression and other problems. Is it for you? Read on.
Cognitive-behavioral therapy (CBT) is a type of psychotherapy that is particularly effective for anxiety, depression and many related difficulties. It is based on the notion that what we think, what we do, and how we feel all impact one another; by making changes in any one of these three components, we can create improvement in the others. CBT can be done individually or in groups, but individual work is more common.
CBT is widely used because research has shown it to be very effective for several specific and common psychological problems. For some conditions CBT is more effective than medication, for others it’s considered equally as effective.
What problems is CBT used for?
Cognitive-behavioral therapy is used for a variety of emotional and behavioral difficulties. They include:
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Drug and alcohol overuse
- Hair pulling, skin picking and other body-focused repetitive behaviors (BFRBs)
- Eating disorders
- Relationship issues
- Anger management
- Anxiety and panic attacks
- Social anxiety
- Low self-esteem
What’s it like to do CBT?
Many people say that doing CBT is like doing traditional therapy but it’s more practical, more work, and yields better results. Others describe it as being like a combination of therapy and a class. As in a class, there is material you’re expected to learn.
In CBT you and your therapist work together as a team. The therapist and you discuss what you’d like to change in your life, how to best accomplish that, and then set about the work of achieving that change. They also help you decide on what kind of change would be healthy and realistic. As you do the work to reach your goal, your therapist guides you, holds you accountable, and supports you and your work.
In contrast to traditional therapy, CBT focuses on the problems you’re encountering in your life today. Most of the time you and your therapist can find changes to make today that will alleviate problems you’ve been having. Typically this does not require extensive discussion of your childhood.
It has an emphasis on problem-solving
CBT can feel extremely practical. Let’s say that one of your goals is to reduce depression. You and your therapist may agree that engaging in more pleasant activities is likely to help. In that case, you may spend some of the session talking about what you like to do, and how you can overcome obstacles to getting those things on your schedule for the week. CBT is not always profound, but it is always focused on helping you reach your goals.
It’s sometimes focused on thoughts
Often, cognitive-behavioral therapy addresses negative and unhealthy thought patterns. Our thoughts contribute greatly to our mood, to our level of anxiety, and to other emotions. Your therapist may teach you different ways to think about situations that are problematic for you (see the example of Armando, below).
CBT typically helps people address anxiety, relationship and emotional problems by teaching them skills. The more you can improve at the relevant skill, the better the results will be. For example, someone with relationship problems may work to improve the skill of tolerating feeling hurt. Someone with out-of-control worry may work on the skill of talking themselves through their anxiety. Someone with depression may try to improve their ability to do things before they’re feeling quite like doing them. Research shows that by improving skills like these, the problems mentioned above are likely to improve.
How long does the therapy last?
Cognitive-behavioral therapy is often short term. Most standardized CBT treatments are 10-26 sessions long, which translates to several months of weekly treatment. The length of treatment is determined by factors including the problem being addressed, the severity of that problem, and whether you do the exercises given to you by your therapist. Typically the completion of these exercises is critical to having success in treatment. Think of it similarly to physical exercise; if you talk about doing exercise once a week, it’s not going to help that much. Doing the exercise, on the other hand, can bring all kinds of change!
Armando suffered from depression for a few years before he sought help. He ended up seeing a CBT therapist who explained the interrelationships between his thinking, his mood, and his actions. In part, the plan they developed together was to try to help Armando see the extent to which his thinking was negative, unhelpful, or factually inaccurate.
For example, whenever a friend said they couldn’t meet up with Armando, he would often think, “He never really liked me that much, so it’s no surprise he can’t hang out today.” Armando’s therapist helped him recognize that this was a pattern called “mind reading.” Mind reading is making assumptions, without evidence, about what someone else thinks.
Through hard work and practice, Armando was able to limit the mind reading habit he’d developed, and his depression improved as a result. Thanks to this and other changes Armando was able to make, he was able to reduce his depression to the point where he was able to enjoy his life again.
Ashley suffered from a fear of spiders. Even a joke about a spider being nearby was enough to send her into another room in a frantic state. When Ashley sought the help of a therapist, he explained that they would be doing a kind of CBT called exposure therapy.
