6 Min Read

Cognitive-Behavioral Therapy

Heather Lyons, Ph.D.

Between fear and uncertainty surrounding the pandemic, election and political anxiety, and holiday stress, people are seeking therapy in larger numbers than before. In October, a YouGov poll indicated that 23% of 18- to 24-year olds in the United States have sought counseling during the pandemic—an increase from 13% in April. Meanwhile, some therapists report that switching to teletherapy has boosted client attendance and their willingness to open up.

Cognitive-behavioral therapy (CBT), a form of psychotherapy, relies on the concept that many of life’s challenges stem from problematic thinking patterns. By developing healthier ways of thinking, cognitive-behavioral therapists help clients manage stress and improve their quality of life. In practice, CBT involves identifying negative thoughts, behaviors, and emotions and replacing them with healthier responses. 

As a form of talk therapy, CBT can help treat a wide range of mental health conditions, including phobias, anxiety disorders, ADHD, mood disorders, and relationship problems. Whether you’re struggling with mental health symptoms for the first time or searching for healthier ways to cope with stress, CBT can help you navigate your mental health challenges.

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History of Cognitive-Behavioral Therapy

Cognitive-behavioral therapy was developed by psychiatrist Aaron Beck in the 1960s. During the therapy sessions he conducted, Beck realized that clients tended to have an active internal dialogue—almost as if they were talking to themselves. However, during sessions, clients would only say outloud a fraction of this kind of internal thinking.

Beck realized the importance of the relationship between thoughts and feelings, coining the term “automatic thoughts” to describe emotion-filled thoughts that arise during internal dialogue. Although people weren’t always aware of automatic thoughts, they could learn to identify and report them. If a person was feeling upset, their internal dialogue was typically negative and unrealistic. Beck found that identifying these problematic thoughts was integral for clients to understand and overcome their mental health challenges.

Beck called his approach cognitive therapy because of the importance it places on thought patterns. It’s now known as cognitive-behavioral therapy because it incorporates elements of behavior therapy as well. The balance between cognitive and behavioral elements varies between different types of CBT.

Where Do Negative Thoughts Come From?

Cognitive behavior therapy is based on the idea that negative thoughts can block us from seeing things or doing things that stray from what we believe is true. In other words, we hold onto the same thought patterns and fail to learn anything new.

Beck suggested that these thinking patterns arise in childhood, and become automatic and relatively fixed over time. For example, a child who didn’t receive open affection from their parents but was praised for good academic work might think, “I have to do well all the time, or people will reject me.” These rules for living—or dysfunctional assumptions—might help the person and motivate them to work harder. However, these assumptions aren’t always helpful.

Sometimes, things happen that are beyond our control. When we experience failure, dysfunctional thought patterns might be triggered. The person might then begin to have automatic thoughts. For example, they might think, “I’ve failed. No one will like me.”

When we’re in a disturbed state of mind, it’s easy to base our predictions and interpretations of events on biased views, making the situation seem much worse. 

Cognitive-behavioral therapy helps the person identify automatic thoughts and dysfunctional thought patterns. CBT encourages the client to examine past experiences of failure to see what happened to them, or others, in similar situations. Then, after gaining a more realistic perspective, the client may be able to test out what other people think by revealing some of their failures to friends.

Types of Cognitive-Behavioral Therapy

Cognitive behavior therapy encompasses a range of CBT techniques and approaches that address thoughts, behaviors, and emotions. Some specific forms of therapy that involve CBT include:

Dialectical behavior therapy — Although dialectical behavior therapy (DBT) was originally developed to treat borderline personality disorder (BPD), it has been adapted to treat people with multiple different mental health conditions. DBT focuses on accepting negative thoughts, feelings, and behaviors, instead of struggling with them.

In DBT, the therapist’s role is to help the person balance acceptance. By coming to terms with problematic thoughts, feelings, and behaviors, individuals can work with their mental health professional to create a gradual plan to recovery.

Research has shown that DBT is effective at producing long-lasting improvement among patients experiencing mental illness. DBT helps to reduce the frequency and severity of dangerous behaviors, emphasizes the individual’s strengths, and helps to translate the skills learned in therapy to the person’s everyday life.

Rational emotive behavior therapy— Rational emotive behavior therapy (REBT) focuses on identifying problematic beliefs, actively challenging these beliefs, and replacing them with healthier beliefs. To help clients understand how unhealthy thoughts and beliefs create emotional distress, REBT utilizes various methods and tools, including goal-setting and positive visualization.

