Cognitive Behavioral Therapy


Cognitive Behavioral Therapy

What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) is one of the most frequently used therapies to treat psychological problems. It helps patients identify and change unhelpful thought patterns that may be negatively influencing their behavior and emotions. It’s largely based on the belief that thoughts, emotions, and behaviors are connected. The way you think and feel about something or someone can affect what you do. 

CBT is a problem-solving strategy that focuses on current problems and finding solutions to them.  While it does not ignore the influence of past events, it focuses on becoming aware of current negative thinking and how to respond in a more effective way. 

CBT has several core principles including:

  • Psychological problems are partly rooted in faulty or negative ways of thinking.
  • Psychological problems are partly based on learned patterns of unhelpful behavior.
  • People who suffer from psychological problems can learn better ways to cope with them and manage their symptoms.

CBT can be used alone or in combination with other therapies, such as antidepressants or other medications. CBT itself is a combination of cognitive and behavioral therapies. Behavioral therapy assumes that behavior is learned and can be unlearned or changed. Cognitive therapy stresses the importance of a clear idea of your own thoughts, attitudes and expectations. This self-knowledge helps change false or distressing beliefs. It’s not only the situations that are causing problems, but the importance the patient attaches to them. 

Who developed cognitive behavioral therapy?

Aaron Beck of the Beck Institute in Philadelphia developed CBT in the early 1900s.

Who needs cognitive behavioral therapy?

CBT can be used to treat almost anyone as well as treat a wide variety of mental health issues. It can help manage stressful life situations, regardless of mental health diagnosis. 

What does cognitive behavioral therapy treat?

CBT has demonstrated effectiveness for many psychological concerns including:

  • Anxiety disorders, panic disorder and phobia 
  • Bipolar disorder
  • Chronic pain and physical symptoms
  • Depression
  • Eating disorders
  • Grief or loss
  • Insomnia and sleep disorders
  • Low self-esteem
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Relationship problems
  • Schizophrenia
  • Severe mental illness symptoms
  • Sexual disorders
  • Stress
  • Substance misuse
  • Trauma from abuse or violence

How does cognitive behavioral therapy work?

Patients work with their therapist to gain a clear understanding of the problem and develop a treatment strategy. The treatment strategy includes learning to identify negative thoughts, specific core ideas, or thought patterns that worsen emotional problems. The patient learns to challenge negative thought patterns, and develop strategies to replace them with healthier thoughts and behaviors.

CBT includes the use of the following strategies, although not all strategies are used with every patient:

  • Recognize distortions in thinking and learn how to reevaluate them in light of reality
  • Gain a better understanding of the behavior and motivation of others
  • Learn new problem-solving skills to cope with difficult situations
  • Develop a greater sense of confidence in one’s own abilities
  • Recognize and face fears instead of avoiding them
  • Role play to prepare for potentially difficult interactions with others
  • Learn to calm the mind and relax the body with techniques such as relaxation, stress management and assertiveness
  • Learn self-acceptance, self-confidence, and self-worth 
  • Set goals that are specific, measurable, achievable, realistic and time-limited – the SMART strategy
  • Question the assumptions you have about yourself and the current situation; consider different viewpoints about the situation
  • Journaling negative thoughts along with the positive thoughts you replace them with

CBT places an emphasis on helping individuals learn to be their own therapist. Patients practice techniques during the therapy session, and are assigned “homework” exercises to become more comfortable with and apply what they learned during therapy sessions. By developing strong coping skills, patients can change their own thinking, negative emotions and behavior. They become able to replace self-criticizing thoughts with self-compassionate ones.

Techniques include:

  • Self-talk – the therapist asks what you tell yourself about a certain situation, and challenges you to replace negative or critical self-talk with compassionate, constructive self-talk.
  • Cognitive restructuring involves looking at distortions in thinking or exaggerated thoughts, such as black-and-white thinking, jumping to conclusions, over-generalizations, or catastrophizing the scope of the situation (assuming the worst will happen, believing you’re in a worse situation than you are, or exaggerating the difficulties you face).
  • Thought recording challenges the patient to come up with unbiased evidence supporting a negative belief and the evidence against it. The comparison helps develop more realistic thoughts.
  • Positive activities can improve overall positivity and improve mood, such as scheduling a rewarding activity each day, buying yourself fresh flowers or fruit, watching your favorite movie, or taking a picnic lunch to the park.
  • Situation exposure or desensitization involves slowly exposing yourself to things or situations you fear until they lead to fewer negative feelings.

