Cognitive behavioral therapy: What it is, how it works, and who it’s best for

Cognitive behavioral therapy (CBT) focuses on helping people identify negative thought and behavior patterns that may cause their distress. A therapist works with them to make appropriate changes or replace these thoughts and behaviors with more positive ways of thinking and acting so that they can engage more meaningfully with themselves and others.

According to the Journal of the Royal College of General Practitioners, CBT is the most widely researched and evidence-based form of talk therapy. It is also shown to be effective for managing a range of mental health conditions, including eating disorders, obsessive-compulsive disorders (OCD), post-traumatic stress disorders (PTSD), mood disorders, depression, anxiety disorders, and substance use disorders. 

While cognitive behavioral therapy is proven to be effective, it’s not the only evidence-based treatment. Understanding what to expect, how it works, and who it might be best for can enable more informed decisions and stronger therapeutic outcomes.

What is cognitive behavioral therapy?

Cognitive behavioral therapy is a “time-sensitive, structured, present-oriented” talk therapy that works to change a client’s thoughts and behavior by drawing attention to thought patterns. This helps people recognize repetitive self-defeating thoughts or behaviors that affect their wellbeing.

As its name suggests, cognitive behavioral therapy consists of two therapeutic interventions: Cognitive therapy and behavioral therapy.

Cognitive therapy involves helping people become conscious of negative thinking and beliefs and reframes them into thoughts that are healthier and more grounded in reality. 

Behavioral therapy, on the other hand, involves more hands-on participation. Here, a therapist will give a client assignments to help them more effectively navigate challenges and distressing situations.

How cognitive behavioral therapy works

Cognitive behavioral therapy is premised on the idea that an individual’s thoughts, emotions, and actions are interconnected. A person interprets a situation and acts according to how they feel or what they think in the moment. If their thought process is irrational, distressing, or unhelpful, it can distort how they may view or act toward a situation. The therapist works with them to approach problems with a more balanced mindset.

Here’s an example: You meet a long-lost friend, catch up on each other’s lives, exchange numbers, and promise to keep in touch. You get home and text them as promised, but when you don’t hear back after a few days, you decide they didn’t actually enjoy seeing you. You block their number and “move on.”

CBT would help someone see that their thought pattern led them to jump to a negative conclusion without knowing the facts — why their long-lost friend didn’t respond to your message. There are countless other ways to interpret the situation without coming to a negative conclusion. Cognitive behavioral therapy helps people distinguish thoughts from facts and process experiences in a way that more closely aligns with their present circumstances.

The science behind cognitive behavioral therapy

Aaron T. Beck, a psychiatrist who also studied psychoanalysis, developed cognitive therapy in the 1960s while conducting research on the nature of depression. The CBT approach explores Beck’s three levels of cognition which correspond to negative thought patterns:

1. Core beliefs: These are deeply held beliefs about yourself and the people around you (e.g., “I’m unloveable”).
2. Dysfunctional assumptions: These are ingrained unhelpful principles that you may live by (e.g., “If you don’t have intimate relationships with people, they can’t hurt you”).
3. Negative automatic thoughts: These are thought patterns that automatically come up when you face a particular situation (e.g., Telling yourself “I never do anything right” after making a mistake).

A therapist helps clients recognize negative or unhelpful thoughts and reframe them to be more realistic and accurately reflect their situation.

What does a cognitive behavioral therapy session look like?

“CBT is a modality of treatment that encourages collaborative work between the therapist and client,” says Alma member Jessica Rios-Flores, LCSW. For this reason, the client and the therapist have to build trust and maintain closeness between themselves. 

The therapist begins by asking the client questions to understand the nature of their problem or situation. These questions give the therapist insight into unhealthy patterns of thoughts, feelings, and behaviors that the client may have, according to Rios-Flores.

The therapist then provides the client with homework or exposure exercises to complete outside of the therapy session. According to an 2005 study, these assignments are essential the success of cognitive behavioral therapy.

CBT teaches the client to manage their thoughts and behaviors and successfully address new problems or situations independently. It mostly focuses on the present, though past experiences may be explored as they, too, can influence a client’s current circumstances. It helps them build habits, skills, and healthy coping strategies when faced with distressing situations.

How long might cognitive behavioral therapy last?

CBT is a structured short-term treatment that has no standard duration. Treatment is based on a client’s goals, objectives, and progress, says Rios-Flores, adding that “treatment can last up to 20 weeks, and each session can go from 30 to 60 minutes.”

What type of person is cognitive behavioral therapy best for?

Studies show that CBT is beneficial for treating depression, anxiety, and eating disorders, says Rios-Flores. “So, if you want to change unhealthy thought patterns and behaviors, then CBT would be a great form of therapy for you.”

For CBT to be effective, the client must actively participate in each session and take on assignments out of the therapy room. CBT is therefore best suited to those who can stay committed and proactive in meeting their therapy goals.

Cognitive behavioral therapy may also benefit people who are interested in learning skills to manage specific symptoms and who respond well to goal-setting, direct feedback, and coaching.

Are therapy apps and self-guided journals effective?

A growing number of apps offer self-guided CBT and are designed to supplement or replace individual therapy. While therapy apps can be beneficial in that they are accessible, location agnostic, and cost-effective, evidence to support their efficacy is often lacking. Research has not definitively proven that self-guided apps are a suitable replacement for individual work with a therapist, and it is not yet clear what conditions or types of people such apps might be best for.

In spite of this, CBT apps can be beneficial if and when a person can’t attend in-person sessions, says Rios-Flores. “It is better than not engaging in therapy.” Self-guided apps may also be recommended for people who have ended therapy, she adds. Similarly, CBT journals are becoming increasingly popular. The guided notebooks, often designed in partnership with licensed clinicians, may help a person keep track of their thought patterns, emotions, and progress when handling stressful situations. These journals provide an outlet to help people freely express their feelings. Much like CBT apps, they can supplement individual therapy or serve as a means of continued support after treatment has ended.

Understanding the difference between cognitive behavioral therapy and psychodynamic therapy

Cognitive behavioral therapy is a practice that has been studied and proven to improve mental health, says Rios-Flores. “It helps the individual focus on what is currently going on and develop coping skills to move into the present and future.” The skills a client adopts through cognitive behavioral therapy can help them, even after therapy, to more effectively function in the present.

With psychodynamic therapy, the therapist helps the client uncover past issues that may influence the present problem and resolve them accordingly. Treatment is typically longer and slower, and may last for more than a year.

One approach is not inherently better than the other, but rather one may be better suited to an individual client’s needs, learning style, and overall preferences. Most therapists will also tailor treatment to a client’s needs, meaning that cognitive behavioral and psychodynamic therapy aren’t necessarily mutually exclusive.