Cognitive Behavioral Therapy: How Does CBT Work?

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Medical News TodaySubscribeHow does cognitive behavioral therapy work?

Medically reviewed by Bethany Juby, PsyD — Written by Kathleen Davis, FNP — Updated on October 17, 2023

What is CBT?
How does it work?
What it can do
Strategies
What can CBT treat?
CBT vs. other therapies
Summary

Cognitive behavioral therapy (CBT) is a therapy technique that aims to help people find new ways to behave by changing their thought patterns. Therapists may use strategies such as role-playing and assigning homework.

CBT rests on the assumption that the way people think and interpret life events affects how they behave and feel. Therapy sessions focus on exploring and developing methods to deal with challenges and behaviors that arise from day to day. This type of therapy can be effective in treating depression, anxiety, bipolar disorder, and other mental health conditions.

CBT often consists of 6–20 one-on-one sessions, though some people may have more. It can also take the form of group sessions.

Read on to learn more about CBT, including its aims, how it works, common strategies, and how it compares to other types of therapy.

What is CBT?

Sad Woman Seen Through Glass With Man Reflecting — Ramzi Rizk/EyeEm/Getty Images

CBT is a type of psychotherapy focusing on how someone’s thoughts, attitudes, and beliefs may affect their actions and feelings.

The American Psychological Association explains that CBT relies on the following beliefs:

Unhelpful ways of thinking and behaving can lead to psychological distress.
People can learn more beneficial ways of thinking and behaving.
New habits can relieve symptoms of mental and physical conditions and allow people to act in more beneficial ways.

The central theory is that problems arise from events and the meanings that people assign to them. Unhelpful thoughts may make it difficult for someone to function confidently in various situations.

CBT can help people make positive changes to how they feel and act. It can also equip people with coping strategies that help them deal with challenges.

A course of CBT consists of a series of sessions in which a counselor and an individual or group meet regularly and collaborate. Counselors typically hold these meetings weekly or every 2 weeks.

How does it work?

Some forms of psychotherapy focus on looking into the past to understand current feelings. Instead, CBT focuses on present thoughts and beliefs. It emphasizes the need to identify, challenge, and change how a person views a situation.

Although counselors typically personalize sessions to an individual, CBT steps may include:

an individual assessment
establishing goals and areas to work on early in the process
regularly checking the person’s mood and any life updates
collaboratively setting agendas for each session
reviewing any homework
punctuating discussions with feedback and summaries
assigning further homework at the end of sessions

Changing distortions and perceptions

CBT aims to transform ways of thinking and behaving that stand in the way of how a person would like to live their life. This involves identifying negative perceptions or distortions that affect behavior.

A distorted view can make a person more susceptible to:

an unhelpful mindset
jumping to conclusions
mistakenly seeing situations as catastrophic
seeing things as either good or bad, with nothing in between

If people learn fearful or unhelpful ways of thinking, they can start to think in this way automatically. CBT focuses on challenging these automatic thoughts and comparing them with reality.

When a person comes to view a particular situation in a more helpful way, their distress may decrease, and they can take actions or make decisions that are more likely to serve them in the long term.

An example: Dental phobia

A person with dental phobia may fear going to the dentist because they believe they will experience severe pain or even death by having a dental procedure. This fear may stem from a negative experience, perhaps in childhood.

A CBT therapist can work with the person to address this thinking, which says, “Because I had pain with a filling, all dental visits will be painful.”

CBT encourages affected people to see future dental treatments in a new way. A therapist may also devise a way to approach dental visits in small, manageable steps to overcome the fear.

For example, a 2022 study uses CBT administered by dentists to attempt to overcome dental phobias.

What can CBT do?