Ashley’s first task in exposure therapy was to say the word “spider” out loud, which was very difficult for her. This was called an “exposure” exercise, the therapist said. She did this exposure repeatedly until her anxiety levels dropped. Then she moved on to looking at a picture of a small spider. This scared her more than she cared to admit, but after repeated exposure to the picture over several weeks, it no longer bothered her.
Eventually Ashley was able to watch a whole documentary about spiders with a surprising degree of comfort. By the end of therapy, Ashley was no longer nearly as reactive to spiders (or the idea of spiders).
Distinguishing features of CBT
CBT is different from traditional counseling or therapy in several ways:
Identification of goals
During or shortly after your initial assessment, a CBT therapist will ask you what your goals are for therapy. Ideally these will be measurable goals, such as “I want to decrease my drinking to one drink per night,” or “I want to have zero panic attacks per week,” or “I want to get into fewer fights with my boyfriend.”
Throughout CBT, you and your therapist will discuss your progress toward your goals. This can be accomplished by having you track the goal (keeping a log of fights with your boyfriend, e.g.), or by using standardized questionnaires or interviews designed to assess specific problems. In this way, you and your therapist can scientifically monitor how well the therapy is working.
Typically in CBT the therapist will begin the session by setting an agenda – you and the therapist both add items to it. This ensures that the appropriate material gets covered, and any specific issues you have will be addressed. In some ways this is more reminiscent of a meeting than of a traditional therapy session. However, it helps ensure that you’re learning precisely the skills and tools that will help you progress toward your goals.
CBT is effective because it produces measurable change, typically by helping you learn different ways to handle situations, thoughts or emotions. How does that change occur? Through practicing different skills and different habits. CBT guides you in this practice through assigned homework exercises you’ll be asked to do between sessions.
What these exercises are will vary according to the problem being addressed. For example, if someone is working toward a goal in CBT of reducing marijuana use, their homework might be to keep written track of every time they used it. Another would be someone with depression who agrees to go for a walk in their favorite park every morning.
Feedback and specific instructions from therapist
In some older therapies like psychoanalytic or psychodynamic therapy, the therapist often tries to remain silent when a client is describing a problem. This is done to facilitate the client’s gaining insight around the problem. CBT is different; a CBT therapist is often quite directive. Insight is not the goal in CBT (although it is often a byproduct). Measurable improvement is the goal. The therapist’s actions reflect that.
Is CBT a new therapy?
CBT has its roots in the behavioral research of pioneers like Ivan Pavlov, John Watson, B.F. Skinner, Mary Cover Jones and others in the late nineteenth and early 20th centuries. In the late 1950s and 1960s, therapists who would later call themselves “cognitive therapists” began to recognize the importance of beliefs and of how we talk to ourselves. These two schools of thought (behaviorism and cognitive therapy) became somewhat fused in the 1970s and 1980s and became what is now known as cognitive-behavioral therapy.
Cognitive-behavioral Therapy FAQ
CBT tends to be shorter-term and more problem-focused than traditional therapy. Typically it focuses on teaching you skills to better cope with specific problems. It usually does not involve exploring possible childhood origins of problems.
Depending on the problem it’s being used for, CBT can work by helping you change your thinking, change your reactivity to certain situations or emotions, or change things you do that create problems.
Yes. Decades of rigorous clinical research has gone into the development and testing of various CBT therapies for anxiety, depression, substance abuse and other emotional problems.
Yes — research shows that several self-guided CBT online courses are effective. However, these courses are typically based on having an accurate diagnosis, which is sometimes difficult to do by yourself.
It varies, but typically CBT takes months and not years.
In the United States, mental health services are typically covered thanks to the passage of recent state and federal parity laws. CBT is a form of psychotherapy, which is a covered healthcare service.
How can I find a CBT therapist?
Finding the right therapist for you can be a real challenge. (Consult our guide on how to find a therapist for some useful guidance.) The therapist directories from the Anxiety and Depression Association of America as well as the Association of Behavioral and Cognitive Therapies are excellent resources with nationwide listings.
Many people search for therapists in online directories such as Psychology Today and ZocDoc. When perusing the summary for a therapist, look for how prominently the therapist mentions CBT as part of their approach to treatment. If you can, try to find someone with extensive training in CBT.
To learn more about whether CBT could be helpful for you or a loved one, feel free to get in touch with us.
Last updated: May 16, 2020