How Effective Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is regarded as the gold standard for treating a variety of mental health conditions, including anxiety and depression. The basis of CBT is that our thoughts influence our behavior and feelings. We can change our negative behaviors and emotions by altering negative thought patterns.

There are benefits and limitations to using CBT; it does not work for everyone, and it is just one part of a larger mental health care plan. In this article, learn more about CBT.

Young woman with glass of water sitting on couch and looking at counselor while listening to his advice during psychological session

shironosov / Getty Images

Goal of Cognitive Behavioral Therapy

A simple definition of CBT is that it is a goal-oriented, time-limited psychotherapy that identifies and changes maladaptive thought patterns. CBT aims to help the patient develop a more fluid and positive way of thinking and behaving and, therefore, experience positive emotional changes and better functioning in their daily life.

Theories and Notable Figures

CBT was pioneered in the 1960s by American psychiatrist Aaron Beck. In his practice, Beck noticed that his patients with depression often had distorted cognition. In other words, they experienced automatic negative thoughts that filtered reality in biased ways that made them feel bad.

Focusing on these distorted thoughts produced both negative behaviors and feelings in patients. When Beck encouraged patients to challenge these thoughts, they improved emotionally.

In 1979, Beck published Cognitive Therapy for Depression, a book that shared his research and a theory that he called cognitive therapy. This marked one of the first times a psychological treatment was based on empirical science.

Since then, Beck's cognitive therapy has been heavily researched and is now called cognitive behavioral therapy.

CBT Example Scenario

One example of CBT and distorted thoughts is that a person might have an argument with a friend and think, "I am a bad friend," even though they have plenty of other friendships.

This distorted thought may then lead them to isolate themselves, not reach out to existing friends, and not put effort into developing new friendships.

Through CBT, a person may learn that it is normal for some friendships to end, and this doesn't mean they are innately a bad friend.

By changing their thought pattern to, "I can be a good friend, but not all friendships last forever," they may change their behavior in existing friendships and feel happier and more positive regarding their relationships and self-esteem.

Benefits of Doing CBT

CBT is one of the most effective forms of psychotherapy for a variety of mental health diagnoses. Researchers have performed over 2,000 studies on CBT to date, making it the most widely researched form of psychological treatment.

CBT effectively treats the following mental health conditions:

How is CBT so effective at treating those mental health conditions? Through CBT, a person learns to:

  • Recognize their distorted thoughts and how these may be creating problems in their life
  • Reevaluate and change negative thought patterns
  • Have a better understanding of other people's motivations and behavior
  • Use problem-solving and coping skills in challenging situations
  • Gain greater confidence in their ability to handle negative thoughts and emotions and preempt problematic behaviors

Limitations of CBT

Despite being lauded as the gold standard of psychotherapy treatment for some mental health conditions, CBT will not work for everyone.

For CBT to work, negative thought patterns must be at the root of the person's problems. If the issues are due to learning difficulties, substance use, or more complex diagnoses, then CBT may not be beneficial.

CBT also does not address broader issues within society, family units, institutions, or culture that may be contributing to an individual's problems.

Additionally, CBT is a very active form of therapy. A person will only benefit from CBT if they are ready to work toward change. This includes participating in sessions and completing assigned homework outside of sessions.

Common CBT Techniques 

CBT therapists use a variety of tailored strategies to help you reach your goals.

Common CBT strategies include:

  • Identifying and challenging distorted thoughts and beliefs
  • Scheduling pleasant activities
  • Exposure therapy to unpleasant/triggering thoughts, situations, or sensations to decrease avoidance
  • Emphasizing safety, control, esteem, intimacy, and trust
  • Establishing positive structure, routines, rules, and expectations
  • Techniques to calm and relax the mind and body
  • Role-playing to prepare for challenging future interactions

Homework is a central aspect of CBT. Your therapist will assign you homework at the end of each session that you must complete before your next session. This could be in the form of worksheets, journaling, or entering into certain situations or having conversations in your daily life.

Subtypes of CBT

Over the years, a number of CBT protocols have been developed for various mental health conditions.

Subtypes of CBT include:

What Happens During a CBT Session?

