Cognitive Behavioral Therapy (CBT): What You Need to Know

Those initial interpretations (which CBT therapists call “automatic thoughts”) can lead a person to develop problematic underlying internal beliefs about themselves and others, as well as about the world around them and/or the future. Those beliefs then can negatively influence a person’s behavior.

The goal of CBT treatment is for people to learn to identify and reevaluate any distorted, unhelpful, or inaccurate thought patterns that are negatively impacting their behavior, explains Karol Darsa, PsyD, a licensed psychologist who practices CBT and is the founder and executive director of Reconnect Integrative Trauma Treatment Centers in Los Angeles. “One may not be able to control a specific situation but controlling how they interpret the situation can help them cope with it better,” Dr. Darsa says.

In fact, CBT arose from Dr. Beck’s finding that just helping his patients identify and change distorted thinking patterns and underlying beliefs often led to long-lasting psychological improvement and behavioral changes.

According to the National Alliance on Mental Illness, CBT also helps people to develop and practice new behaviors that make it easier to manage and prevent problems. These new behaviors might include:

• Making time for activities that you enjoy and give you a sense of accomplishment
• Breaking big tasks down into little, more manageable ones
• Gradually facing down fears until they no longer stop you from doing things that are important to you

  

CBT is beneficial not only for people diagnosed with a mental health disorder but also people who just have trouble managing emotions caused or worsened by negative thought patterns, Darsa says.

Mental health professionals commonly use CBT to treat:

• Anger issues
• Anxiety disorders, such as panic disorder or specific phobias
• Depression
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Stress
• Substance use disorders

In an initial CBT session, the therapist will ask you several background questions about yourself, your overall health, and the mental health concerns you’re currently experiencing, says Sarah Gleason, who is a licensed professional counselor and licensed chemical dependency counselor at the Taylor Counseling Group in The Woodlands, Texas. They’ll also ask what your goals for therapy are and explain what you can expect to achieve over time.

“Every therapist is somewhat different in how they conduct their sessions, but with a CBT therapist, you will be getting the same tools to utilize when not in the therapy room,” Gleason explains.

Gleason offers an example of how to apply the cognitive model: “Susie” was not invited to “Jackie’s” party with her other friends, a situation she found hurtful. Susie’s automatic thought was, “They must not want to be my friend anymore.” This caused Susie to feel sad and have a stomachache — examples of emotional and physiological reactions to a situation. As a result, Susie decides not to talk to her friends next time she sees them — an example of a behavioral reaction.

Using the cognitive model to assess the situation could help Susie learn to recognize and interrupt similar negative automatic thoughts in the future and to practice replacing them with more constructive thoughts, says Gleason. “Instead of Susie thinking her friends don’t want to be friends anymore, she might instead think something like, ‘Jackie knew that I was busy with my family on the night of her party, which must be why I wasn’t invited.’”

And instead of deciding she’ll no longer talk to her friends, Susie could reach out to Jackie and calmly communicate how not being invited to the party made her feel. Then Jackie, upon learning she inadvertently hurt Susie’s feelings, could explain why it happened and together they could agree on how to avoid future misunderstandings.

Over the years, CBT has evolved to include distinct subsets targeted at treating specific mental health disorders, such as:

• Dialectical Behavioral Therapy (DBT) This form of CBT was first designed to treat people with borderline personality disorder and chronic suicidal thoughts or behaviors. It’s now used for other conditions, too, like depression, PTSD, and eating disorders. In DBT sessions, participants practice skills like mindfulness, distress tolerance, and emotional regulation.

  

• Cognitive Processing Therapy  (CPT) This type of CBT is commonly used to treat people with PTSD by helping them learn to assess and change distressing thoughts that have been affecting them since their traumatic experiences first happened.

  

• Rational Emotive Behavior Therapy (REBT) Developed by psychologist Albert Ellis, PhD, this form of CBT employs a technique called “disputing” to help reframe maladaptive beliefs into helpful ones.

  

Most licensed therapists have websites that list the therapeutic techniques (aka modalities) in which they’re trained. If you’d like to connect with a mental health professional who offers CBT, you might want to first browse the professional’s website and then email or call them to ask them more about their experience with CBT.

Both Darsa and Gleason recommend using Psychology Today’s “Find a Therapist” tool to help pinpoint CBT therapists in your area. Other helpful tools include:

• Anxiety & Depression Association of America’s “Find a Therapist Directory”
• American Psychiatric Association’s “Find a Psychiatrist” tool

CBT and other types of talk therapy can be expensive, but there are ways to ease the financial burden. Before seeking treatment, ask your insurance provider which mental health services they cover and if they have a directory of therapists who accept your insurance. You can also ask therapists you reach out to which health insurances they accept.

In addition, many therapists offer lower rates for shorter sessions, or sliding-scale pricing based on one’s income, to help make therapy more affordable and accessible.