During a course of CBT, a person can learn to:

develop an awareness of automatic, unhelpful thoughts
challenge underlying assumptions that may be unhelpful
distinguish between facts and unhelpful thoughts
develop a more helpful way of thinking and seeing situations

Strategies

The exact course of a person’s CBT varies, depending on their symptoms and circumstances. During a typical course, a person:

has regular one-on-one or group sessions or a combination of both
gets frequent feedback
does role-playing activities
learns ways to calm the mind and body
has gradually increased exposure to the things they fear
does homework assignments
keeps a cognitive behavioral diary
practices skills to promote positive behavioral change and growth

What can it treat?

Psychologists created the first CBT models more than 50 years ago to treat depression. However, since then, new waves of CBT have emerged with new treatment approaches.

A 2021 review suggests CBT can be effective for a variety of mental, physical, and behavioral conditions in the short term, including:

attention deficit hyperactivity disorder (ADHD)
generalized anxiety disorder
depression
eating disorders, such as bulimia nervosa
hypochondriasis
chronic fatigue syndrome
fibromyalgia
substance misuse and addiction
panic disorder
post-traumatic stress disorder
tinnitus

However, the authors highlight that more research is necessary to assess long-term efficacy.

CBT vs. other types of therapy

There are many types of therapy available to people. The best type of therapy for someone may depend on the condition they have or the specific problem they want to overcome. Other types of talk or behavioral therapy include:

Dialectical behavior therapy: This type of therapy focuses on mindfulness, regulating emotions, accepting uncomfortable thoughts, and balancing change and acceptance.
Eye movement desensitization and reprocessing therapy: This therapy aims to change adverse reactions to traumatic memories, pairing recollections of the memories with specific eye movements.
Interpersonal therapy: This type of talking therapy aims to help people recognize and change negative patterns in their relationships with others.
Psychodynamic therapy: This talk therapy aims to help people identify and overcome unhelpful feelings or behaviors due to past experiences.
Emotion-focused therapy: This type of therapy aims to help people identify, regulate, and resolve emotions rather than suppressing them.
Mindfulness therapy: This type of therapy aims to help people observe and accept the present without judgment, using the practice of mindfulness.
Animal-assisted therapy: This type of therapy involves animals, typically to help reduce feelings of anxiety.

However, a 2018 article suggests that CBT is the gold standard therapy because extensive research supports it, research does not demonstrate another form of therapy that is systematically superior, and it aligns with modern models of human minds and behaviors.

Summary

CBT is a form of psychotherapy. During CBT, a person learns to change their perceptions in a way that has a helpful effect on their behavior and mood. It can help with many mental health conditions, ranging from depression to chronic pain.

A counselor and client work together to identify goals and expected outcomes. The individual must be an active participant in the therapy to benefit from it.

Anyone considering CBT should find a qualified professional. A doctor may be able to recommend local CBT specialists.

Depression
Mental Health
Alcohol / Addiction / Illegal Drugs
Anxiety / Stress
Psychology / Psychiatry

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Chand SP, et al. (2023). Cognitive behavioral therapy.https://www.ncbi.nlm.nih.gov/books/NBK470241/
David D, et al. (2018). 50 years of rational‐emotive and cognitive‐behavioral therapy: A systematic review and meta‐analysis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836900/
David D, et al. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/
Hauge MS, et al. (2022). Dentist-administered CBT for dental anxiety.https://link.springer.com/chapter/10.1007/978-3-031-04248-5_13
Nakao M, et al. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489050/
Overview - Cognitive behavioural therapy (CBT). (2022).https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
Types of talking therapy. (2022).https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/types-of-talking-therapies/
What is cognitive behavioral therapy? (2017).https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Whitfield G. (2018). Group cognitive–behavioural therapy for anxiety and depression.https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/group-cognitivebehavioural-therapy-for-anxiety-and-depression/458CD3360742FE9E90AEB107493E2F0C

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Medically reviewed by Bethany Juby, PsyD — Written by Kathleen Davis, FNP — Updated on October 17, 2023

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What is CBT?

How does it work?

Changing distortions and perceptions

An example: Dental phobia

What can CBT do?

Strategies

What can it treat?

CBT vs. other types of therapy

Summary

How we reviewed this article:

Latest news

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