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Cognitive Behavioral Therapy

Reviewed by Psychology Today Staff

Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs. Considered a "solutions-oriented" form of talk therapy, CBT rests on the idea that thoughts and perceptions influence behavior.

Feeling distressed, in some cases, may distort one’s perception of reality. CBT aims to identify harmful thoughts, assess whether they are an accurate depiction of reality, and, if they are not, employ strategies to challenge and overcome them.

CBT is appropriate for people of all ages, including children, adolescents, and adults. Evidence has mounted that CBT can address numerous conditions, such as major depressive disorder, anxiety disorders, post-traumatic stress disorder, eating disorders, obsessive-compulsive disorders, and many others.

CBT is a preferred modality of therapy among practitioners and insurance companies alike as it can be effective in a brief period of time, generally 5 to 20 sessions, though there is no set time frame. Research indicates that CBT can be delivered effectively online, in addition to face-to-face therapy sessions.

CBT in Practice

CBT focuses on present circumstances and emotions in real time, as opposed to childhood events. A clinician who practices CBT will likely ask about family history to get a better sense of the entire person, but will not spend inordinate time on past events. The emphasis is on what a person is telling themselves that might result in anxiety or disturbance. A person is then encouraged to address rational concerns practically, and to challenge irrational beliefs, rumination or catastrophizing.

For example, a person who is upset about being single will be encouraged to take concrete measures but also question any undue negativity or unwarranted premise ("I will be alone forever") that they attach to this present-day fact.

For more on psychotherapy in practice, visit the Therapy Center.

How long does CBT generally take to be effective?

A typical course of CBT is around 5 to 20 weekly sessions of about 45 minutes each. Treatment may continue for additional sessions that are spaced further apart, while the person keeps practicing skills on their own. The full course of treatment may last from 3 to 6 months, and longer in some cases if needed.

In therapy, patients will learn to identify and challenge harmful thoughts, and replace them with a more realistic, healthy perspective. Patients may receive assignments between sessions, such as exercises to observe and recognize their thought patterns, and apply the skills they learn to real situations in their life.

Why does CBT work?

CBT programs tend to be structured and systematic, which makes it more likely that a person gets an adequate “dose” of healthy thinking and behaviors. For example, a patient with depression may be asked to write down the thoughts he has when something upsetting happens, and then to work with the therapist to test how helpful and accurate the thoughts are. Repeated and focused practice is an integral part of CBT. CBT centers around building new habits—which we may know but need to remember and implement successfully.

Additionally, CBT programs can be standardized and tested so that the mental health field can identify which programs are effective, how long they take, and the benefits that patients can expect.

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What Conditions Can CBT Treat?

CBT originally evolved to treat depression, but research now shows that it can address a wide array of conditions, such as anxiety, post-traumatic stress disorder, substance use disorder, and phobias. Versions have also been created to treat insomnia and eating disorders. But beyond treating clinical challenges, CBT can also provide the skills people need to improve their relationships, happiness, and overall fulfillment in life.

Can CBT help with depression?

Yes, many studies have documented the benefits of CBT for treating depression. Research shows that CBT is often equally as effective as antidepressants; patients who receive CBT may also be less likely to relapse after treatment than those who receive medication. CBT can provide patients with the inner resources they need to heal—and to prevent a depressive episode from recurring in the future.

Can CBT help with anxiety?

CBT is an effective and lasting treatment for anxiety disorders, research shows. CBT provides the tools to alter the thoughts and behaviors that exacerbate anxiety. For example, someone with social anxiety might think, “I feel so awkward at parties. Everyone must think I’m a loser.” This thought may lead to feelings of sadness, shame, and fear, when then lead to behaviors like isolation and avoidance. CBT can help people learn to identify and challenge distorted thoughts, and then replace them with realistic thoughts, changing the cycle of anxiety.

The Origins of CBT

CBT was founded by psychiatrist Aaron Beck in the 1960s, following his disillusionment with Freudian psychoanalysis and a desire to explore more empirical forms of therapy. CBT also has roots in Rational Emotive Behavioral Therapy (REBT), the brainchild of psychologist Albert Ellis. The two were pioneers in changing the therapeutic landscape to offer patients a new treatment option—one that is short-term, goal-oriented, and scientifically validated.

Who developed CBT?

The creator of cognitive behavioral therapy is Aaron Beck, a psychiatrist at the University of Pennsylvania. In the 1960s, Beck was practicing psychoanalysis. But he came to realize that the approach was failing to treat his depressed patients—entrenched negative thoughts prevented them from overcoming the disorder. So he developed cognitive behavior therapy, rooted in the philosophy of Albert Ellis’s rational emotive behavior therapy, to change these harmful patterns of “emotional reasoning” and spark genuine change.

What is rational emotive behavior therapy?

In the 1950s, the psychologist Albert Ellis became discouraged by psychoanalysis. When treating his patients, he discovered that becoming aware of one’s beliefs and challenges didn’t necessarily change them. Ellis developed what is now called "rational emotive behavior therapy" (REBT). The groundbreaking therapy is based on his core philosophy: that most of our behavioral and emotional problems—from getting over a breakup to handling child abuse—stem from our own irrational beliefs about our situations and how we should be treated. By changing those beliefs, we can change our emotions and behaviors for the better.

Rational emotive behavior therapy later sparked the creation of cognitive behavior therapy. Both encompass the notion that emotions and behavior are predominantly generated by ideas, beliefs, attitudes, and thinking, so changing one’s thinking can lead to emotion and behavior change. Yet there are also a few differences between REBT and CBT. Unlike CBT, REBT explores the philosophic roots of emotional disturbances, encourages unconditional self-acceptance, and distinguishes between self-destructive negative emotions and appropriate negative emotions.

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