Cognitive Behavioral Therapy (CBT): How, When, And Why It Works

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Psych CentralSubscribeAll About Cognitive Behavioral Therapy (CBT)

Medically reviewed by Ashleigh Golden, PsyD — Written by Kate Bettino — Updated on June 2, 2021

How it works
Key principles
Common goals
Benefits
Drawbacks
What to expect
Is it right for me?

Cognitive behavioral therapy (CBT) is an evidence-based and widely used form of psychotherapy that’s helped many people around the world.

Therapists use cognitive behavioral therapy to help people with mental and physical health challenges like:

depression
anxiety
trauma
chronic pain
irritable bowel syndrome (IBS)

The goal of CBT is to help you adapt and change your mindset and behaviors by reassesing distorted thought patterns.

Whether you’re living with a mental health condition or just keep finding yourself worrying about the little things, CBT could be a helpful tool if you’re looking for an evidence-backed therapy to relieve persistent mental health symptoms.

How does cognitive behavioral therapy work?

Basically, CBT works by identifying, tackling, and changing unhelpful thinking so that your mindset, behaviors, and overall well-being improve with practice.

When you change the way you feel about specific situations, for example, it will likely be easier to adapt your behaviors in the future.

In mental health conditions like depression, anxiety, substance use, phobias, and many others, negative thinking takes many forms, like:

thinking in black and white
overgeneralizing
ignoring the positive and focusing on the negative
catastrophizing

In CBT, you’ll work with your therapist to identify the thinking patterns that cause your distress. This is an important step in managing overwhelming emotions and unhelpful behaviors.

Though many people think therapy is just chatting with a doctor, CBT is actually very structured and tailored to each person.

Over time, you’ll learn CBT techniques to acknowledge and challenge thoughts that get in your way.

CBT strategies might include:

keeping track of your thoughts and reviewing them later
confronting situations that create anxiety to learn coping mechanisms
practicing problem-solving with your therapist
role-playing interactions with others

By practicing CBT strategies like these with your therapist — and at home by yourself — you’ll develop useful skills like:

gaining awareness of unhelpful thoughts and how they impact your emotional state
getting a more logical understanding of other people’s actions
challenging automatic assumptions
accurately assessing reality
coping with triggering or upsetting situations
learning positive self-talk and how to boost confidence
relaxation techniques

The idea is to apply the skills you learn in therapy to your daily life. It’s like exercising any muscle to make it stronger, except this time that muscle is your brain.

It requires both you and your therapist to be collaborative, committed, and communicative.

What’s the principle behind CBT?

In the 1960s, psychiatrist Aaron Beck realized that the people he helped with depression often showed specific thinking patterns that didn’t serve them.

He explained emotional conditions using a cognitive model: Thoughts control how people view themselves, others, and their environment, which impacts their mood and behavior.

In other words, if you perceive everything around you to be bad, you’ll likely feel pretty bad, too.

The basic principle that underlies cognitive behavioral therapy is that most emotional and behavioral reactions are learned — and so they can be unlearned or changed.

Unlike many other forms of psychotherapy, CBT is mostly concerned with present feelings and events, not past trauma or life history. That’s not to say those topics won’t come up in therapy, but they’re not the central focus of CBT treatment.

What are some common goals in CBT?

Some goals in CBT include:

forming new habits
learning interpersonal skills
developing constructive coping mechanisms
reducing or managing stress and anxiety
shifting from negative thinking to a more balanced outlook
learning how to express feelings

How long does cognitive behavioral therapy take to work?

The time it takes to make progress toward these goals is different for everyone. Some people see results after only a few CBT sessions, while others require a few months to learn how to manage their symptoms.

You may start out with one session per week, and then gradually decrease the frequency. However, this will depend on both your and your therapist’s availability and accessibility.

What are the benefits of CBT?

Research in 2015 indicated that CBT is often just as or more effective in reducing symptoms than other types of therapy, especially when it comes to anxiety disorders.

That being said, medication does still perform better for some conditions, and many people find it most beneficial to combine CBT with medication.

