How does Cognitive Behavioral therapy improve the conditions of patients with emotional and mental challenges?

Cognitive behavioral therapy (CBT) is a treatment approach that helps you recognize negative or unhelpful thought and behavior patterns.

CBT aims to help you identify and explore the ways your emotions and thoughts can affect your actions. Once you notice these patterns, you can begin learning how to change your behaviors and develop new coping strategies.

CBT addresses the here and now, and focuses less on the past. For some conditions in some people, other forms of psychotherapy are equally or even more effective. The key is that there is no one size that fits all.

Read on to learn more about CBT, including:

• core concepts
• what it can help treat
• what to expect during a session

CBT is largely based on the idea that your thoughts, emotions, and actions are connected. In other words, the way you think and feel about something can affect what you do.

If you’re under a lot of stress at work, for example, you might see situations differently and make choices you wouldn’t ordinarily make. But another key concept of CBT is that these thought and behavior patterns can be changed.

According to the American Psychological Association, the core concepts of CBT include:

1. psychological issues are partly based on unhelpful ways of thinking
2. psychological issues are partly based on learned patterns of behavior
3. those living with these issues can improve with better coping mechanisms and management to help relieve their symptoms

The cycle of thoughts and behaviors

Here’s a closer look at how thoughts and emotions can influence behavior — in a positive or negative way:

• Inaccurate or negative perceptions or thoughts contribute to emotional distress and mental health concerns.
• These thoughts and the resulting distress sometimes lead to unhelpful or harmful behaviors.
• Eventually, these thoughts and resulting behaviors can become a pattern that repeats itself.
• Learning how to address and change these patterns can help you deal with problems as they arise, which can help reduce future distress.

So how does one go about reworking these patterns? CBT involves the use of many varied techniques. Your therapist will work with you to find the ones that work best for you.

Typical treatment often involves the following:

• recognizing how inaccurate thinking can worsen problems
• learning new problem-solving skills
• gaining confidence and a better understanding and appreciation of your self-worth
• learning how to face fears and challenges
• using role play and calming techniques when faced with potentially challenging situations

The goal of these techniques is to replace unhelpful or self-defeating thoughts with more encouraging and realistic ones.

For example, “I’ll never have a lasting relationship” might become, “None of my previous relationships have lasted very long. Reconsidering what I really need from a partner could help me find someone I’ll be compatible with long term.”

These are some of the most popular techniques used in CBT:

• SMART goals. SMART goals are specific, measurable, achievable, realistic, and time-limited.
• Guided discovery and questioning. By questioning the assumptions you have about yourself or your current situation, your therapist can help you learn to challenge these thoughts and consider different viewpoints.
• Journaling. You might be asked to jot down negative beliefs that come up during the week and the positive ones you can replace them with.
• Self-talk. Your therapist may ask what you tell yourself about a certain situation or experience and challenge you to replace negative or critical self-talk with compassionate, constructive self-talk.
• Cognitive restructuring. This involves looking at any cognitive distortions affecting your thoughts — such as black-and-white thinking, jumping to conclusions, or catastrophizing — and beginning to unravel them.
• Thought recording. In this technique, you’ll record thoughts and feelings experienced during a specific situation, then come up with unbiased evidence supporting your negative belief and evidence against it. You’ll use this evidence to develop a more realistic thought.
• Positive activities. Scheduling a rewarding activity each day can help increase overall positivity and improve your mood. Some examples might be buying yourself fresh flowers or fruit, watching your favorite movie, or taking a picnic lunch to the park.
• Situation exposure. This involves listing situations or things that cause distress, in order of the level of distress they cause, and slowly exposing yourself to these things until they lead to fewer negative feelings. Systematic desensitization is a similar technique where you’ll learn relaxation techniques to help you cope with your feelings in a difficult situation.

Homework is another important part of CBT, regardless of the techniques you use. Just as school assignments helped you practice and develop the skills you learned in class, therapy assignments can help you become more familiar with the skills you’re developing.

This might involve more practice with skills you learn in therapy, such as replacing self-criticizing thoughts with self-compassionate ones or keeping track of unhelpful thoughts in a journal.

CBT is one of the most studied therapy approaches. In fact, many experts consider it to be the best treatment available for a number of mental health conditions.

Here’s some research behind it:

• A 2018 review of 41 studies looking at CBT in the treatment of anxiety disorders, PTSD, and OCD found evidence to suggest that it could help improve symptoms in all of these situations. The approach was most effective for OCD, anxiety, and stress.
• A 2018 study looking at CBT for anxiety in young people found that the approach appeared to have good long-term results. More than half of the participants in the study no longer met criteria for anxiety at follow-up, which took place 2 or more years after they completed therapy.
• Research published in 2011 suggests that CBT can not only help treat depression, but it may also help reduce the chances of relapse after treatment. Additionally, it may help improve symptoms of bipolar disorder when paired with medication, but more research is needed to help support this finding.
• One 2017 study looking at 43 people with OCD found evidence to suggest brain function appeared to improve after CBT, particularly with regard to resisting compulsions.
• A 2018 study looking at 104 people found evidence to suggest CBT can also help improve cognitive function for people with major depression and PTSD.
• Research from 2010 shows that CBT can also be an effective tool when dealing with substance misuse. According to the National Institute on Drug Abuse, CBT can also be used to help people cope with addiction and avoid relapse after treatment.
• Newer research from 2020 and 2021 even shows that both virtual and internet-based CBT hold promise for effective treatment. More research is needed to see how to best treat people virtually and if blended techniques could also be beneficial.

