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:
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.
Aaron Beck of the Beck Institute in Philadelphia developed CBT in the early 1900s.
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.
CBT has demonstrated effectiveness for many psychological concerns including:
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:
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:
CBT typically includes these steps:
These steps will help you get the most out of your therapy:
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.
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: https://div12.org/treatments/.
Although CBT is considered a short-term therapy (from five to 20 sessions), its length depends on several factors:
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.
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:
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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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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