Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is one of the most studied forms of psychotherapy, combining two therapeutic approaches: cognitive therapy and behavioral therapy. CBT has decades of empirical analysis demonstrating its effectiveness,[1] and has been recommended by the American Psychological Association[2] and The National Institute for Health and Care Excellence[3] as an effective treatment for common mental health problems. A recent meta-analysis found that it is as effective as

psychopharmacological treatments at the short term, but more effective in the long term.[4]

Although the approach to treatment depends on what is being treated, the premise of CBT is that your thoughts, feelings, and behavior are interrelated and mutually reinforcing.

When this comes to negative patterns, these often involve what are called “cognitive distortions”. Cognitive distortions falsify otherwise veridical perceptual content. So, for example, imagine that you are on a diet but decide to cheat a bit and have a spoonful of ice cream. If you think “I’ve completely blown my diet”, you are likely demonstrating what is known as all-or-nothing thinking, or a tendency to view things in absolute, black and white categories. The importance of identifying cognitive distortions is that, because they falsify mental content, the feelings based on these thoughts come out more extreme than they otherwise would. If you think that a spoonful of ice-cream is no big deal in the scope of a months-long diet, you probably won’t feel too bad about it; if you think you’ve just ruined the progress you’ve made, you’re bound to be more upset. This won’t just stay in your mind – according to CBT your negative feelings will emerge in your behavior: perhaps even more severely restrictive dieting.

CBT differs from many other treatment methods in that it is focused on developing practical solutions to current problems that can be implemented immediately. Rather than unpacking your personal history in great depth, CBT is mainly concerned with identifying and changing current problems. That does not mean that you will walk away with a “cure” immediately – your therapist will still need to understand how you are approaching problem situations and familiarize themselves with your patterns of thinking, feeling, and acting.

Another essential difference between CBT and many other modalities is that CBT often involves homework. To really benefit, you have to take an active part in your treatment and work on problems between sessions. Doing that homework is an important part of addressing your symptoms, but you are not always expected to complete it without any problems. Processing your feelings about the between-session work with your therapist will provide valuable insight into how you may best overcome similar obstacles elsewhere. By discussing not only what went wrong but what went right, you and your therapist will identify areas of need and where to build on skills you already have.

[1] Öst, L.-G. (2008). Cognitive behavior therapy for anxiety disorders: 40 years of progress. Nordic Journal of Psychiatry, 62(sup47), 5-10.

[2] Society of Clinical Psychology. (2022). Psychological treatments. Division 12: American Psychological Association. Retrieved from https://div12.org/treatments/

[3] The National Institute for Health and Care Excellence (2011). Common mental health problems: Identification and pathways to care. Retrieved from: https://www.nice.org.uk/guidance/cg123/chapter/Recommendations

[4] 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.