What Is Cognitive Behavioral Therapy (CBT) and How Does It Work?

Table of ContentsView AllTable of ContentsTypes of CBTApproachesUsesBenefitsEffectivenessConsiderationsHow to Start CBT

Table of ContentsView All

View All

Table of Contents

Types of CBT

Approaches

Uses

Benefits

Effectiveness

Considerations

How to Start CBT

Close

Cognitive behavioral therapy (CBT) is a type ofpsychotherapeutic treatmentthat helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.

Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen our emotional difficulties,depression, andanxiety. These spontaneous negative thoughts also have a detrimental influence on our mood.

Through CBT, faulty thoughts are identified, challenged, and replaced with more objective, realistic thoughts.

1:31Everything You Need to Know About CBT

1:31

Everything You Need to Know About CBT

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Types of Cognitive Behavioral Therapy

CBT encompasses a range of techniques and approaches that address our thoughts, emotions, and behaviors. These can range from structured psychotherapies to self-help practices. Some of the specific types of therapeutic approaches that involve cognitive behavioral therapy include:

While each type of cognitive behavioral therapy takes a different approach, all work to address the underlying thought patterns that contribute to psychological distress.

Cognitive Behavioral Therapy Techniques

CBT is about more than identifying thought patterns. It uses a wide range of strategies to help people overcome these patterns. Here are just a few examples of techniques used in cognitive behavioral therapy.

Identifying Negative Thoughts

It is important to learn what thoughts, feelings, and situations are contributing to maladaptive, unhelpful, or harmful behaviors.This process can be difficult, however, especially for people who struggle withintrospection. But taking the time to identify these thoughts can lead to self-discovery and provide insights that are essential to the treatment process.

Practicing New Skills

In cognitive behavioral therapy, people are often taught new skills that can be used in real-world situations. For example, someone with asubstance use disordermight practice new coping skills and rehearse ways to avoid or deal with social situations that could potentially trigger a relapse.

Goal-Setting

Goal setting can be an important step in recovery from mental illness, helping you to make changes to improve your health and life. During cognitive behavioral therapy, a therapist can help you build andstrengthen your goal-setting skills.

This might involve teaching you how to identify your goal or how to distinguish between short- and long-term goals. It may also include helping you setSMART goals(specific, measurable, attainable, relevant, and time-based), with a focus on the process as much as the end outcome.

Problem-Solving

Learningproblem-solving skillsduring cognitive behavioral therapy can help you learn how to identify and solve problems that may arise from life stressors, both big and small. It can also help reduce the negative impact of psychological and physical illness.

Problem-solving in CBT often involves five steps:

Self-Monitoring

Also known as diary work,self-monitoringis an important cognitive behavioral therapy technique. It involves tracking behaviors, symptoms, or experiences over time and sharing them with your therapist.

Self-monitoring can provide your therapist with the information they need to give you the best treatment. For example, for people with eating disorders, self-monitoring may involve keeping track of eating habits, as well as any thoughts or feelings that went along with consuming a meal or snack.

Additional cognitive behavioral therapy techniques may includejournaling,role-playing, engaging inrelaxation strategies, and usingmental distractions.

What Cognitive Behavioral Therapy Can Help With

Cognitive behavioral therapy can be used as a short-term treatment to help individuals learn to focus on present thoughts and beliefs.

CBT is used to treat a wide range of conditions, including:

In addition to mental health conditions, cognitive behavioral therapy has also been found to help people cope with:

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Benefits of Cognitive Behavioral Therapy

The underlying concept behind CBT is that thoughts and feelings play a fundamental role in behavior.For example, a person who spends a lot of time thinking about plane crashes, runway accidents, and other air disasters may avoid air travel as a result.

The goal of cognitive behavioral therapy is to teach people that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment.

CBT is known for providing the following key benefits:

One of the greatest benefits of cognitive behavioral therapy is that it helps clients developcoping skillsthat can be useful both now and in the future.

Effectiveness of Cognitive Behavioral Therapy

CBT emerged during the 1960s and originated in the work of psychiatristAaron Beck, who noted that certain types of thinking contributed to emotional problems. Beck labeled these “automatic negative thoughts” and developed the process of cognitive therapy.

