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Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people become more aware of their negative thought patterns so that they can effectively respond to challenging situations. This type of therapy focuses on replacing automatic negative thoughts with more realistic thoughts so that clients are less likely to experience the emotional difficulties often associated with such detrimental thinking patterns. Whether used alone or in combination with other types of therapy, CBT is used to treat a variety of afflictions ranging from daily stress to mental health disorders such as posttraumatic stress disorder and depression.
CBT is known for providing people with significant results over a short period of time. Because it’s a short-term therapy, clients may attend anywhere between five and 20 sessions depending on their condition. Regardless of the duration, though, CBT typically includes the following steps:
1. Identify challenging conditions or situations. The first step in reshaping distressing behavior is recognizing the reasons why you’re experiencing emotional discomfort. Whether you’re grieving a loss, struggling with a medical condition, or experiencing symptoms of an undiagnosed mental health disorder, you and your therapist can work together to decide which issues you’d like to focus on.
2. Familiarize yourself with your thoughts and feelings regarding these problems. Once you’ve determined your focus, your therapist will likely prompt you to discuss your feelings surrounding the prominent issue. Outside of your sessions, your therapist may also assign homework, encouraging you to keep a journal of your thoughts throughout your daily life so that you can share them upon your return.
3. Recognize detrimental thought patterns. Now that your therapist is familiar with the situations that are linked to your negative thoughts, you may be asked to pay attention to your behavioral responses to certain scenarios. Your therapist will want you to address your physical, emotional, and behavioral reactions to different situations in your life that cause you stress. This way, you can begin to recognize the relationship between your thoughts and your actions.
4. Replace negative thinking with realistic responses. This is often the most challenging step in CBT, as your therapist will likely ask you whether your view of a certain situation is based on factual information or an inaccurate perception of reality. In this way, you will have to challenge your long-standing beliefs about your own life. With practice, though, you will be able to look at your life from a more objective point of view and recognize the ways in which you may have incorrectly perceived certain situations.
Cognitive behavioral therapy is viewed as a preferred type of psychotherapy due to its efficacy. Here are some mental health issues that are regularly treated by CBT:
Anxiety disorders – A 2020 study of 93 individuals seeking treatment in a university outpatient clinic found that CBT was helpful in treating social anxiety disorder. After attending 16 sessions of therapy, patients’ scores on several anxiety outcome measures significantly decreased. Patients also reported significant increases in their quality of life after receiving CBT treatment (Butler et al., 2020).
Attention-deficit / hyperactivity disorder (ADHD) – In a recent study, 250 college students with ADHD attended weekly CBT therapy sessions over the course of two academic semesters. The findings revealed that students experienced ADHD symptom improvements of over 50%, a significant change (Anastopoulos et al., 2021).
Depression – A study of 32 individuals with major depressive disorder found neurological changes associated with CBT. After 14 sessions of CBT, MRI scans of the 21 participants who completed the entirety of the treatment revealed changes in neurons associated with emotional regulation, demonstrating implications of significant improvement in terms of emotional maturity (Rubin-Falcone et al., 2020).
Eating disorders – In 2019, a meta-analysis of 20 studies found support for the effectiveness of CBT in the treatment of the full spectrum of eating disorders. All of the studies found a reduction in eating disorder behaviors and overall psychopathology in clients with eating disorders who underwent CBT (Atwood & Friedman, 2020).
Obsessive-compulsive disorder (OCD) – In 2020, data were collected from 573 individuals with OCD who were enrolled in CBT trials. It was found that most behaviors associated with OCD drastically improved after treatment. This study found that, no matter how severe a participant’s avoidance or impairment, there were still measurable improvements after CBT (Selles et al., 2020).
Post-traumatic stress disorder (PTSD) – Across two twelve-week studies with a total of 482 participants, more than 30 percent of the sample experienced “sudden gains” between the second and tenth treatments, which means that there were significant and stable improvements from one therapy session to the next. While the majority of participants experienced some kind of improvement over the course of the twelve sessions, this finding demonstrates the rate at which CBT patients experience improvements (Wiedemann et al., 2020).
Sleep disorders – In one study, 208 women with insomnia attended six weekly sessions of either CBT or standard insomnia treatment. By the end of the study period, it was found that insomnia severity scores decreased more than twice as much for participants who received CBT compared with those who received standard treatment. Additionally, the women who attended CBT sessions reported less time spent lying awake in bed and greater improvements in overall sleep quality (Felder et al., 2020).
Especially if it’s your first time going to therapy, you may feel overwhelmed and hesitate to open up to your therapist. Here are a few steps you can take to make CBT as helpful as possible for yourself:
Remember that your therapist is a trained professional. It’s completely normal to struggle with the idea of sharing your innermost thoughts with someone you hardly know. Practitioners of CBT, though, are there to listen. Except under very specific circumstances, your conversations with your therapist are completely confidential, and you are more than welcome to ask them questions, too. During your first session, you may have questions about the type of therapy and your therapist’s intentions. Since your therapist is there to make you feel comfortable, they will likely encourage you to ask any questions that you may have. Therapists aren’t there to judge you, but rather to help you recognize patterns in your behavior and make changes for the better.
