Cognitive Behavioral Therapy (CBT)

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a blend of two existing forms of therapy: cognitive therapy and behavior therapy. This approach grew out of the cognitive therapy that psychiatrist Dr. Aaron Beck developed in the early 1960s, and is now one of the most widely used and well-researched therapy approaches (Hofmann et al., 2012). CBT has been extensively studied, and has been shown to be effective in treating a wide range of conditions including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness.

How Does CBT Work?

CBT is a form of psychotherapy that is used by counselors, social workers, and psychologists to treat a variety of emotional and behavioral issues. CBT recognizes that thoughts, emotions, and behaviors are all connected. The main goal of CBT is to improve a person’s mental and emotional well-being by making positive changes in the way people think and behave. This is usually done in 1:1 sessions with a trained therapist who works with a client to set and achieve specific goals for treatment.

For example, anxiety disorders often involve a combination of worried “what if…”  thoughts that create feelings of anxiety. A common way people cope with these thoughts and feelings is to avoid situations that scare them. While this can temporarily make someone feel less worried and anxious, avoidance tends to worsen anxiety in the long term. Some of the techniques commonly used in CBT focus on changing the way people think about situations in effort to stop the unhealthy cycle.

Sample Case: A CBT therapist working with someone who has anxiety about getting blood work done might encourage the person to turn their ‘what if’ thoughts into ‘even if’ thoughts. This technique is called re-framing, and can help people think more rationally during times when they feel anxious.

Another aspect of CBT focuses on behavioral change. In this example, a CBT therapist may encourage the person to weigh the pros and cons of canceling their appointment, and then identify other choices where the pros outweigh the cons.

As you can see in the above sample case, CBT can be an effective way to help people make changes to the way they think and react during times when they feel emotional. CBT can also be used to treat other types of mental health and substance use disorders. It’s often used in conjunction with other psychotherapy approaches as well as other forms of treatment like psychiatric medication. Unlike other psychotherapy approaches, CBT deals with your current problems rather than focusing solely on issues from the past. Using CBT, a client can begin to break problematic patterns of behavior or change unhelpful thought patterns fueling these behaviors.

CBT has also shaped several related approaches. Dialectical behavior therapy (DBT) adds skills for managing intense emotions, acceptance and commitment therapy (ACT) focuses on making room for difficult thoughts while acting on personal values, and mindfulness-based cognitive therapy (MBCT) combines CBT with mindfulness to help keep depression from returning. For obsessive-compulsive disorder (OCD), a specialized form of CBT called exposure and response prevention (ERP) is often recommended, and children and teens who have experienced trauma may be offered trauma-focused CBT (TF-CBT).

Is CBT a Good Option for Me?

Cognitive behavioral therapy is used to treat a number of common mental health issues. In recent years, it has become the go-to form of psychotherapy due to its ability to improve the current mental state and improve day-to-day life in a relatively short amount of time. Often, CBT is provided on a weekly basis for a period of a few months at which point a person has often developed the CBT “skills” needed to manage their problems on their own. CBT is usually short-term, often about 5 to 20 sessions (Mayo Clinic Staff, 2025).

CBT is one of the therapeutic approaches with the most research supporting its effectiveness. Some of the mental health disorders CBT has had the most documented success in treating include anxiety disorders, anger issues, depression, and specific types of substance use disorders (Cuijpers et al., 2023; Hofmann et al., 2012). There is also evidence that CBT is helpful for marriage or family problems and eating disorders, either as a first line of defense or in conjunction with other treatment methods. For post-traumatic stress disorder (PTSD), CBT and closely related trauma-focused therapies, such as cognitive processing therapy (CPT) and prolonged exposure, are among the most strongly recommended treatments (American Psychological Association, 2017).

Some people who prefer a less directive approach or just want to “vent” might find that CBT is too structured of an approach for them. Generally, CBT is a good fit for people who:

• want a more structured approach
• want a therapist who is more direct
• want to work on specific issues and problems happening in their lives now
• want to develop new ways to cope or respond to these problems

What Can I Expect During CBT Treatment?

CBT is often held in weekly or bi-weekly sessions consisting of 45-60 minute conversations between you and your therapist. Cognitive behavioral therapists deliver interventions in a strategic manner (Wenzel, 2017). Early on, your therapist will work with you to set specific goals for your therapy, which will be reviewed frequently. After setting goals, the therapist will likely provide some education on the specific issue, diagnosis or problem bringing you to therapy, and may also introduce some CBT specific information. Often, this will include an explanation about how thoughts, feelings, and behaviors are linked and some exploration of your patterns. 

From there, a CBT therapist will usually introduce some key skills to try outside of sessions. These skills might include ways to interrupt or “re-frame” unhelpful thoughts, cope more effectively with difficult emotions, or learn new ways to approach problem solving or decision making. The eventual aim of cognitive behavioral therapy is to apply the lessons you learn in your CBT sessions to your daily life. That’s why CBT often includes doing “homework” outside of your therapy sessions which may include worksheets, mood or thought trackers, and practicing specific CBT skills.

