Cognitive-Behavioral Therapy - How It Works & Who Can Benefit

If you’ve ever heard anything about mental health therapy, you’ve probably heard of cognitive-behavioral therapy or CBT. It’s arguably the most common and well-known therapy method today. It has been proven to be an effective treatment for a multitude of mental health conditions, including anxiety disorders, depression, obsessive-compulsive disorder (OCD), and more.

But what, exactly, is CBT? And is it helpful for everyone?

What is cognitive-behavioral therapy (CBT)?

CBT refers to any treatment method based on the fundamental principle that our thoughts, emotions, and behaviors are all interconnected.

We often make the mistake of believing our emotional reaction to events and situations is caused by the situation itself. CBT practitioners teach your emotional reaction comes from your perception of what happened or your thoughts about the situation. They help you identify and address unhelpful thinking and behavior patterns that may be leading you to feel painful emotions like anxiety or sadness.

This might be a familiar concept to many today, but when Aaron Beck created CBT in the 1960s^[1], it was an innovative way of thinking about mental health. Before CBT, the primary way of thinking about mental health was through Freud’s psychoanalytic lens. Psychoanalysts believed all mental health problems were conflicts between the conscious and unconscious minds.

CBT built upon the first wave of behavioral therapy to change the landscape of psychological treatment. Now, it’s the most widely used form of treatment worldwide.

Types of CBT

Most therapists today incorporate a general form of CBT and help clients address unhelpful and irrational thinking patterns. In addition to this broader form of CBT, different, more tailored treatment methods fall under the CBT umbrella. These are types of CBT designed to treat specific mental health conditions.

Some examples include:

• Exposure and response prevention (ERP) is a type of CBT designed to treat obsessive-compulsive disorder (OCD). Rather than helping people challenge irrational thoughts, which isn’t effective for people with OCD, ERP helps people tolerate their intrusive thoughts without reacting with compulsions.
• Mindfulness-based cognitive therapy is a type of CBT incorporating lessons from mindfulness, an ancient practice that encourages staying present in each moment.
• Trauma-focused CBT allows you to build a narrative of past traumatic experiences and restructure the negative thinking patterns that have arisen from the experience. It’s primarily used with children and teens.
• Rational emotive behavior therapy (REBT) is a type of CBT that puts a heavier focus on the impact irrational thinking has on emotions. REBT practitioners strive to help you change these thinking patterns before painful emotions arise.
• Dialectical behavior therapy, or DBT, is considered a type of CBT by many, although it includes other types of techniques as well. DBT is a comprehensive therapy technique initially designed to help people cope with suicidal thoughts. Clients learn several different strategies in DBT, some of them being CBT-based.

Is CBT effective, and who is it effective for?

CBT is the most extensively studied mental health treatment today. The Beck Institute, named after the father of CBT, Aaron Beck, reports that over 2000 peer-reviewed studies have found CBT effective for many mental health conditions^[2]. BT has even been found to help reduce the distress associated with some physical health conditions.

Some of the health conditions CBT is effective for include:

• Major depressive disorder and other types of depression
• Generalized anxiety disorder
• Social anxiety disorder
• Insomnia and other sleep disorders
• Bipolar disorder
• Chronic pain
• Migraine
• Personality disorders, including borderline personality disorder and avoidant personality disorder
• Substance use disorders
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Part of the reason CBT is so extensively studied is that it can deliver results quickly. This doesn’t mean CBT is your only treatment option—many other holistic treatment methods can also help—but starting with CBT is typically effective.

Key principles of CBT

Every type of CBT is based on a few fundamental principles described below in detail. Understanding these basic principles can help you know what to expect if you receive CBT.

CBT Principle 1: Psychological problems are caused, in part, by unhelpful and irrational thoughts.

This is one of the core overarching principles that guide CBT. CBT is based on the foundation that our thoughts, not our external circumstances, cause emotional suffering and psychological problems. In other words, it’s not the events or life circumstances themselves – it’s how we think about these circumstances.

For example, consider two people who haven’t received a text from a friend for several days.

One of them could think, “I wonder how she’s doing. I should check in with her.” The moment could pass without causing any emotional pain. The second person could think, “She probably hates me. Why do I always lose friends like this? What is wrong with me?” The same situation could lead the second person to feel anxious and depressed.

CBT works by helping you change your thoughts to feel better emotionally.

CBT Principle 2: We all make automatic incorrect assumptions about external circumstances.

In CBT, cognitive distortions are the common automatic negative thoughts and assumptions we sometimes make. We don’t choose to have cognitive distortions, but these negative and unhelpful thinking patterns are often deeply ingrained in us. They’re automatic because we often make these assumptions without realizing they’re irrational.

Experts have defined several categories of common cognitive distortions, which are sometimes called “thinking traps.” Some examples include:

• All or nothing: Viewing situations in extreme, black-and-white terms without recognizing any middle ground or shades of gray.
• Disqualifying the positive: Focusing too heavily on the negative aspects of a situation and discounting any positives as a “fluke.”
• Catastrophizing: Exaggerating the potential adverse outcomes of a situation and expecting the worst possible scenario.
• Mind reading: Assuming you know what others think or feel without concrete evidence.
• Fortune-telling: Assuming future events will be adverse without sufficient evidence.
• Labeling: Assigning overly simplistic and negative labels to yourself or others without considering human complexities.
• Personalization: Assuming everything is your fault and blaming yourself for things outside your control.

CBT works by helping you identify when a negative thought falls into one of these cognitive distortions and to think more rationally.

CBT Principle 3: Psychological problems are also caused, in part, by unhelpful behaviors.

The “B” in CBT stands for behavioral. CBT practitioners also teach about the harmful behaviors that can lead to psychological distress.

For example, substance use, poor communication, and risky behaviors can lead your mental health to get worse. We’re also less likely to engage in positive behaviors when we live with mental health problems – for example, we may be less likely to exercise, connect with loved ones, or regularly practice good habits.

Some CBT techniques focus on helping you change your behaviors rather than your thoughts. For example, behavioral activation helps you continue engaging in healthy behaviors—like exercise—even when mental health symptoms sap your motivation. Learning healthy ways to manage stress is also an important CBT technique.

CBT Principle 4: CBT is goal-oriented, focused, and aims to be time-limited.

Unlike some other mental health therapies, like psychodynamic therapy, CBT is designed to be structured, goal-oriented, and time-limited. In other words, CBT treatment is meant to have an end goal. It shouldn’t last forever.

In your initial sessions, your therapist will discuss your treatment goals. What do you want to get out of your mental health treatment journey? How would you like to feel when this is all done, and how will you know treatment has succeeded? Clearly defined goals are essential in CBT, so your therapist may help you be more concrete about your vision.

CBT sessions also tend to be more structured than some other types of treatment. Your therapist may help you practice specific skills and even assign homework to practice skills between sessions.

Get the best mental health treatment in Washington state

At The Center • A Place of HOPE, we use a Whole Person Care approach to mental health treatment. We use evidence-based practices like CBT, but we also deeply understand mental health symptoms don’t happen in a vacuum. We also use holistic treatment methods that address your physical, emotional, spiritual, and nutritional health.

We have four decades of experience helping people like you overcome mental health concerns to live the life they dream of.

1 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9667129/
2 – https://beckinstitute.org/cbt-resources/resources-for-professionals-and-students/research-corner/