Where earlier behavior therapies had focused almost exclusively on associations,reinforcements, and punishments to modify behavior, the cognitive approach addresses how thoughts and feelings affect behaviors.

Today, cognitive behavioral therapy is one of the most well-studied forms of treatment. It has been shown to be effective in the treatment of a range of mental conditions, including anxiety, depression, eating disorders, insomnia,obsessive-compulsive disorder, panic disorder,post-traumatic stress disorder, and substance use disorder.

CBT is one of the most researched types of therapy, in part, because treatment is focused on very specific goals and results can be measured relatively easily.

Verywell Mind’sCost of Therapy Survey, which sought to learn more about how Americans deal with the financial burdens associated with therapy, found that Americans overwhelmingly feel the benefits of therapy:80% say therapy is a good investment91% are satisfied with the quality of therapy they receive84% are satisfied with their progress toward mental health goals

Verywell Mind’sCost of Therapy Survey, which sought to learn more about how Americans deal with the financial burdens associated with therapy, found that Americans overwhelmingly feel the benefits of therapy:

Things to Consider With Cognitive Behavioral Therapy

There are several challenges that people may face when engaging in cognitive behavioral therapy. Here are a few to consider.

Change Can Be Difficult

Initially, some patients suggest that while they recognize that certain thoughts are not rational or healthy, simply becoming aware of these thoughts does not make it easy to alter them.

CBT Is Very Structured

Cognitive behavioral therapy doesn’t focus on underlying, unconscious resistance to change as much as other approaches, such aspsychoanalytic psychotherapy.Instead, it tends to be more structured, so it may not be suitable for people who may find structure difficult or who want to more freely explore their past and their emotions.

You Must Be Willing to Change

For cognitive behavioral therapy to be effective, you must be ready and willing to spend time and effort analyzing your thoughts and feelings. This self-analysis can be difficult, but it is a great way to learn more about how your internal states impact your outward behavior.

Progress Is Often Gradual

There is no magic therapy bullet - all therapy, including CBT, takes time and effort.

How to Get Started With Cognitive Behavioral Therapy

Cognitive behavioral therapy can be an effective treatment choice for a range of psychological issues. If you or someone you love might benefit from this form of therapy, consider the following steps:

What to Expect With Cognitive Behavioral Therapy

If you’re new to cognitive behavioral therapy, you may have uncertainties or fears of what to expect. In many ways, the first session begins much like your first appointment with any new healthcare provider.

During the first session, you’ll likely spend some time filling out paperwork such as HIPAA forms (privacy forms), insurance information, medical history, current medications, and a therapist-patient service agreement. If you’re participating in online therapy, you’ll likely fill out these forms online.

Also be prepared to answer questionsabout what brought you to therapy, yoursymptoms, and your history—including your childhood, education, career, relationships (family, romantic, friends), and current living situation.

Once the therapist has a better idea of who you are, the challenges you face, and your goals for cognitive behavioral therapy, they can help you increase your awareness of the thoughts and beliefs you have that are unhelpful or unrealistic. Next, strategies are implemented to help you develop healthier thoughts and behavior patterns.

During later sessions, you will discuss how your strategies are working and change the ones that aren’t. Your therapist may also suggest cognitive behavioral therapy techniques you can do yourself between sessions, such as journaling to identify negative thoughts or practicing new skills toovercome your anxiety.