Cognitive behavioral therapy is often considered the gold standard of psychotherapy — but it’s certainly not the only approach. Read on to discover the different types of therapy and which one may work best for your needs.

Psychodynamic therapy

Psychodynamic therapy is often a longer-term approach to mental health treatment compared with CBT.

Psychodynamic therapy was developed from psychoanalysis, where you are encouraged to talk about anything on your mind to uncover patterns in thoughts or behavior. In psychodynamic therapy, you’ll examine your emotions, relationships, and thought patterns to explore the connection between your unconscious mind and your actions.

This form of therapy can be useful for addressing a variety of mental health conditions including depression, anxiety, eating disorders, and substance use disorder.

Behavioral therapy

According to behavioral theory, certain behaviors that might affect your life negatively develop from things you learned in your past. In behavioral therapy, instead of focusing on unconscious reasons for your behaviors, your therapist will help you identify ways to change behavioral reactions and patterns that cause distress.

Behavioral therapy is often focused on current issues and how to change them. People most commonly seek this form of therapy to treat depression, anxiety, panic disorders, and anger issues.

Humanistic therapy

Humanistic therapy is based on the idea that your unique worldview impacts your choices and actions. In this therapeutic approach, you’ll work with a therapist to better understand your worldview and develop true self-acceptance.

Humanistic therapy tends to focus more on your day-to-day life than other types of therapy. Humanistic therapists work from the idea that you are the expert in your difficulties, and they will let you guide the direction of your sessions, trusting that you know what you need to talk about. Instead of treating a specific diagnosis, this form of therapy is often used to help you develop as a whole.

It’s important to note that this comparison of therapeutic approaches, subtypes, and issues that each type of therapy is useful for addressing is not exhaustive. Each therapist will take their own approach when working with clients, and the type of therapy that works best for you will depend on a number of factors.

CBT can be used for a wide variety of mental health issues — as mentioned above — and including schizophrenia, insomnia, bipolar disorder, and psychosis. Some people even turn to CBT for help coping with chronic health issues, like irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia. That said, some sources say CBT may not be for people who have brain diseases, brain injuries, or other issues that impact thinking.

Whereas other types of therapy may look at how previous events have affected your current state of mind, CBT tends to focus much more on current issues and moving forward. CBT also focuses exclusively on the individual versus any family problems or other situations that may impact a person’s life.

Perhaps most important of all, CBT is for people who want to take a very active role in their own healing process. While the therapist helps to break down different thoughts and feelings in therapy sessions, each session likely involves getting some type of homework intended to apply different learned coping skills in everyday life.

There are benefits to engaging in any type of therapy — not just for yourself, but also for your family members, partner, or other people in your life.

Benefits and pros specifically related to CBT:

• The overall course of therapy is short. The duration of therapy tends to be shorter than in other types — typically five to 20 sessions in all.
• As a result, CBT may be more affordable than other options that take place over a longer period of time. It may also be more affordable if you get it in a group setting.
• CBT reaps long-term results. Research on depression shows that people who have had CBT are less likely to relapse than people who took antidepressant medications with no therapy.
• Sessions are flexible and offered in various formats. For example, you can go to in-person sessions that are either individual or group. Some people even get CBT online or via phone.
• Skills learned in therapy can be applied directly to everyday life. The goal of CBT is to give tools to the person receiving therapy. These tools help them take control of their issues during the course of therapy and beyond.
• Playing an active role in healing may be empowering to people who get CBT. With time, the goal for people in therapy is to overcome issues on their own using the tools they picked up in their sessions.
• CBT be used with or without medication. Some people may only need CBT while others may find it a useful complement to medications they are taking.

Beginning therapy can seem overwhelming. It’s OK to feel nervous about your first session. You might wonder what the therapist will ask. You may even feel anxious about sharing your difficulties with a stranger.

CBT sessions tend to be very structured, but your first appointment may look a bit different.

Here’s a high-level look at what to expect during that first visit:

• Your therapist will ask about symptoms, emotions, and feelings you experience. Emotional distress often manifests physically, too. Symptoms such as headaches, body aches, or stomach upset may be relevant, so it’s a good idea to mention them.
• They’ll also ask about the specific difficulties you’re experiencing. Feel free to share anything that comes to mind, even if it doesn’t bother you too much. Therapy can help you deal with any challenges you experience, large or small.
• You’ll go over general therapy policies, such as confidentiality, and talk about therapy costs, session length, and the number of sessions your therapist recommends.
• You’ll talk about your goals for therapy, or what you want from treatment.

