Cognitive Behavioral Therapy (CBT): How It Works And What To Expect

Cognitive behavioral therapy (CBT) is a common form of talk therapy that focuses on the connection between your thoughts, feelings, and behaviors. The core idea is that changing unhelpful thinking patterns may help you shift how you feel and how you respond to difficult situations. CBT is often used to help people manage anxiety, depression, and other mental health concerns, and it is considered one of the most evidence-based approaches to therapy available today.

What is cognitive behavioral therapy?

Cognitive behavioral therapy is a type of therapy that helps people recognize and change cognitive distortions and unhelpful thought patterns. Often, clients may be unaware of these unhelpful patterns of thinking until they learn how these patterns can impact their lives in a negative way. At that point, they can begin to change the way they think about things. CBT focuses on helping you gain insight and understanding into your thoughts, feelings, and behaviors.

CBT tends to be a short-term, goal-oriented approach to therapy. The focus is on helping you recognize how your thoughts can significantly impact your moods or contribute to negative feelings, and then learn coping techniques that may help you change unhelpful behavior. It is considered an evidence-based approach supported by extensive research, and it can be practiced in person or through online sessions.

If you are curious about whether CBT could be a good fit for you, you can get started by connecting with a licensed therapist who can help you explore your options.

How cognitive behavioral therapy works

In your first CBT session with a licensed mental health professional, you may learn that cognitive behavior therapy has several core principles and works by addressing unhelpful behavior and thinking patterns that can contribute to negative emotions and worsen the symptoms of mental illness.

CBT is a collaborative process. Your therapist typically starts with an assessment of your concerns, then helps you identify these unhelpful patterns and replace them with more helpful ones. From there, you may work together to challenge distorted thoughts and build new skills you can apply in daily life. This approach, combined with constructive coping mechanisms, can help create lasting behavioral change and make stressful situations easier to manage. If you would like to understand more about what CBT stands for, one of the key concepts your therapist may introduce early on is cognitive distortions.

Common cognitive distortions CBT addresses

Cognitive distortions are unhelpful thinking patterns that can affect your mood and behavior. A therapist can help you recognize and reframe these patterns in therapy. Here are some of the most common distortions CBT may address:

• Filtering: You focus on the negative details of a situation while ignoring the positive ones.
• Black-and-white thinking: You see things as all good or all bad, with no middle ground or shades of gray.
• Overgeneralization: You draw a broad conclusion based on a single event, assuming it will always happen again.
• Catastrophizing: You imagine the worst possible outcome based on a small detail.
• Personalization: You believe an event was about you or caused by you, even when other factors are at play.
• Emotional reasoning: You assume that because you feel a certain way, it must be true.
• Should statements: You tell yourself what you "should" or "ought to" do, which can induce guilt or shame.
• Labeling: You define yourself by a single quality or mistake, such as "I'm a failure."

Once you can recognize these patterns, a therapist can introduce practical tools to help you respond to them differently.

CBT techniques therapists commonly use

A CBT therapist helps people recognize and overcome distortions like the ones above, practice positive behaviors, and build problem-solving skills they can apply in their daily lives. Over the course of treatment, therapists may draw on a range of cognitive behavioral therapy techniques. Below are some of the core methods you may encounter:

1. Cognitive restructuring or reframing: This involves changing negative thoughts into more constructive ones. For example, instead of telling yourself, "My last relationship ended, so I'll never find love," you might tell yourself, "That relationship may not have been the right fit, but the right person for me is out there."
2. Behavioral activation: This technique involves doing activities you enjoy, even when you lack motivation, based on the idea that initiating the activity may help make it enjoyable. It may be especially helpful for managing symptoms of depression.
3. Exposure techniques: You may gradually and safely confront situations or reminders you tend to avoid, which can help reduce fear over time.
4. Journaling and thought records: CBT often involves "homework" in the form of worksheets or journaling prompts intended to help you build a deeper understanding of your thoughts, feelings, and responses to stressful situations.
5. Relaxation and mindfulness exercises: Techniques like deep breathing or grounding exercises may help you manage stress and stay present in difficult moments.

