Cognitive Behavioral Therapy (CBT) for Mental Health

Reviewed by Jenna Neilsen, MSW, LCSW, a clinical social worker/therapist at ADHD Advisor, with specializations in anxiety, depression, ADHD, PTSD, and relationships

What is cognitive behavioral therapy (CBT)?

Are you worried and anxious much of the time? Do you feel overwhelmed, hopeless, or unable to control intrusive thoughts? Cognitive behavioral therapy (CBT) or “talk therapy” examines how your thoughts, emotions, and behavior are connected. The main principle of CBT is to increase awareness of your negative thinking so you can respond to challenges in a more effective way.

CBT is conducted through a series of structured sessions in collaboration with a mental health professional. The goal is to provide tools that can be applied to manage unhealthy thinking and behavioral patterns in order to reduce distress.

Cognitive behavioral therapy can be useful for treating many different issues, including depression, anxiety, PTSD, substance abuse, and eating disorders. It can also help with emotional trauma, dealing with grief and loss, managing physical symptoms of a chronic illness, or coping with the stressful circumstances of daily life. CBT alone may be recommended if medication isn’t the best option, or it may be used in combination with other treatments and lifestyle changes.

Taking the first step towards change is often the hardest part. If you’re hesitant about trying CBT, keep in mind that it is a short-term technique which involves minimal risk or side effects. CBT can be delivered in person, either individually or in a group setting with family members or other people with similar concerns. Online therapy sessions have become increasingly popular, particularly during the pandemic, and can be a great option if you don’t have access to local mental health resources or feel more comfortable talking from home.

How CBT works

As the name implies, cognitive behavioral therapy is formulated on two different components: thoughts (cognition) and behaviors.

The cognitive aspect of CBT

The cognitive aspect is applied to what we think about and how this is processed. This is composed of core beliefs, dysfunctional assumptions, and negative automatic thoughts.

Negative core beliefs are learned early in life, primarily based on childhood experiences. For example, you may have formed negative views about yourself, the world around you, or how you see the future. You may also have negative core beliefs about other people, assuming they can’t be trusted or always have ulterior motives.

Dysfunctional of false assumptions about yourself could include the belief that you're somehow inadequate or “My worth is connected with what others think of me.”

One of the primary cognitive components of CBT is to increase awareness of these types of views and how your thinking is based on long standing, negative assumptions. To accomplish this, your therapist may suggest:

Keeping thought records to help you recognize negative thinking patterns that may not actually be true. For example, you may think “Nobody cares about me,” or “If I don’t do well, it means I’m a failure.” As you become more aware of these negative thoughts, you can learn to reframe or replace them with more positive views, such as “Nobody is perfect. We all make mistakes, but that doesn’t mean I’m a failure.” Reframing your thoughts can also help you learn to view problems as challenges, rather than dwelling on them and feeling overwhelmed.

[Read: How to Stop Worrying]

Role-playing. Your therapist may take on the role of another person in order to re-enact an anxiety-provoking situation. For example, if you’re fearful about going to the doctor for a check-up, the therapist will assume the role of the doctor and act out the scenario with you. Over time, this can help you build your confidence and find the best way to handle this type of situation in the future. The next time you see your doctor, you’ll have a less stressful experience because you’ve already worked out the issues that were making you feel worried or afraid.

The behavioral aspect of CBT

The behavioral component of CBT is most often used for anxiety-related disorders. This usually involves:

Activity scheduling. Planning each day in advance can make it seem more manageable, improve your decision-making, and reduce worry. Activity scheduling also helps you look forward to activities you enjoy to boost your mood and outlook—whether it’s taking a leisurely walk, getting involved in a community group, going out with friends, or visiting a museum.

Graded task assignments are manageable steps to decrease apathy and procrastination and overcome anxiety-provoking situations. If you’re depressed or anxious, for example, but want to plan an outing with a friend to go to a movie, the first step might be deciding which friend to go with. The next steps could involve calling your friend and choosing which movie to see. The final step would be following through and actually going to the movie theatre with your friend.

Testing out anxiety-producing predictions. These types of tasks are introduced gradually so that you learn to tolerate anxiety over time. For example, if you’re fearful about leaving the house, you may be asked to walk down the street and see if something bad actually happens. This technique can also help address avoidance behaviors that prevent you from facing your fears.

