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What Is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy (CBT) is an effective treatment for many psychological disorders.
Cognitive Behavioral Therapy (CBT) is a short-term treatment that teaches clients specific skills. What makes CBT unique is that it focuses on the ways that a person’s cognitions (i.e., thoughts), emotions, and behaviors are connected and affect one another. Because emotions, thoughts, and behaviors are all linked, CBT allows for therapists to intervene at different points in the cycle.
CBT is the term used for a group of psychological treatments that are proven to be effective in treating many psychological disorders. Some people have a limited view of what psychological therapy is, perhaps because of the old-fashioned treatments shown on TV or in the movies. CBT is very different from this. It is usually a short-term treatment (i.e., often between 6-20 sessions, depending on what is being treated) that focuses on teaching clients specific skills. CBT focuses on the ways that a person’s cognitions (i.e., thoughts), emotions, and behaviors are connected and affect one another. Because emotions, thoughts, and behaviors are all linked, CBT allows for therapists to intervene at different points in the cycle.
Therapists differ regarding how much they emphasize behavioral and cognitive techniques in therapy. Some focus exclusively on behavioral or cognitive techniques, though most will use a combination of the two. Some common aspects of CBT are:
- The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on themselves.
- The therapist seeks to help the client discover that they are powerful and capable of choosing more helpful thoughts and behaviors.
- Treatment is often short-term. Clients actively participate in treatment in and out of session. The skills that are taught in these therapies require practice. Therefore, homework is often included in therapy.
- Treatment is goal-oriented to resolve present-day problems.
- Therapy involves working step-by-step to achieve goals. The therapist and client develop goals for therapy together, and track progress toward goals throughout the course of treatment.
A more detailed discussion of cognitive and behavioral techniques is described below.
Cognitive Components of CBT
The basis of the cognitive component of CBT is the idea that thoughts can influence feelings, and that your emotional response is based on your interpretation of a situation. For example, imagine feeling shortness of breath and your heart racing. If these physical symptoms pop up while sitting quietly on a park bench, you might think that something is wrong with your body (“maybe I’m having a heart attack”) which would probably make you feel anxious (your emotion). In contrast, if you felt these same physical sensations while running on a treadmill, you would likely expect your heart to race, and would not consider it a result of a medical ailment. You probably would not feel fear or anxiety. In short, different interpretations of those same sensations lead to entirely different reactions and emotions.
Cognitive therapy suggests that many of our emotions are due to our thinking – the ways that we perceive or interpret our environments. Sometimes, these interpretations are not the only way of looking at the situation. For example, you might believe that an ambiguous text message means that you’re being rejected or pushed away, or that a funny physical sensation in your body means that you have some rare disease. Other people may set unrealistic expectations for themselves, or put all their focus on being accepted by others. These types of thoughts often lead to negative emotion, and they are not the only way to see a given situation.
In cognitive therapy, clients learn to:
- Distinguish between thoughts and feelings.
- Become aware of the ways thoughts can influence feelings.
- Learn about thoughts that seem to occur automatically, without even realizing how they may affect emotions.
- Evaluate critically whether these “automatic” thoughts and assumptions are accurate, or perhaps biased.
- Develop the skills to notice, interrupt, and correct these unhelpful thoughts independently.
Behavioral Components of CBT
The behavioral aspects of CBT are derived from a wealth of research into how we learn. The two primary ways that we learn are by association (classical conditioning) and through consequences to our actions/reactions (operant conditioning).
Associative learning happens when two things occur closely together in time, so we pair them together. For example, if you are going through a stressful period in your life, you may feel anxious while riding a subway. Through pairing that anxious feeling with your commute, you may learn to associate the subway with anxiety or danger.
The other form of learning (operant conditioning) happens when a particular action is either increased or decreased by the consequences that come after. Let’s go back to the subway example above. When you have thoughts of riding the subway, you might feel anxious, so you might decide to avoid this mode of transportation. When you decide not to ride the subway, you feel relieved and your anxiety decreases. This avoidance of the subway is rewarded or reinforced by the relief you experienced. This increases the likelihood that you will avoid the subway in the future. Unfortunately, this avoidance behavior will also prevent you from learning that you could face your fears and successfully ride the subway.
CBT helps people try new ways of acting and reacting to both external situations and their internal experiences. These behaviors are chosen through collaboration with your therapist and thoughtful consideration to what would most improve your life. A therapist may help someone who is afraid of riding the subway by helping them to learn how their anxiety works, identify that they fear both their own anxiety and the subway, and help them develop a plan to systematically face their fears. The process by which you gradually face your fears, with the help of a skilled therapist, is a behavioral technique called “exposure therapy.” Through this process a new type of learning occurs in which you gradually overcome your fear of these situations. Research shows that through practice, we can replace unhelpful actions and reactions with healthy coping behaviors.
One of ABCT’s most important goals is to help increase public awareness and understanding of mental health difficulties. Please click on the links below to learn about psychological symptoms.
Choosing the right treatment from a range of options can be an overwhelming task, especially if you are already suffering from psychological symptoms. ABCT provides resources to help the general public navigate through this confusion and make informed decisions as to their care or the care of a loved one. Please click on the links below to learn more about treatment.