The more you are able to implement what you learn in CBT into your daily life, the more you’ll get out of treatment and the faster your recovery will be. As progress is made, it is common for a CBT therapist to recommend meeting less frequently or even terminating therapy because you have achieved your goals. While this can be a difficult transition, it also is a marker of progress you have made in treatment. Also, many people find that coming in periodically for sessions helps them to refresh their skills and maintain the progress they have made in treatment.

Common CBT Techniques

CBT therapists draw on a set of practical techniques and choose the ones that fit each person’s goals (Wenzel, 2017). Four of the most common are:

• Cognitive restructuring: Noticing unhelpful thoughts, checking the evidence for them, and replacing them with more balanced ones. Re-framing a “what if” thought, as in the sample case above, is one example.
• Behavioral activation: Scheduling meaningful or enjoyable activities to break the cycle of withdrawal and low mood that often comes with depression.
• Exposure: Gradually and safely facing feared situations instead of avoiding them, so anxiety has a chance to decrease over time.
• Problem solving: Breaking a problem into smaller steps, brainstorming options, and weighing the pros and cons of each.

Questions to Ask During a Consultation

Finding a therapist who is a good fit for you is important, so plan on speaking to more than one person before making a decision to book your first appointment. Most therapists offer free phone consultations and will be happy to answer any questions you have for them about treatment. Some questions that people find helpful in making a decision about what therapist to choose include:

• What days/times would you be available to meet with me?
• Do you offer sessions in person or online?
• What is your style of counseling? (example: Do you use CBT?)
• Have you worked with other people with the issues I have (ie: anxiety, depression, etc.)?
• How long does treatment typically last?
• What could I expect to gain from treatment?
• How would a typical session go?

Asking questions like this can be helpful in finding a therapist who you are comfortable with. There are no right/wrong answers to these questions, but you will find that some therapists will answer the questions in ways that sound like they would match your needs better than others. The most important thing to gain from these initial conversations is a sense of how the therapist operates and whether you would feel comfortable with them. After all, many people go to counseling to discuss very personal and private details about themselves and their lives, so it is important to find a therapist who makes you feel comfortable about taking this step.

CBT Frequently Asked Questions

Who is CBT for?

CBT can help adults, teens, and children with a wide range of concerns, including anxiety, depression, anger, and substance use. It tends to be a good fit for people who want a structured, skills-based approach and are willing to practice what they learn between sessions.

Can CBT be done online?

Yes. Many CBT therapists offer sessions by secure video, and some programs deliver CBT through structured online lessons with regular check-ins from a therapist, often called internet-based CBT (iCBT). A review of 31 randomized trials found that therapist-supported iCBT worked about as well as face-to-face CBT across a range of conditions, most often depression and anxiety (Hedman-Lagerlöf et al., 2023).

Can I do CBT on my own?

Self-guided CBT books, apps, and online programs can help some people, especially when symptoms are mild. A large analysis of internet-based CBT for depression found that self-guided programs worked about as well as guided ones for mild symptoms, but programs with support from a therapist or coach were more effective overall, especially for moderate to severe depression (Karyotaki et al., 2021). If symptoms are getting in the way of daily life, working with a trained CBT therapist is usually the better place to start.

Final Thoughts

CBT is a popular type of psychotherapy that can help people struggling with mood problems, anxiety disorders, impulse control and substance use disorders. CBT therapists tend to use more structured approaches in therapy that focus on teaching skills to help clients reach their goals. Most CBT skills attempt to help people change thought and behavior patterns that are contributing to their issue or problem.

Find a CBT therapist in your area or online in your state. Get the tools to start feeling better today.

This article is for general information only and is not a substitute for advice from a licensed mental health professional.

References

American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline/treatments

Beck, A. T. (1970). Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy, 1(2), 184–200. https://doi.org/10.1016/S0005-7894(70)80030-2

Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: A comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105–115. https://doi.org/10.1002/wps.21069

Hedman-Lagerlöf, E., Carlbring, P., Švärdman, F., Riper, H., Cuijpers, P., & Andersson, G. (2023). Therapist-supported Internet-based cognitive behaviour therapy yields similar effects as face-to-face therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. World Psychiatry, 22(2), 305–314. https://doi.org/10.1002/wps.21088

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1

Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F. M. G., Furukawa, T. A., Cuijpers, P., Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration, Riper, H., Patel, V., Mira, A., Gemmil, A. W., Yeung, A. S., Lange, A., Williams, A. D., Mackinnon, A., Geraedts, A., van Straten, A., Meyer, B., Björkelund, C., . . . Forsell, Y. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371. https://doi.org/10.1001/jamapsychiatry.2020.4364

Mayo Clinic Staff. (2025, February 26). Cognitive behavioral therapy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

Wenzel, A. (2017). Basic strategies of cognitive behavioral therapy. Psychiatric Clinics of North America, 40(4), 597–609. https://doi.org/10.1016/j.psc.2017.07.001