Cognitive-Behavioral Therapy (CBT) Overview

Cognitive therapy was developed by Aaron T. Beck at the University of Pennsylvania in the early 1960’s as a structured, short-term, present-oriented psychotherapy for depression. The practice of cognitive therapy was directed toward solving current problems and modifying dysfunctional thinking and behavior.¹Since that time, Beck and others have successfully adapted this therapy to a wide array of psychiatric disorders and populations. The cognitive model proposes that distorted or dysfunctional thinking is common to all psychological disturbances and subsequently influences the patient’s mood and behavior.²Realistic evaluation and modification of thoughts are one aspect of cognitive treatment with a patient’s improvement resulting from the modification of those underlying dysfunctional beliefs.² The therapist seeks in a variety of ways to produce cognitive change—change in an individual’s thinking and belief system—in order to bring about lasting emotional and behavioral change.

Various forms of cognitive behavioral therapy have been developed by other theorists as well such as Albert Ellis’s rational-emotive therapy,³Donald Meichenbaum’s cognitive-behavioral modification,⁴ and Arnold Lazarus’s multimodal therapy.⁵ Cognitive therapy has been extensively tested since the first outcome study was published in 1977.⁶ Controlled studies have proven its efficacy in the treatment of various anxiety and depressive disorders. By a wide margin, CBT has more evidence from well-controlled research showing that it works for specified disorders than any other treatment. For example, according to a review article in 2001, approximately 80% of the treatments for specific disorders (for both adults and children) characterized as having research support fall within the CBT class.⁷ Consequently, CBT predominates among empirically supported treatments for particular disorders.

Cognitive-behavioral therapy (CBT) is a form of talk therapy. This means that you discuss your thoughts, feelings, and behaviors with a mental health professional. CBT focuses on how the way you think affects the way you feel and act.

Your therapist helps you identify negative thoughts and evaluates how realistic these thoughts are. Then, he or she teaches you to unlearn negative thought patterns and learn new, helpful ones.

CBT is a problem-solving approach. While you cannot control other people or situations, you can control the way you perceive and react to a particular situation. CBT teaches you the skills to change your thinking. It can also help you manage your reactions to stressful people and situations.

The goal of CBT is to change your thought process. This will allow healthy and realistic responses to difficult situations. Many patients notice an improvement in their symptoms within 3-4 weeks of beginning CBT.

Prior to Procedure

There is no specific preparation for CBT. You may be asked to fill out a questionnaire about your feelings.

Description of the Procedure

You may receive CBT in one-on-one therapy sessions or in a group format. CBT can be divided into two parts: functional analysisand skills training.

Functional Analysis

You and your therapist will identify stressful situations. You will also determine the thoughts that lead to or worsen these situations. These thoughts will then be analyzed to see if they are realistic and appropriate. For example, your therapist may point out negative thought patterns, such as “I cannot handle this” or "people are laughing at me.”

Skills Training

Next, your therapist guides you to reduce unhealthy ways of thinking and to learn healthier ways. Instead of thinking “I cannot handle this,” you will learn to draw on your strengths: “I have handled difficult situations before, so I can handle this one.”

You will also learn to ask more questions about yourself before making a conclusion. For example, “Could those people be laughing at something other than me?” The goal is to replace irrational thought patterns with better ones.

Skills training takes a lot of practice. You will often be given “homework.” You might practice deep-breathing exercises or role-play how to act in certain social situations. For example, a person dealing with substance abuse might practice ways to decline an alcoholic drink.

Homework is vital to the success of CBT. You must practice new, rational responses until they replace your previous, unhealthy responses. Homework also allows you to try new skills. You will then be able to give feedback on which works best for you.

How Long Will It Take?

The length of an individual session is usually 50-100 minutes. Group sessions may last longer. Treatment sessions may occur 1-2 times per week for 12-16 weeks.

This is a general guideline. Depending on your situation, treatment may be longer or shorter. Keep in mind that it may take several tries to unlearn poor habits and to learn healthy ones.

Post-therapy Care

You may be given homework between sessions. You will need to practice the strategies you and your therapist have discussed.

Some therapists advise that you return for a check-up about three, six, and twelve months after therapy has ended. In addition, you may call your therapist whenever the need arises.

1. Beck, A. T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry, 10, 561-571.
2. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press.
3. Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
4. Meichenbaum, D. (1977). Cognitive-behavior modification: An integrative approach. New York: Plenum Press.
5. Lazarus, A. (1976). Multimodal behavior therapy. New York: Springer.
6. Rush, A. J., Beck, A. T., Kovacs, M., & Hollon, S. D. (1977). Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy and Research, 1(1), 17-37.
7. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.