What to Expect During Your First Therapy Session

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

15 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A.The efficacy of cognitive behavioral therapy: A review of meta-analyses.Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1Merriam-Webster.Cognitive behavioral therapy.Rnic K, Dozois DJ, Martin RA.Cognitive distortions, humor styles, and depression.Eur J Psychol.2016;12(3):348-62. doi:10.5964/ejop.v12i3.1118Lazarus AA, Abramovitz A.A multimodal behavioral approach to performance anxiety.J Clin Psychol.2004;60(8):831-40. doi:10.1002/jclp.20041Lincoln TM, Riehle M, Pillny M, et al.Using functional analysis as a framework to guide individualized treatment for negative symptoms.Front Psychol.2017;8:2108. doi:10.3389/fpsyg.2017.02108Ugueto AM, Santucci LC, Krumholz LS, Weisz JR.Problem-solving skills training.Evidence-Based CBT for Anxiety and Depression in Children and Adolescents: A Competencies-Based Approach. 2014. doi:10.1002/9781118500576.ch17Lindgreen P, Lomborg K, Clausen L.Patient experiences using a self-monitoring app in eating disorder treatment: Qualitative study.JMIR Mhealth Uhealth.2018;6(6):e10253. doi:10.2196/10253Tsitsas GD, Paschali AA.A cognitive-behavior therapy applied to a social anxiety disorder and a specific phobia, case study.Health Psychol Res.2014;2(3):1603. doi:10.4081/hpr.2014.1603Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH.The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders.Cureus. 2017;9(8):e1626.Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191. doi:10.7326/M14-2841Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Oud M, De winter L, Vermeulen-smit E, et al.Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis.Eur Psychiatry. 2019;57:33-45. doi:10.1016/j.eurpsy.2018.12.008Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S.Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials.Depress Anxiety. 2018;35(6):502–14. doi:10.1002/da.22728National Institute on Drug Abuse (NIDA).Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine).Gaudiano BA.Cognitive-behavioural therapies: Achievements and challenges.Evid Based Ment Health. 2008;11(1):5-7. doi:10.1136/ebmh.11.1.5Additional ReadingBeck JS.Cognitive Behavior Therapy: Basics and Beyond.Coull G, Morris PG.The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review.Psycholog Med. 2011;41(11):2239-2252. doi:10.1017/S0033291711000900

15 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A.The efficacy of cognitive behavioral therapy: A review of meta-analyses.Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1Merriam-Webster.Cognitive behavioral therapy.Rnic K, Dozois DJ, Martin RA.Cognitive distortions, humor styles, and depression.Eur J Psychol.2016;12(3):348-62. doi:10.5964/ejop.v12i3.1118Lazarus AA, Abramovitz A.A multimodal behavioral approach to performance anxiety.J Clin Psychol.2004;60(8):831-40. doi:10.1002/jclp.20041Lincoln TM, Riehle M, Pillny M, et al.Using functional analysis as a framework to guide individualized treatment for negative symptoms.Front Psychol.2017;8:2108. doi:10.3389/fpsyg.2017.02108Ugueto AM, Santucci LC, Krumholz LS, Weisz JR.Problem-solving skills training.Evidence-Based CBT for Anxiety and Depression in Children and Adolescents: A Competencies-Based Approach. 2014. doi:10.1002/9781118500576.ch17Lindgreen P, Lomborg K, Clausen L.Patient experiences using a self-monitoring app in eating disorder treatment: Qualitative study.JMIR Mhealth Uhealth.2018;6(6):e10253. doi:10.2196/10253Tsitsas GD, Paschali AA.A cognitive-behavior therapy applied to a social anxiety disorder and a specific phobia, case study.Health Psychol Res.2014;2(3):1603. doi:10.4081/hpr.2014.1603Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH.The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders.Cureus. 2017;9(8):e1626.Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191. doi:10.7326/M14-2841Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Oud M, De winter L, Vermeulen-smit E, et al.Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis.Eur Psychiatry. 2019;57:33-45. doi:10.1016/j.eurpsy.2018.12.008Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S.Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials.Depress Anxiety. 2018;35(6):502–14. doi:10.1002/da.22728National Institute on Drug Abuse (NIDA).Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine).Gaudiano BA.Cognitive-behavioural therapies: Achievements and challenges.Evid Based Ment Health. 2008;11(1):5-7. doi:10.1136/ebmh.11.1.5Additional ReadingBeck JS.Cognitive Behavior Therapy: Basics and Beyond.Coull G, Morris PG.The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review.Psycholog Med. 2011;41(11):2239-2252. doi:10.1017/S0033291711000900