Learning relaxation and breathing techniques can be extremely useful for minimizing anxiety or alleviating a panic attack. Deep breathing exercises and mindfulness meditation are effective ways to relieve stress, focus on the present moment, and disconnect yourself from obsessive or negative thoughts. Your therapist may recommend listening to a guided meditation or practicing relaxation techniques whenever you’re feeling anxious.

Benefits of CBT

CBT has been referred to as the “gold standard” of treatment because it is considered to be a highly effective approach for numerous problems. Research studies have shown that CBT can greatly improve quality of life and overall functioning.

With CBT, you can achieve more self-awareness and take control of negative self-talk. At the completion of your CBT treatment, you should be able to reframe negative thinking patterns and change your behavior. Since you will no longer be stuck in an unproductive mindset, you will feel less anxious and depressed. This will enable you to find more enjoyment in your daily life and feel motivated to make healthier lifestyle choices such as exercising regularly, eating more nutritious foods, and making sleep a priority.

Along with improving coping skills, CBT can also be effective for building self-esteem and self-confidence. The problem-solving abilities you’ll gain can be applied to all areas of your life. This also facilitates better decision-making and less procrastination when faced with challenges. CBT can also teach you how to communicate more effectively and manage your emotions to improve your relationships.

While the benefits are numerous, CBT is not suitable for everyone, so it’s important to consider both the pros and cons of talk therapy.

Advantages of CBT

• CBT can be tailored to the individual in order to target specific goals or problems.
• It can provide everyday skills and coping strategies that are easy to use.
• It offers support and accountability as you work in conjunction with a therapist or other mental health professional.
• Can be just as effective as medication in treating many mental health issues in the long-term.
• The treatment can be completed in a relatively short period of time, as compared to other types of therapy.
• Various tools can be incorporated to enhance the process, such as books, videos, apps, and computerized programs.

Disadvantages

• As with any type of therapy, finding the right therapist that you trust and feel comfortable with may take some work.
• CBT may bring up issues that make you feel uncomfortable. This may initially create additional anxiety or worsen existing behavioral problems.
• The focus of CBT is on addressing the issues you are currently facing, not causes or symptoms stemming from the past.

Types of CBT

There are various types of CBT that may be recommended by your therapist, depending on the specific issues you are dealing with. The goals remain the same for all types—to modify your negative ways of thinking and develop more effective coping skills.

Some of the main types of CBT include:

Dialectical behavior therapy (DBT) was developed mainly to treat people with borderline personality disorder (BPD), but is now used for a variety of mental health issues, including ADHD, eating disorders, substance abuse, and PTSD. DBT is similar to CBT, but is more focused on coming to terms with uncomfortable feelings, emotions, and behaviors. This can improve coping skills and problem-solving abilities to cultivate more resilience.

Mindfulness-based cognitive therapy (MBCT) combines CBT with meditation to treat anxiety, depression, and bipolar disorder. You may be familiar with mindfulness techniques for stress reduction or as part of a yoga practice. The goal of MBCT is to help you become less-judgmental and concentrate more on a present-moment mindset.

Acceptance and commitment therapy (ACT) utilizes strategies related to acceptance and mindfulness to increase the ability to concentrate on a present-oriented state of being. With ACT, you will be working towards behavior change by dealing with thoughts, feelings, and memories that you have been avoiding.

Rational emotive behavior therapy (REBT) was the foundation for CBT and is based on how our thoughts influence our behavior. The three principles are activating events, beliefs, and consequences. We often have irrational thoughts and beliefs that shape our behavior on a daily basis, even though we may not be consciously aware of these thoughts. This therapy promotes the development of more rational thinking to foster healthier behaviors and responses to situations.

Exposure therapy is a type of CBT used for obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and various phobias and irrational fears. The triggers for your anxiety are identified and specific techniques are applied to reduce these sensations. One method of exposure therapy targets these triggers all at once time (flooding). The other strategy is a more gradual process of dealing with different triggers over a period of time (desensitization).

