Cognitive Behavioral Therapy (CBT)

What is CBT?

Cognitive behavioral therapy (CBT) is a form of psychotherapy based on the idea that thoughts, feelings, physical sensations and actions are interconnected — and that unhelpful patterns in thinking and behavior can keep emotional difficulties going. CBT helps you notice these patterns and practice new ways of responding.

CBT is practical and present-focused. While it may explore how patterns developed, most of the work centers on what is happening now and what you can do differently.

How CBT works

A CBT therapist works collaboratively with you to:

• Identify problems and set goals you want to work toward.
• Notice thought patterns, such as catastrophizing or all-or-nothing thinking, and examine how accurate or helpful they are.
• Test beliefs through experiments, gathering real-world evidence rather than relying on reassurance.
• Change behaviors that maintain problems, such as avoidance or withdrawal.
• Build skills — problem-solving, relaxation, planning activities — that you can use independently.

What CBT can help with

CBT has strong research support for many conditions, including:

• Anxiety disorders, including panic disorder, social anxiety and phobias
• Depression
• OCD (using exposure and response prevention)
• PTSD (using trauma-focused CBT approaches)
• Insomnia (using CBT-I — see sleep disorders)
• Eating disorders

It is also used alongside medical care for chronic pain and other health conditions.

What to expect

CBT is typically structured and time-limited — often somewhere around 6 to 20 weekly sessions, depending on the concern. You’ll usually be asked to practice skills between sessions, sometimes called “homework.” Progress is often tracked with brief questionnaires so you and your therapist can see what is working.

Types of CBT

• Exposure therapy and exposure and response prevention (ERP) for anxiety and OCD. See exposure therapy.
• Behavioral activation for depression.
• CBT for insomnia (CBT-I).
• Trauma-focused CBT and cognitive processing therapy for PTSD.
• Related “third-wave” therapies such as DBT and acceptance and commitment therapy (ACT).

Limitations

CBT requires active participation, and it may not suit everyone’s preferences or needs. Some people benefit more from other approaches, from medication, or from a combination. If you are not noticing progress after a reasonable period, it’s worth discussing with your therapist.