CBT typically includes these steps:

  • Identify troubling situations or conditions in your life, and decide what problems or goals you want to focus on.  
  • Become aware of your thoughts, emotions and beliefs about these problems. Observe what you tell yourself about an experience, your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. 
  • Identify negative or inaccurate thinking by paying attention to your physical, emotional and behavioral responses in different situations.
  • Reshape negative or inaccurate thinking by asking yourself whether your view of a situation is based on fact or on an inaccurate perception of reality.

These steps will help you get the most out of your therapy:

  • Approach therapy as a partnership with your therapist, including shared decision-making, agreement on the major issues to work on, goal setting, and how to assess progress.
  • Be open and honest about your thoughts and experiences. Be willing to examine new insights and ways of doing things.
  • Stick to your treatment plan and don’t skip any therapy sessions. It could disrupt your progress. 
  • Don't expect instant results. CBT is a process that can require hard work. Early in therapy you may be confronted with past and current conflicts that are painful and upsetting. It may take several sessions before you see any improvement.
  • Do your homework between sessions so you can learn to apply what you learned in therapy sessions.

Can cognitive behavioral therapy be used for couples and/or families?

The structure and tools of CBT can be tailored to one-on-one therapy, or to couples or family therapy by focusing on the intra- and interpersonal skills of each individual. Participating members learn how their own thought patterns and core beliefs play a role in the patient’s negative behaviors. Online resources are available to make participating in CBT possible in areas with few local mental health resources.

Is cognitive behavioral therapy effective?

Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications. It is particularly effective in treating anxiety, stress, and obsessive-compulsive disorder. A 2018 study of anxiety in young people showed that the results lasted long term. More than half of the study participants no longer met the diagnostic criteria for anxiety at follow-up testing, more than two years after completing therapy. CBT has strong research support as the most effective form of treatment for depression and anxiety. It has a 50-75% effective response after five to 15 sessions. 

The American Psychological Association maintains a frequently updated list of evidence-based practice guidelines for each treatment and diagnosis at: 

How long does cognitive behavioral therapy last?

Although CBT is considered a short-term therapy (from five to 20 sessions), its length depends on several factors:

  • Severity of your symptoms
  • Amount of stress you’re having
  • Length of time you’ve had symptoms
  • Type of disorder 
  • How quickly you make progress
  • Amount of support you receive from family and others

Are there any risks with cognitive behavioral therapy?

Generally, there’s no risk with CBT. However, self-examination can make you feel emotionally uncomfortable or vulnerable at times. Remembering painful experiences or emotions may upset you or make you angry. You may feel physically drained after a challenging session. Working with a skilled therapist will minimize discomfort and you’ll learn to conquer your negative feelings and fears. 

Who provides cognitive behavioral therapy?

All types of psychotherapists utilize CBT, including psychiatrists, psychologists, licensed counselors, family therapists, licensed social workers, psychiatric nurses and others licensed professionals with mental health training. Psychotherapist is a general term, not a job title, and does not indicate education, training, or licensure. 

You’ll be working with your therapist in a collaborative fashion to both understand your problem and develop an effective treatment strategy. In choosing a psychotherapist you’ll need to check their:

  • Education and mental health training. Most have a master’s or doctoral degree and specific training in psychological counseling. Psychiatrists are medical doctors who specialize in mental health and psychotherapy, and can also prescribe medications.
  • Your state’s licensure and certification for their discipline.
  • Area of expertise. Ask if they have experience with treating your symptoms or condition. 

You may meet with several therapists before you find one with whom you trust, are compatible with, and work well together.

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American Psychological Association. (2017, July) What is Cognitive Behavioral Therapy? Retrieved 2-25-22, {}
Mayo Clinic. (n.d.) Cognitive behavioral therapy. Retrieved 2-25-22, {|
healthline (n.d.) What is cognitive behavioral therapy? Retrieved 2-25-22, {}
National Center for Biotechnology Information (2016. Sept.) Cognitive behavioral therapy. Retrieved 2-25-22, {}


Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998. Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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