Feel free to ask any questions you have as they come up. You might consider asking:

• about trying medication along with therapy, if you’re interested in combining the two
• how your therapist can help if you’re having thoughts of suicide or find yourself in a crisis
• if your therapist has experience helping others with similar concerns
• how you’ll know therapy is helping
• what will happen in the other sessions

In general, seeing a therapist you can communicate and work well with will help you get the most out of your therapy sessions. If something doesn’t feel right about one therapist, it’s perfectly OK to see someone else. Not every therapist will be a good fit for you or your situation.

CBT can be helpful. But if you decide to try it, there are a few things to keep in mind.

It’s not a cure

Therapy can help improve concerns you’re experiencing, but it will not necessarily eliminate them. Mental health issues and emotional distress could persist, even after therapy ends.

The goal of CBT is to help you develop the skills to deal with difficulties on your own in the moment when they come up. Some people view the approach as training to provide their own therapy.

Results take time

CBT can last for weeks or months, usually with one session each week. In your first few sessions, you and your therapist will likely talk about how long therapy might last.

That being said, it’ll take some time before you see results. If you don’t feel better after a few sessions, you might worry therapy isn’t working, but give it time. Keep doing your homework and practicing your skills between sessions.

Undoing deep-set patterns is major work, so go easy on yourself.

It can be challenging

Therapy can challenge you emotionally. It often helps you get better over time, but the process can be difficult. You’ll need to talk about things that might be painful or distressing. Don’t worry if you cry during a session — it can be a typical experience during therapy.

It’s just one of many options

While CBT can be helpful for many people, it does not work for everyone. If you don’t see any results after a few sessions, do not feel discouraged. Check in with your therapist.

A good therapist can help you recognize when one approach is not working. They can usually recommend other approaches that might help more.

How to find a therapist

Finding a therapist can feel daunting, but it does not have to be. Start by asking yourself a few basic questions:

• What issues do you want to address? These can be specific or vague.
• Are there any specific traits you’d like in a therapist? For example, are you more comfortable with someone who shares your gender?
• How much can you realistically afford to spend per session? Do you want someone who offers sliding-scale prices or payment plans?
• Where will therapy fit into your schedule? Do you need a therapist who can see you on a specific day of the week? Or someone who has sessions at night?
• Next, start making a list of therapists in your area. If you live in the United States, head over to the American Psychological Association’s therapist locator.

Concerned about the cost? Our guide to affordable therapy can help.

Typical CBT treatment often involves identifying personal beliefs or feelings that negatively impact your life and learning new problem-solving skills. Your therapist will work to help you gain confidence and better understand and appreciate your self-worth by facing fears and learning to use calming techniques during challenging situations.

There are a number of techniques your therapist might use during a session, but some of the most popular involve:

• setting achievable goals
• practicing cognitive restructuring
• journaling
• undergoing situation exposure

A cognitive behavioral therapist will often assign homework to help you practice the skills you learn in therapy, such as replacing self-criticizing thoughts or journaling.

What are some cognitive behavioral interventions?

There are a number of interventions, or techniques, used during CBT.

All cognitive behavioral interventions share a number of general characteristics, including:

• therapist-client collaboration
• an emphasis on environment-behavior relations
• a time-limited and present focus

Common CBT techniques include:

• thought recording and journaling
• exposure therapy
• role-playing

What can I expect in CBT?

CBT focuses on finding ways to change current thought patterns and behaviors that are negatively impacting your life.

CBT is usually a short-term process that provides you with tools to solve problems you are currently going through. While specific goals should be set by you and the therapist, the general goal of CBT is to reframe your negative thoughts into positive feelings and behaviors.

What are examples of cognitive behavioral therapy?

Examples of CBT techniques might include the following:

• Exposing yourself to situations that cause anxiety, like going into a crowded public space.
• Journaling about your thoughts throughout the day and recording your feelings about your thoughts.
• Engaging in mindfulness meditation, where you tune into the thoughts that come into your mind and let them pass without judgment.
• Looking at overwhelming tasks in a new way by breaking them up into smaller, more manageable pieces.
• Scheduling activities that make you nervous or give you anxiety.
• Role-playing to practice social skills or to improve your communication skills.

What is the goal of CBT?

People come to therapy for a variety of reasons, so the individual goal will vary by person. With CBT, the ultimate goal is to focus on the relationship between thoughts, feelings, and behaviors.

Through therapy, exercises, and homework, a therapist encourages people to recognize and gain control over their automatic thoughts and to learn ways to change their behaviors. As a result, a person may feel better, leading to a more positive cycle between these three things.

In other words: Positive feelings = positive thoughts = positive behaviors.

CBT may be a good therapy choice for you if you’re looking for something that’s focused on current problems you’re facing versus those that happened in the past.

It’s a short-term therapy that requires you to be actively involved in the process. Meeting with a therapist can help you identify your therapy goals and discover whether CBT or its subtypes are the right choice in your particular situation.

If CBT isn’t what’s best for you, there are various other types of therapy that may be a better fit. Reach out to a doctor or a licensed mental health professional for help navigating the options.