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A.The efficacy of cognitive behavioral therapy: A review of meta-analyses.Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1Merriam-Webster.Cognitive behavioral therapy.Rnic K, Dozois DJ, Martin RA.Cognitive distortions, humor styles, and depression.Eur J Psychol.2016;12(3):348-62. doi:10.5964/ejop.v12i3.1118Lazarus AA, Abramovitz A.A multimodal behavioral approach to performance anxiety.J Clin Psychol.2004;60(8):831-40. doi:10.1002/jclp.20041Lincoln TM, Riehle M, Pillny M, et al.Using functional analysis as a framework to guide individualized treatment for negative symptoms.Front Psychol.2017;8:2108. doi:10.3389/fpsyg.2017.02108Ugueto AM, Santucci LC, Krumholz LS, Weisz JR.Problem-solving skills training.Evidence-Based CBT for Anxiety and Depression in Children and Adolescents: A Competencies-Based Approach. 2014. doi:10.1002/9781118500576.ch17Lindgreen P, Lomborg K, Clausen L.Patient experiences using a self-monitoring app in eating disorder treatment: Qualitative study.JMIR Mhealth Uhealth.2018;6(6):e10253. doi:10.2196/10253Tsitsas GD, Paschali AA.A cognitive-behavior therapy applied to a social anxiety disorder and a specific phobia, case study.Health Psychol Res.2014;2(3):1603. doi:10.4081/hpr.2014.1603Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH.The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders.Cureus. 2017;9(8):e1626.Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191. doi:10.7326/M14-2841Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Oud M, De winter L, Vermeulen-smit E, et al.Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis.Eur Psychiatry. 2019;57:33-45. doi:10.1016/j.eurpsy.2018.12.008Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S.Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials.Depress Anxiety. 2018;35(6):502–14. doi:10.1002/da.22728National Institute on Drug Abuse (NIDA).Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine).Gaudiano BA.Cognitive-behavioural therapies: Achievements and challenges.Evid Based Ment Health. 2008;11(1):5-7. doi:10.1136/ebmh.11.1.5

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A.The efficacy of cognitive behavioral therapy: A review of meta-analyses.Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1

Merriam-Webster.Cognitive behavioral therapy.

Rnic K, Dozois DJ, Martin RA.Cognitive distortions, humor styles, and depression.Eur J Psychol.2016;12(3):348-62. doi:10.5964/ejop.v12i3.1118

Lazarus AA, Abramovitz A.A multimodal behavioral approach to performance anxiety.J Clin Psychol.2004;60(8):831-40. doi:10.1002/jclp.20041

Lincoln TM, Riehle M, Pillny M, et al.Using functional analysis as a framework to guide individualized treatment for negative symptoms.Front Psychol.2017;8:2108. doi:10.3389/fpsyg.2017.02108

Ugueto AM, Santucci LC, Krumholz LS, Weisz JR.Problem-solving skills training.Evidence-Based CBT for Anxiety and Depression in Children and Adolescents: A Competencies-Based Approach. 2014. doi:10.1002/9781118500576.ch17

Lindgreen P, Lomborg K, Clausen L.Patient experiences using a self-monitoring app in eating disorder treatment: Qualitative study.JMIR Mhealth Uhealth.2018;6(6):e10253. doi:10.2196/10253

Tsitsas GD, Paschali AA.A cognitive-behavior therapy applied to a social anxiety disorder and a specific phobia, case study.Health Psychol Res.2014;2(3):1603. doi:10.4081/hpr.2014.1603

Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH.The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders.Cureus. 2017;9(8):e1626.

Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191. doi:10.7326/M14-2841

Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004

Oud M, De winter L, Vermeulen-smit E, et al.Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis.Eur Psychiatry. 2019;57:33-45. doi:10.1016/j.eurpsy.2018.12.008

Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S.Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials.Depress Anxiety. 2018;35(6):502–14. doi:10.1002/da.22728

National Institute on Drug Abuse (NIDA).Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine).

Gaudiano BA.Cognitive-behavioural therapies: Achievements and challenges.Evid Based Ment Health. 2008;11(1):5-7. doi:10.1136/ebmh.11.1.5

Beck JS.Cognitive Behavior Therapy: Basics and Beyond.Coull G, Morris PG.The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review.Psycholog Med. 2011;41(11):2239-2252. doi:10.1017/S0033291711000900

Beck JS.Cognitive Behavior Therapy: Basics and Beyond.

Coull G, Morris PG.The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review.Psycholog Med. 2011;41(11):2239-2252. doi:10.1017/S0033291711000900

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