What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT) is a structured, short-term, present-oriented and goal-driven psychotherapeutic approach, which is widely used and highly effective. It is based on the premise that thoughts, emotions, and behaviors are all connected and that changing one can lead to positive changes in the others.

An example

A client is feeling depressed and anxious, has difficulty concentrating and getting their work done on time. They miss a deadline and think “I can’t do anything right.” They feel disappointed in themselves, sad or perhaps even ashamed. Instead of trying to get the work done, they give up and behave by spending the day in bed, procrastinating and avoiding the work. Laying in bed might momentarily make them feel better, but makes the problem worse in the long-term by reinforcing their belief that they “can’t do anything right” or “are a failure” or “are incapable.” CBT would help this client identify and change their negative thoughts to more positive and realistic ones like “I didn’t get it done on time, but if I keep working on it I can hand it in later today.” The aim of the therapy would be to help the client identify situations in which they are in fact capable and increase their confidence to get things done. Over time, the client will learn skills and build helpful coping strategies to manage their depression and anxiety.

What problems can CBT treat?

• Depression

• Anxiety

• Obsessive compulsive disorder (OCD)

• Specific phobias

• Eating disorders

• PTSD

• Substance use

• Insomnia

• Personality disorders

Who is it appropriate for?

CBT is suitable for almost everyone, including children, adolescents and adults. CBT can be culturally-adapted to suit clients from various backgrounds and cultures as well.

How long does CBT take?

CBT is generally considered a short-term therapy, meaning that it can be effective in a short period of time, generally anywhere from 5 to 20 sessions, though there is no set time frame. The length of therapy depends on the client’s presenting problems and goals.

How does CBT work?

CBT can be delivered in many formats, including in person or online, as well as via individual therapy, group or self-help programs. Typically the first few sessions are dedicated to the initial assessment and formulation of the treatment plan. During this time the therapist and client work together to identify the client’s problems and goals. Middle sessions are dedicated to psychoeducation, skills acquisition and techniques like cognitive restructuring and behavioral activation. During this time, the client is encouraged to identify and challenge negative and irrational thoughts and beliefs and to make behavioral changes. They also learn to identify, label and understand how their emotions are related to their thoughts and behaviors and employ relaxation and mindfulness techniques. Later sessions are dedicated to consolidating what has been learned, reflecting on progress that has been made and relapse prevention.

How is CBT different from other therapies?

• Present-focused: CBT is aimed at present circumstances and difficulties, as opposed to early childhood events and upbringing. Though the therapist will ask about your mental health history, the focus is on what your thoughts, feelings and behaviors are like now.

• Collaborative: the therapist takes an active role in CBT by structuring sessions, helping the client identify thoughts, feelings and behaviors, teaching them coping strategies and assigning action plans in between sessions. 

• Structured and time-limited: as mentioned in the question above, CBT follows a general structure, and is shorter in duration in comparison to therapies like psychoanalysis, which are more long-term and ongoing.

• Goal-oriented: in CBT, therapist and client focus on achieving the client’s specific goals by implementing strategies and reflecting on progress.

• Action-oriented: CBT is action-oriented in that it focuses on making changes and building healthy habits and coping strategies. The goal of CBT is to equip the client with resources and tools that they can use on their own, which can often have a long-lasting positive impact on their life.

• Evidence-based: CBT has been extensively researched and studied in many different populations, disorders and settings. Thousands of randomized controlled trials (RCTs) have been conducted on CBT. It has a strong evidence-base suggesting its efficacy in the treatment of a range of mental health conditions. Research also indicates that CBT is equally effective when delivered online as it is in person. See specific research links below.

How effective is CBT?

CBT has been shown to be highly effective as a treatment for several disorders in a variety of populations. Research shows that it is equally effective online as it is in person. Research supports the efficacy of CBT for many disorders. CBT is very effective for adult depression, anxiety, panic disorder, social phobia, PTSD, as well as childhood depressive and anxiety disorder. It is also effective for marital distress, anger, somatic disorders and chronic pain. CBT has been shown to be superior to the use of antidepressant medication in the treatment of adult mild to moderate depression.