Stick to your treatment plan as much as possible. While therapy can be challenging, skipping sessions or disregarding your therapist’s counseling can be detrimental to your progress. Instead, consider why you’re feeling unmotivated or discouraged and talk to your therapist about it. Perhaps there is another route you can take. Your therapist will want to do what works best for you and will help you progress as much as possible, so share your thoughts and concerns with them rather than cancelling sessions.
Do your homework. While you may find that you get a lot out of sessions with your therapist, follow through with assignments outside of therapy. Keeping journals or writing down your thoughts will allow you to apply what you’ve learned during your sessions and may bring up some questions that you’d never think to ask otherwise. Plus, homework is great preparation for life beyond CBT. The more comfortable you become with recognizing and responding to your emotions and behaviors, the better equipped you’ll be to follow through on helpful practices when your therapy sessions end.
Remember that healthy change doesn’t happen instantly. Especially when you’re confronting issues that you haven’t addressed before, therapy can be a real challenge. Keep in mind that it may take several sessions before you start to see some changes. Trust the process and your therapist’s expertise. After some time, you will begin to improve.
Can't afford a therapist or don't have the time or interest to see one? There are many cognitive behavioral therapy apps out there that can help. These vary from AI-assisted chat bots to self-guided tools and journaling. Here are a few different CBT apps you can try, based on what you need:
LIFE Intelligence is a self-care app to holistically manage stress and anxiety, improve work productivity, and build lasting relationships. Since it covers information for both mental health, work, and relationships, CBT is a pretty small part of what LIFE teaches. But, that also means CBT is one of the app's free-forever features. The app guides you through step-by-step CBT in lessons such as “Retrain Your Thoughts” and “Catch Cognitive Distortions.”
Betterhelp matches you with a provider, which is great if you're able to spend the money to get professional help. After going through onboarding and getting matched (a few days to process), you can make appointments and text your therapist. While Betterhelp can be pricey (a few hundred dollars a month) but it will give you the closest experience to in-person therapy while still saving quite a bit.
Sometimes we just want to talk. If that's how you're feeling, Youper is an AI-assisted chat bot that uses CBT to respond to the things you say. You can tell it how you're feeling, log moods, and it'll send you some kind words and helpful tips. If you're looking for some simple answers without the hefty price tag of a real therapist, this is a good option. You can't do much with the free version, but at $79/month the premium is still cheaper than Betterhelp.
References:
Anastopoulos, A. D., Langberg, J. M, Eddy, L. D., Silvia, P. J., & Labban, J. D. (2021). A
randomized control trial examining CBT for college students with ADHD. Journal of Consulting and Clinical Psychology, 89(1), 21-33.
Atwood, M. E., & Friedman, A. (2020). A systematic review of enhanced cognitive behavioral
therapy (CBT‐E) for eating disorders. International Journal of Eating Disorders, 53(3), 311-330.
Butler, R. M., O’Day, E. B., Swee, M. B., Horenstein, A., & Heimberg, R. G. (2020). Cognitive
behavioral therapy for social anxiety disorder: Predictors of treatment outcome in a quasi-naturalistic setting. Behavior Therapy.
Felder, J. N., Epel, E. S., Neuhaus, J., Krystal, A. D., & Prather, A. A. (2020). Efficacy of digital
cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: a randomized clinical trial. JAMA psychiatry, 77(5), 484-492.
Rubin-Falcone, H., Weber, J., Kishon, R., Ochsner, K., Delaparte, L., Doré, B., Raman, S.,
Denny, B. T., Oquendo, M. A., Mann, J. J., & Miller, J. M. (2020). Neural predictors and effects of cognitive behavioral therapy for depression: The role of emotional reactivity and regulation. Psychological Medicine, 50(1), 146-160.
Selles, R. R., Højgaard, D. R., Ivarsson, T., Thomsen, P. H., McBride, N. M., Storch, E. A.,
Geller, D., Wilhelm, S., Farrell, L. J., Waters, A. M., Mathieu, S., & Stewart, S. E. (2020). Avoidance, insight, impairment recognition concordance, and cognitive-behavioral therapy outcomes in pediatric obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 59(5), 650-659.
Wiedemann, M., Stott, R., Nickless, A., Beierl, E. T., Wild, J., Warnock-Parkes, E., Grey, N.,
Clark, D. M., & Ehlers, A. (2020). Cognitive processes associated with sudden gains in cognitive therapy for posttraumatic stress disorder in routine care. Journal of Consulting and Clinical Psychology, 88(5), 455-469.
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