In REBT treatment, behavior therapists work with clients to identify rigid thought patterns and irrational beliefs. The therapist will help the client to understand how irrational these thoughts are and how they lead to unhealthy actions. With the help of CBT techniques, clients can learn to reduce negative thoughts and replace them with healthier, more constructive, self-accepting thoughts.

Cognitive processing therapy — Cognitive processing therapy (CPT) has been proven effective for posttraumatic stress disorder (PTSD) treatment through multiple studies. CPT focuses on teaching clients a set of skills to challenge negative thoughts and gain control over the impact they have on everyday life. CPT is effective in clients who may have endured recent traumas, as well as those dealing with the impacts of past events.

What Does Cognitive-Behavioral Therapy Look Like?

Cognitive behavior therapies are usually short-term treatments that focus on teaching clients specific skills, such as mindfulness techniques and coping mechanisms. CBT is different from many other psychotherapy approaches, as it focuses on the ways that a person’s thoughts, emotions, and behaviors are connected to and affect each other, according to the Association for Cognitive and Behavioral Therapies (ACBT).

Although the structure and content of your sessions will vary depending on your cognitive-behavioral therapist, most CBT therapies involve:

Homework assignments — The core principles of CBT involve identifying negative thoughts or false beliefs and restructuring them. Sometimes, people being treated with CBT will have homework between sessions where they practice replacing negative thoughts with more realistic thoughts or record their negative thoughts in a journal.

Working on homework assignments between sessions is an important component of the healing process. At the start of therapy, your therapist might ask you to keep a diary of any situations that trigger feelings of anxiety or stress, so they can examine their thought processes surrounding the incident. Later on, your therapist might ask you to evaluate coping mechanisms to cope with particular situations.

Structured sessions — Unlike many other types of talk therapies, cognitive behavior therapy sessions have a solid structure, rather than the client talking openly about whatever comes to mind. At the beginning of treatment, the client meets with the therapist to describe specific problems and set goals. These problems might be symptoms, such as sleeping trouble or having trouble concentrating on work. They could also be life problems, such as stress at work or arguments with family members.

As treatment continues, these problems and goals become the basis for planning the content of sessions. Typically, at the beginning of a therapy session, the client and therapist will decide on the main topics they want to work on and discuss conclusions from the last session. Toward the end of the session, the therapist will plan a homework assignment for the client to complete outside of the session. 

At the beginning of treatment, the therapist takes a more active role in structuring therapy sessions. Over time, as the client makes mental health progress, they take more responsibility for the structure and content of the sessions. By the end of treatment, clients feel empowered to independently navigate their current problems.

Group sessions — Although CBT typically involves individual sessions, it’s also well-suited for group therapy, or family therapy sessions, particularly at the beginning of treatment. Many people benefit from sharing their experiences with others, even though this might seem intimidating at first. Groups can also provide valuable support and advice because it comes from people who have experienced similar problems.

Who Can Benefit from Cognitive-Behavioral Therapy?

As a form of talk therapy, cognitive-behavioral therapy can be an effective treatment for the following mental health conditions and issues in life:

CBT is also sometimes used to treat people with long-term medical conditions, such as:

  • Fibromyalgia
  • Chronic fatigue syndrome (CS)
  • Irritable bowel syndrome (IBS)

Although CBT cannot cure physical symptoms, it can help people better cope with their symptoms. Individuals who undergo CBT treatment have shown changes in brain activity, suggesting that this type of therapy may also help to improve cognitive functioning.

Finding a Cognitive-Behavioral Therapist

Of the many roadblocks to seeking professional help, from working with your insurance company to actually going to your first appointment, it’s essential to take the time to find the right therapist. Talk therapy isn’t a one-size-fits-all approach—and placing your mental health in the right hands can significantly influence treatment, according to the American Psychological Association.

To find the best CBT therapist for your mental health needs, reach out to a mental health professional through WithTherapy. We’ll connect you to a licensed cognitive-behavioral therapist you feel comfortable with, regardless of your personal preferences and requirements.

Above all else, all you need to succeed in therapy is a willingness to be open and honest. One of the experienced CBT therapists on the WithTherapy platform will help you navigate the process and provide a safe space to express your thoughts and feelings.

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