Cognitive Behavioral Therapy, What Is It and How it Works

Written by Kimberly Holland and Katie Nave

Cognitive behavioural therapy (CBT) is a type of psychotherapy. This form of therapy modifies thought patterns to help change moods and behaviours.

It’s based on the idea that negative actions or feelings are the results of current distorted beliefs or thoughts, not unconscious forces from the past.

CBT is a blend of cognitive therapy and behavioural therapy. Cognitive therapy focuses on your moods and thoughts. Behavioural therapy specifically targets actions and behaviours.

A therapist practising the combined approach of CBT works with you in an agreed-upon location, offering guidance and direction. You and your therapist may work to identify specific negative thought patterns and behavioural responses to challenging or stressful situations.

This type of therapy is commonly used for a wide range of mental health challenges and diagnoses, including:

- depression
- anxiety
- eating disorders
- post-traumatic stress disorder (PTSD)
- insomnia
- obsessive-compulsive disorder (OCD)
- bipolar disorder
- phobias
- chronic pain
- panic attacks

Treatment typically involves developing more balanced and constructive ways to respond to stressors. Ideally, these new responses will help you cope with or recover from challenging mental health conditions or unwanted behaviours.

The principles of CBT can be applied outside of the therapist’s office, providing you with coping tools to help you through life’s challenges. CBT teaches you to become aware of and adjust negative patterns, which can help you reframe your thinking during moments of heightened anxiety or panic.

It can also provide new coping skills, like meditation or journaling, for those struggling with a substance use disorder or depression.

How does CBT work?

CBT is a more short-term approach than psychoanalysis and psychodynamic therapies. Other types of therapies may require several years for discovery and treatment.

CBT often requires only up to 20 sessions, according to the National Health Services, but you can continue seeing your therapist for as long as you need. Every situation is unique, so how long you pursue treatment is up to you and your therapist.

CBT sessions provide opportunities to identify current life situations that may be causing or contributing to your mental health conditions, like anxiety or depression. CBT allows you and your therapist to identify patterns of thinking or distorted perceptions that are no longer serving you.

This is different from psychoanalysis. This type of therapy involves working backward through your life history to discover an unconscious source of the problems you’re facing.

You may be asked to keep a journal as part of CBT. The journal provides a place for you to record life events and your reactions. Your therapist can help you break down reactions and thought patterns into several categories of self-defeating thought (also known as cognitive distortions).

These may include:

- all-or-nothing thinking: viewing the world in absolute, black-and-white terms
- disqualifying the positive: rejecting positive experiences by insisting they “don’t count” for some reason
- automatic negative reactions: having habitual, scolding thoughts
- magnifying or minimizing the importance of an event: making a bigger deal about a specific event or moment
- overgeneralization: drawing overly broad conclusions from a single event
- personalization: taking things too personally or feeling actions are specifically directed at you
- mental filter: picking out a single negative detail and dwelling on it exclusively so that the vision of reality becomes darkened

You and your therapist can also use the journal to help replace negative thought patterns or perceptions with more constructive ones. This can be done through a series of well-practised techniques, such as:

- learning to manage and modify distorted thoughts and reactions
- learning to accurately and comprehensively assess external situations and reactions or emotional behaviour
- practising self-talk that is accurate and balanced
- using self-evaluation to reflect and respond appropriately

You can practice these coping methods on your own or with your therapist. Alternately, you can practice them in controlled settings in which you’re confronted with challenges. You can use these settings to build on your ability to respond successfully.

How can CBT help with depression?

If you’re someone who struggles with depression, your therapist may use CBT techniques to help you uncover unhealthy patterns of thought and identify how they may be affecting:

- your mood
- beliefs about yourself
- your overall outlook on life
You may also be assigned “homework” so that you can practice replacing negative thoughts with more positive thoughts in real time.

How well does CBT work for depression?

CBT has been proven to be effective in treating mild to moderate levels of depression. In some cases, it can be combined with other treatments, like antidepressants or other medications, to treat depression.

What other conditions can CBT treat?

Cognitive behavioural therapy is widely used to treat an array of mental health conditions in children, adolescents, and adults. These may include:

- antisocial behaviours (including lying, stealing, and hurting animals or other people)
- anxiety
- attention deficit hyperactivity disorder
- bipolar disorder
- conduct disorder
- depression
- eating disorders such as binge eating, anorexia, and bulimia
- general stress
- personality disorders
- phobias
- schizophrenia
- sexual disorders
- insomnia
- social skill problems
- substance use disorder

In certain cases, cognitive behavioural therapy may be combined with other treatments to help with depression.

Are there any risks?

There is little long-term emotional risk associated with CBT. But exploring painful feelings and experiences can be stressful. Treatment may involve facing situations you’d otherwise avoid.

For instance, you may be asked to spend time in public places if you have a fear of crowds. Alternately, you may need to confront difficult sources of trauma, like the death of a loved one.

These scenarios can provide opportunities to practice altered responses to stressful or adverse situations. The eventual goal of therapy is to teach you how to deal with anxiety and stress in a safe and constructive manner.

What experts say

“There is a massive tidal wave of evidence for cognitive behavioural therapy that suggests it is very effective at treating certain problems,” Simon Rego, PsyD of Montefiore Medical Center in New York, told Healthline. “The breadth of evidence isn’t as extensive for other forms of psychotherapy.”

That’s not to say other therapies aren’t equally effective and beneficial. “They just don’t fit as neatly into anything that can be studied,” Rego says. “More evidence-based studies have been conducted on the results of cognitive behavioural therapy than any other kind.”

What can I expect from CBT?

Your CBT experience will be unique based on your situation but know that there is no right or wrong way to experience therapy.

Your therapist will take time to get to know you, so be prepared to discuss:

- what brought you to therapy
- your mental health history
- current circumstances

Will CBT help my depression?

CBT has been found to be effective in treating those with mild to moderate depression. It has also been proven effective when combined with other treatment options, like antidepressants or other medications.

Remember that change is often gradual, requiring a time commitment and the willingness to be open to the experience.

Takeaway

Cognitive behavioural therapy (CBT) is a type of psychotherapy that helps you recognize and replace negative or unhelpful thought and behaviour patterns. It can be a highly rewarding and effective form of mental health support for those affected by anxiety, depression, OCD, insomnia, substance use disorder, and more.

CBT requires a willingness to be open to change, along with a time commitment to do the work with your trusted therapist.

The goal of CBT is to help you develop the skills to help deal with difficulties on your own, at the moment when they come up, ideally giving you tools that last a lifetime.

Content source: https://www.healthline.com/health/depression/cognitive-behavioral-therapy