You may be wondering what to expect in a CBT session. No CBT session is the same, but here is a rough structure of what to expect:

  • First, your therapist will ask you about your mood and ask for an update since your last session. This may include probing questions about recent events and how you've been coping.
  • Next, your therapist will guide you in some bridging from your previous session to help with continuity. This could be bringing up notes or concerns from your last session and drawing connections to how you are doing today.
  • You will next discuss an agenda for the rest of your session. This will be done collaboratively with your therapist. For instance, you may mention something you want to discuss, and your therapist may have alternative suggestions. Together, you'll make a plan.
  • Any homework from your previous session is also reviewed at this point. You may discuss the results of your homework and any feelings, thoughts, or behaviors that were brought up or changed by completing it.
  • Next, you will continue with your agreed-upon agenda. Your therapist will offer feedback and support while discussing a specific problem. Alternatively, you may do an activity such as role-play or exposure treatment.
  • Finally, your CBT session will end with a short review and homework assignment.

While CBT is structured, your therapist will tailor therapy to your unique case, identity, and mental health concerns. Many practitioners approach therapy in an eclectic way and may use CBT elements alongside other therapeutic approaches.

CBT Is Personalized

CBT is different for everybody. Someone with depression may spend their session discussing distorted thoughts in depth or perhaps create a schedule to help them initiate pleasurable activities. In contrast, someone with agoraphobia may spend a session on exposure to situations that trigger anxiety—such as stepping outside their home, riding a bus, or going to a mall.

Therapists' Professional Backgrounds

CBT therapists come from various professional backgrounds but typically have a license in the mental healthcare field to work with patients.

Many CBT therapists are licensed psychologists, meaning they have a doctorate degree in the field of psychology.

However, CBT therapists also frequently have other professional backgrounds, including:

Those professionals learn about CBT during their degrees but usually go on to get additional training in CBT. The Beck Institute, the National Association of Cognitive-Behavioral Therapists, the Association for Psychological Therapies (APT), and various universities all offer training programs for CBT in the United States.

How to Find a Cognitive Behavioral Therapist 

Talk to your healthcare provider about referral to a CBT therapist, or check out a list of certified therapists to find one in your area.

The National Association of Cognitive-Behavioral Therapists keeps a directory of certified therapists who have met the requirements for certification in CBT and maintain continuing education. The Beck Institute also has a clinician directory of therapists who have completed their training.

When choosing a CBT therapist, consider factors like whether they accept your health insurance, their availability, and whether they specialize in any areas that are specific to your identity (such as gender-informed care, trauma, eating disorders, and more).

Affordability of CBT

Some CBT therapists may offer services on a sliding scale. This means they will charge a different amount based on your income.

If your health insurance doesn't adequately cover CBT, you may consider looking into teletherapy apps that are more affordable than traditional in-office therapy.

Summary

Cognitive behavioral therapy (CBT) is the gold standard psychotherapy for treating anxiety, depression, and other health conditions. This is a time-limited talk therapy that focuses on changing negative thought patterns. CBT is not suitable for everyone.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. David D, Cristea I, Hofmann SG. Why cognitive behavioral therapy is the current gold standard of psychotherapyFront Psychiatry. 2018;9. doi:10.3389/fpsyt.2018.00004

  2. National Health Service. Overview - cognitive behavioural therapy (CBT).

  3. Coffey SF, Banducci AN, Vinci C. Common questions about cognitive behavior therapy for psychiatric disordersAm Fam Physician. 2015;92(9):807-812. PMID: 26554473.

  4. The Beck Institute. The history of cognitive behavior therapy.

  5. Chand SP, Kuckel DP, Huecker MR. Cognitive behavior therapy. In: StatPearls. StatPearls Publishing; 2023.

  6. Jauhar S, McKenna PJ, Radua J, Fung E, Salvador R, Laws KR. Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential biasThe British Journal of Psychiatry. 2014;204(1):20-29. doi:10.1192/bjp.bp.112.116285

  7. National Health Service. How it works - cognitive behavioural therapy (CBT).

  8. American Psychological Association. What is cognitive behavioral therapy?.

By Sarah Bence, OTR/L
Sarah Bence, OTR/L, is an occupational therapist and freelance writer. She specializes in a variety of health topics including mental health, dementia, celiac disease, and endometriosis.