How does cognitive behavioral therapy work?

a woman practicing cognitive journaling while looking at the window

If you’re a mental health professional, a psychology student, or an individual who is seeking help for themselves, you may have asked yourself at some point: How does cognitive behavioral therapy work?

Often known by the acronym “CBT,” this form of talk therapy has become increasingly popular. At its core, CBT is based on the idea that how we think, feel, and act are all interconnected, and that our thoughts determine our feelings and, thus, our behavior.

Keep reading for a helpful summary that includes the history of CBT and how it works plus common cognitive behavioral therapy techniques used by therapists, psychologists, behavior analysts, and counselors.

What is CBT therapy? A brief history

Cognitive behavioral therapy is an umbrella term that includes several different approaches to therapy that share common elements. Rational emotive behavior therapy (REBT) is one of the earliest forms of CBT and was developed by Albert Ellis in the 1950s. And cognitive therapy was developed and coined by Aaron Beck in the 1960s.

What sets CBT apart from other psychotherapy models is its highly structured and goal-oriented approach.

Cognitive behavioral therapy is based on the following principles:

  • Psychological problems are partially based on negative, flawed, or unhelpful ways of thinking.
  • Psychological problems are partially based on unhelpful behavior patterns we learn from others.
  • Psychological problems are partially based on problematic or negative core beliefs about ourselves and the world around us.
  • People who are struggling with their mental health are capable of learning new and better ways to address their issues, cope with distress, and live happier lives.

    Mental health professionals use CBT in their practices to help clients manage their mental and emotional health and essentially “become their own therapist.” This form of talk therapy has been extensively researched and practiced since its inception and is one of the most common types of psychotherapy. Throughout the years, CBT has been adapted for use with couples, children, teens, and adults.

    How does cognitive behavioral therapy work, exactly?

    CBT helps people become more aware of their internal biases, negative assumptions, and behavioral patterns. The goal is to learn new and better ways of dealing with strong emotions, distinguishing between thoughts and reality, and ultimately reducing psychological distress.

    It has proven to be an effective treatment for a variety of mental health issues, including:

  • Anxiety: People with anxiety disorders often struggle with negative cognitive distortions which can be very distressing both for the anxious person and the people in their life. CBT helps break down these thoughts into manageable pieces, assess them objectively, and come up with a more realistic interpretation.
  • Depression: Studies have shown that for people suffering from chronic clinical depression, CBT therapy and antidepressant medication together are more effective than either treatment alone.
  • Post-traumatic stress disorder (PTSD): CBT can be a useful therapeutic framework for those who suffer from PTSD, as it helps clients desensitize themselves to their triggers.

    Overall, one of the main goals of CBT is for clients to change the behavior patterns that may be holding them back from achieving what they want in life. With practice and support, many clients are able to become more confident, improve their emotional regulation, stay calm during conflict or stressful experiences, and face their fears instead of avoiding confrontation or discomfort.

    Common cognitive behavioral therapy techniques

    Psychotherapists who apply CBT in their practices will typically customize treatment to meet the unique needs of each client. In the first few sessions, clients and therapists talk about ongoing issues in the client’s life and identify priorities to work on together. Under the guidance of a trained practitioner, clients often benefit from cognitive behavioral therapy techniques like:

    1. Journaling

    Sometimes called “cognitive journaling,” this practice is often the first step in a client’s CBT journey. This kind of reflection is especially helpful for those who are struggling with negative spirals and feel stuck in old behaviors that no longer suit them. According to a 2018 study, emotionally-focused journaling has been associated with decreased depressive symptoms after one month and increased resilience by the second month.

    Depending on the client, some therapists will assign homework in the form of specific question prompts or worksheets designed to guide you through a particular thought process. Later, when you are feeling more emotionally regulated, you can look back at your notes and start to identify patterns.

    2. Identify cognitive distortion patterns

    Clients and therapists work together to recognize cognitive distortion patterns. These can be thought of as faulty, misinformed, or incomplete perceptions of yourself and the world that sometimes become ingrained in your psyche. Some of the most common patterns include:

  • Dichotomous thinking: Compartmentalizing the world in “black and white”, this refers to seeing things as two separate categories with no gray or overlap in between.
  • Overgeneralization: Focusing on isolated incidents and using the information to make sweeping assumptions.
  • Disqualifying the positive: Discounting good things that conflict with your negative views of yourself or the world.
  • Mind reading: Assuming other people’s thoughts or motivations.
  • Fortune telling: Deciding how something will turn out before it even happens.
  • Minimization: Accepting that positive things are real but treating their existence as insignificant.
  • Catastrophizing: Assuming the worst possible outcome is the most likely.

    3. Guided discovery

    This therapeutic method is a back-and-forth process between the therapist and client. Clients must be active participants and speak openly and honestly for guided discovery to be effective.

    Therapists ask open-ended questions that encourage clients to get curious about their personal biases, thought processes, expectations, behaviors, fears, and more. It’s easier to make positive changes when you have a clear idea of how your unique brain works.

    This tactic is especially useful for chronically depressed people whose minds are in the habit of negative thinking, making maladaptive thought patterns inevitable. But the hopeful truth is that thoughts and beliefs are not permanent, as long as you are open to new information and willing to work on yourself.

    4. Cognitive restructuring

    People who are dealing with mental health problems often report feeling “stuck” – not physically, but emotionally. Sometimes, negative thoughts become deeply embedded in a person’s psyche, to the point where they become an automatic response. One widely recognized method of cognitive restructuring comes from the American Psychology Association’s five-step framework:

  • Name what made you upset.
  • Identify feelings that the situation brings up for you (e.g., shame, grief, mistrust, anger, betrayal, insecurity, etc.).
  • Pose questions about the thoughts behind those feelings (e.g., “Why do I feel like my partner doesn’t appreciate me?”)
  • Evaluate and break down those thoughts. Is there real evidence to support the negative thoughts? Is there another way to think about the situation?
  • Make an objective decision about whether the thought is accurate. If it’s not, can the negative thought be replaced by a new, positive one? If the negative thought is accurate, what’s the best course of action to take?

    Cognitive restructuring has shown it is possible to rewire your brain, essentially rerouting the neural pathway to a healthier response.

    Explore more foundational theories in psychology today.

    Those are the basics of how cognitive behavioral therapy works and the techniques involved. CBT can be life changing for many people, but it’s just one tool in a mental health provider’s toolkit. To explore more about working in this field, explore our Psychology Resource Hub.

    If this article has piqued your interest in a mental health career, check out “Should I major in psychology? 7 Signs you’d succeed.

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