The benefits of CBT are extensive. For example:

It often leads to long-term results. Since the emphasis is on identifying unhelpful thinking patterns and building skills for everyday use, CBT’s positive effects can last long after treatment has stopped.
It’s an effective alternative to medicine. For some people, medication simply doesn’t work for them. CBT offers another form of treatment using a completely different approach.
The duration of treatment is pretty short. Unlike other kinds of talk therapy, CBT doesn’t have to go on for years. It can last anywhere around 5 to 20 sessions, though occasional follow-up sessions can be useful.
CBT can take place one-on-one, in groups, or even on your own. Though the approach to CBT is structured, it’s flexible in terms of format. Some apps and workbooks even allow you to practice CBT techniques on your own.
The skills you’ll learn can help beyond your original reason for treatment. The skills CBT often emphasizes, like problem-solving, personal interaction, and time management, can serve you in many aspects of your life.

Are there any risks in CBT?

Though CBT is generally a safe and effective treatment option, it has some potential drawbacks, too.

One 2018 study found therapists reported worsening symptoms in 9% of people in therapy. And during CBT, 27% experienced distress or negative well-being.

Still, it can help to keep in mind that this discomfort tends to be temporary and a normal part of some types of CBT.

The most significant drawback of CBT could be the reappearance of symptoms after therapy has ended. But it’s also not uncommon for this to happen. Your therapist may work with you to create a maintenance plan to keep symptoms at bay when you’re no longer having regular sessions.

Still, the overwhelming majority of research suggests the benefits of CBT outweigh the risks.

Besides the possibility of side effects, CBT does have some drawbacks to consider. For example:

It’s a big commitment. Even though treatment may only last a few months, it takes commitment and persistence to get the results you want. You’ll likely need to practice the skills you’re learning often for them to stick.
It may not be enough. For people with more complex or intense health concerns, CBT may not be the right approach — or it may simply not be enough to reduce symptoms by itself.
It can be uncomfortable. Since part of CBT is addressing how distorted thinking makes you feel, therapy can temporarily stir up or worsen emotional symptoms. It can help to prepare yourself for some discomfort.
It can be expensive. Depending on your insurance, where you live, and other factors, CBT with a professional might be out of reach due to its cost. Still, some therapists offer therapy with sliding scale fees, which means you pay what you can — it can help to look for therapists who offer this.

What can I expect in CBT?

Before therapy even begins, your therapist will probably ask you to fill out a questionnaire used to assess your mental health and keep track of progress later on.

They’ll likely spend most of the first session asking questions and getting to know you and your thought processes so treatment can be customized for you.

Since CBT is a collaborative effort, it’s important to feel comfortable with and connected to your therapist. Even though it can be frustrating and time consuming, don’t be afraid to meet with multiple therapists until you find one that you’re happy with.

Once you’ve gone through all the basic questions, established your goals, and identified distorted patterns of thinking, your therapist can work with you to pick the right techniques to assess and adjust those thoughts.

Be prepared to get some homework, too. CBT often includes out-of-session practice like self-reflection tasks, behavioral exercises, and readings.

Although CBT usually takes place in-person, online options are also available and effective.

Is CBT right for me? Questions to ask before you start

What is CBT used for?

Some of the mental health conditions most commonly treated with CBT include:

generalized anxiety disorder
bulimia nervosa and other eating disorders
major depressive disorder
schizophrenia
substance use disorder
bipolar disorder
phobias
post-traumatic stress disorder (PTSD)

Physical conditions treated with CBT could include:

irritable bowel syndrome (IBS)
chronic fatigue syndrome
fibromyalgia
chronic pain

Who’s most likely to benefit from CBT?

Research shows people of all ages, ethnicities, and genders can benefit from CBT.

But as mentioned before, some people may be more suited for CBT than others.

It’s most likely to help people who:

have challenges they can identify and want to change
have tried medication but not seen any or enough positive results
are eager to improve their mental health and have time to fully commit

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Medically reviewed by Ashleigh Golden, PsyD — Written by Kate Bettino — Updated on June 2, 2021

Cognitive Behavioral Therapy (CBT): How, When, And Why It Works

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How does cognitive behavioral therapy work?

What’s the principle behind CBT?

What are some common goals in CBT?

How long does cognitive behavioral therapy take to work?

What are the benefits of CBT?

Are there any risks in CBT?

What can I expect in CBT?

Is CBT right for me? Questions to ask before you start

What is CBT used for?

Who’s most likely to benefit from CBT?

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