[Read: Therapy for Anxiety Disorders]

Interpersonal therapy (IPT) is most often used to treat depression, but is also effective for other mental health conditions. In these sessions, a therapist will help you examine your relationships with other people and work on developing better social skills to improve interactions with others.

What to expect from CBT

During CBT sessions with a therapist, you will work together to identify problems and find workable solutions to manage these problems. The goals you will focus on the ‘SMART’ model: Specific, Measurable, Achievable, Realistic, and Time-limited.

Your therapist will help you prioritize these goals and set up incremental steps to achieve them. If you’re feeling depressed, for instance, you may have a hard time setting goals or believing that you can attain them. Having the support of a mental health professional can enable you to develop more realistic goals and maintain your motivation throughout the course of treatment.

You may also be given “homework” assignments to guide you during therapy, such as journaling to record your disturbing thoughts or practicing breathing exercises when you’re feeling anxious. All of these components will be important steps in the healing process.

Your first CBT sessions

CBT is a time-limited treatment that is usually completed in 5-20 sessions. You will generally meet with a therapist once-a-week or once every two weeks. Each session lasts about 30-60 minutes.

The first session is primarily an assessment of your current situation. The therapist will ask questions about the challenges you’re facing and how any feelings of anxiety or depression are interfering with your family life, work, or personal relationships. They may also go over a treatment plan that will benefit you.

This is also a time to begin evaluating whether there is a good rapport between you and the therapist.

[Read: Finding a Therapist Who Can Help You Heal]

During your early sessions, the therapist will outline the expectations related to the course of treatment. You will work as a team with the therapist to break down problems into more manageable parts.

Your thoughts, feelings, and behaviors will be addressed through various tasks and exercises. While the aim will be to change specific thoughts and behaviors that are not serving you well in your life, rest assured that you will not be expected to do anything you don’t feel comfortable with.

In subsequent sessions, you will focus on applying these desired modifications to your daily life. By practicing coping techniques and other helpful skills, you will be better able to function independently once the CBT sessions have been completed. This will increase the likelihood that your anxiety, depression, and other symptoms will not resurface.

How to know if CBT is working

During the course of treatment, you will be able to assess whether CBT is having a positive impact. Here are a few indications:

• You are developing new skills that are modifying negative thinking and behaviors in your life.
• You are making headway towards achieving long-term goals by breaking them down into smaller steps.
• Your therapist is able to measure results and provide evidence of your progress with specific tests and exercises.
• You are feeling more optimistic and connected to friends and family members.
• Others have observed and commented on the progress you’re making and are supportive of your efforts.
• You look forward to your CBT sessions and feel motivated to continue with the work.

Your mental health provider should give you an estimated time frame for when you will begin to see results. Some conditions will improve after only about 12 sessions, but others may take a few months.

If you are uncertain about whether the treatment is working, be sure to share your concerns with your therapist. There’s no shame in asking for additional help. Your therapist may recommend combining CBT with medication or trying another type of talk therapy or counseling. The most important thing is to make sure you’re receiving the help you need.

Getting the most from CBT

CBT is a commitment that takes work on your part for a successful outcome. You will be entering into a partnership with a therapist, and how you incorporate their guidance to your advantage is up to you. You will reap the most benefit if you:

Follow through with all the sessions as outlined by your therapist and complete any homework, graded task assignments, or activity scheduling exercises.

Openly share your feelings with your therapist. This includes letting your therapist know if you feel the therapy is not working or is not the right fit for you. You should feel comfortable and have a good rapport with your therapist in order to move forward. There are many therapists to choose from and various types of therapies that can be tailored to your individual needs.

Are ready and willing to change. CBT can be highly effective if you are willing to devote the necessary time and effort it takes to apply these skills to your daily life.

One of the most significant outcomes of CBT is understanding that you have the ability to make changes in your life. CBT can help you realize that other people and outside situations are not responsible for your problems—but rather, it’s often your own thoughts and reactions that create these negative perspectives.

When you change your thoughts, you also change the way you feel and behave. By eliminating “black and white” (all-or-nothing) thinking, you can expand your horizons and embrace a more holistic view of the world. These changes can support the effort you put forth in therapy and offer greater fulfillment in your life.

Last updated or reviewed on December 21, 2023