The role of mindfulness in CBT

Some therapists may also incorporate mindfulness meditation training into their cognitive behavioral therapy practice. Mindfulness involves passively observing experiences, thoughts, and feelings as they arise, without judgment, while attempting to stay present in the moment. Mindfulness may help improve stress management, reduce negative emotions, promote symptom reduction in conditions like anxiety and depression, and improve emotional regulation.

What to expect during CBT sessions

CBT sessions tend to be collaborative, with you as an active participant. When you have your first therapy session, your therapist will likely start by asking you about your life, background, current concerns, and whether there are any specific mental health concerns you hope to address. They may also help you identify specific treatment goals to work toward.

Typical sessions often last around 45 to 60 minutes and may begin with a check-in, followed by reviewing any homework, practicing new skills, and planning for the week ahead. Even if a therapist primarily practices CBT, they may combine it with other approaches like dialectical behavior therapy. Depending on the therapist, this sometimes involves homework, such as journaling, to help you build emotional awareness and practice shifting unhelpful thoughts. Understanding your unique needs can help your therapist find the right combination of approaches for your situation.

Conditions CBT may help treat

Cognitive behavioral therapy has been studied extensively and is supported by peer-reviewed studies and clinical trials. Many of these studies show that cognitive behavioral therapy can be helpful in treating a range of mental health conditions and may contribute to symptom reduction in various psychiatric disorders.

CBT has been used to help people manage the following conditions:

• Anxiety disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Bipolar disorder and other mood disorders
• Phobias
• Certain physical health challenges, such as insomnia and chronic pain

Beyond these examples, people navigating everyday challenges and life transitions, such as marriage, parenthood, grief, relocation, and work challenges, may also benefit from CBT.

How long does CBT treatment typically last?

One reason many people consider CBT is that it tends to be shorter-term compared to some other forms of therapy. A common range is 12-20 sessions, though this can vary quite a bit depending on your individual needs, goals, and the concern you are addressing.

Some people may notice improvement within a few weeks, while others may benefit from a longer course of treatment. Because CBT is goal-oriented, you and your therapist can set these goals collaboratively and revisit them along the way to see what feels most helpful for you.

Benefits of CBT

Learning cognitive behavioral therapy techniques during sessions with your therapist can be helpful for people experiencing anxiety, depression, eating disorders, or other mental health concerns. CBT can help you develop practical coping skills and gain insight into your emotional challenges. Some of the key benefits may include:

• Developing coping skills you can use during stressful situations
• Building problem-solving abilities
• Learning positive behaviors and healthier thinking patterns
• Retaining skills that can continue to help you after therapy ends

Beyond their mental health applications, the skills people develop in CBT may also be applied to everyday challenges, such as stressful situations at work and conflicts in relationships.

How to explore whether CBT is right for you

CBT can be helpful for many people, but it may not be the ideal approach for everyone or every situation. Some personality disorders may respond better to other therapies like dialectical behavior therapy (DBT), and for some people, a combination of therapy and other support may be helpful. CBT also asks for active participation, including homework between sessions, which may not feel right for everyone at every point in their lives.

A therapist can work with you to determine which approach may be the best fit for your unique needs and goals.

Individual vs. group CBT

CBT may be practiced in either individual therapy sessions or group settings. From a clinical perspective, group CBT works similarly to individual CBT in that providers help participants identify and shift unhelpful thought patterns. There may be less one-on-one guidance in group settings, and participants may be encouraged to practice techniques as a group, discuss their experiences with one another, and offer mutual support.

How online therapy can support your CBT journey

Online therapy can make it easier to access CBT from wherever you feel most comfortable. Doing sessions from home may be helpful when practicing certain techniques, and the ability to use in-app messaging between sessions can offer added support as you work through homework or new skills. Flexible scheduling can also make it easier to fit therapy into your daily life.

CBT is a highly evidence-based approach, and research shows that online CBT can be similarly effective to in-person CBT for a range of mental health concerns.

There are many cognitive behavioral therapists among BetterHelp's network of more than 30,000 qualified providers who can teach you valuable skills in recognizing your own cognitive distortions and how to change them. If you feel ready to take the next step, you can connect with a licensed therapist and begin at your own pace.