Cognitive-Behavioral Therapy (CBT) is a widely used, proven, evidence-based approach to psychotherapy that focuses on the connection between thoughts, feelings, and behaviors. CBT treatment operates under the principle that our thoughts influence our emotions and behaviors. Identifying and changing problematic or harmful thought patterns can alleviate stress and anxiety and improve overall well-being. One key feature of this approach is it’s structured and solution-focused, making it a practical and effective treatment with clear results. I use it as a core part of my practice. I cover specific strategies such as Cognitive-behavioral treatment for social anxiety and CBT-I for sleep elsewhere in this blog.
Cognitive-Behavioral Therapy Background
CBT has been extensively researched and has demonstrated effectiveness in treating a wide range of mental health conditions. This includes depression, anxiety disorders, phobias, panic attacks, and general discontent. Cognitive-behavioral therapy is typically time-limited and structured, so you see results quickly. Sometimes, a quick course of cognitive-behavioral treatment can be done within a longer course of treatment so you can work on other issues and goals as well.
Basic Tenets
Cognitive-behavioral therapy offers a practical, evidence-based approach that targets the connection between thoughts, feelings, and behaviors. If you are looking for a collaborative and goal-oriented approach that can have lasting effects and arms you with strategies you can use in many areas of your life. In that case, cognitive behavioral therapy is for you.
Benefits of Cognitive-Behavioral Therapy
- Evidence-Based Effectiveness: Cognitive-behavioral treatment is supported by a substantial body of research demonstrating its effectiveness in treating various diagnoses, including depression, anxiety disorders, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and more.
- Short-Term and Focused: This method is often considered a relatively short-term therapy. Compared to other therapeutic approaches that might require longer periods, many individuals start to experience positive changes within a limited number of sessions.
- Problem-Solving Skills: Cognitive-behavioral treatment equips individuals with practical skills to identify, challenge, and reframe negative thought patterns contributing to emotional distress. This helps you develop healthier ways of thinking and responding to life’s challenges.
- Holistic Approach: Cognitive-behavioral treatment addresses the interconnectedness of thoughts, emotions, and behaviors. By working on changing negative thought patterns, it can improve emotional regulation and behavioral responses.
- Relapse Prevention: Cognitive-behavioral treatment often includes relapse prevention strategies. You will learn to recognize early signs of distress, which helps you apply them to coping skills you’ve acquired to prevent worsening symptoms.
- Customization: CBT is adaptable and tailored to your needs and challenges. We will work to develop personalized strategies and goals.
- Skills for Life: The coping skills and techniques learned in Cognitive-behavioral treatment can extend beyond the therapy sessions, enabling you to apply them to various situations.
- Wide Applicability: Cognitive-behavioral therapy can treat various conditions beyond mental health disorders, such as managing stress, improving communication skills, enhancing self-esteem, and addressing sleep difficulties.
- Combination with Other Treatments: CBT can be combined with other therapeutic approaches or medication, enhancing overall treatment outcomes.
- Empowerment: Cognitive-behavioral treatment empowers you by giving you tools to manage your mental health and well-being. This can increase self-awareness and greater control over your thoughts and emotions.
- Long-Term Benefits: The skills learned can have lasting effects, helping you maintain your mental health and prevent relapse even after the therapy has concluded.
CBT Uses
I use CBT in my practice for a wide range of mental health and general wellness issues. These are the most common:
CBT for Anxiety Disorders
CBT effectively treats various anxiety disorders, including generalized anxiety disorder, social anxiety disorder, panic disorder, and specific phobias. It helps you identify and challenge irrational or distorted thought patterns contributing to anxiety. CBT offers practical tools to manage the underlying stress that causes anxiety by teaching you how to reframe stressful situations, set realistic goals, and develop effective problem-solving skills.
CBT is also a primary treatment for OCD. It involves gradually exposing you to your obsessions and preventing their usual compulsive responses, thereby reducing the impact of obsessions. Finally, cognitive behavioral therapy can be used to treat insomnia rooted in anxiety. It involves changing behaviors and thoughts that contribute to sleep disturbances.
Cognitive-Behavioral Therapy and Depression
I use cognitive behavioral therapy to treat depression by helping you recognize and change negative thought patterns and behaviors that contribute to your feelings of sadness and hopelessness. This approach can help you build healthier self-esteem and self-confidence by challenging negative self-perceptions and developing positive self-beliefs. This can insulate you against future depressive episodes.
Cognitive-behavioral Treatment for Insomnia
Cognitive-behavioral therapy can help with primary insomnia, the type of insomnia that persists even after the original cause of the problem subsides. This method is called CBTI, with the “I” standing for “Insomnia.” This area requires specific training, which I have. CBT for insomnia is time-limited, solution-focused, and powerful. This method can be delivered virtually.
Cognitive-Behavioral Therapy for ADHD
I also use CBT for ADHD. While this approach is less known than other ways of managing an attention deficit, it can be quite effective, especially as an add-on method. CBT for ADHD gives you a toolkit to use to manage the racing thoughts, procrastination, and lack of focus that you might be experiencing.
General Uses for Cognitive-behavioral Therapy
Cognitive behavioral techniques can benefit individuals seeking personal growth, stress reduction, and improved overall well-being, even if they don’t have a specific mental health diagnosis.
Cognitive-Behavioral Therapy Process
In CBT, therapists work with clients to identify and challenge negative thoughts and beliefs contributing to emotional and behavioral difficulties. We look for exaggerated or irrational thinking that you may not even know. Through cognitive strategies, you’ll learn to recognize automatic negative thoughts and replace them with more realistic, positive, and adaptive ones. You’ll feel more in control and competent in creating positive moods and feeling empowered. This approach often involves homework assignments that encourage you to actively apply the skills and techniques learned in therapy to your daily life. Sometimes, you get to do fun experiments where you are the subject!
CBT Techniques
Cognitive-behavioral therapy centers around the following techniques:
Cognitive Restructuring (Reframing): To identify and challenge distorted or irrational thoughts, you are encouraged to examine the evidence for and against a thought and then reframe it into a more balanced and realistic perspective.
Exposure: To reduce fear and anxiety related to specific situations, objects, or memories, you gradually face your fears in a controlled way, starting with less anxiety-provoking situations and working up to more challenging ones.
Thought Records: To track and analyze automatic thoughts and emotional responses, you’ll record situations that trigger distress, as well as your thoughts, emotions, and alternative thoughts to challenge your initial reactions.
Behavioral Experiments: To test the validity of beliefs and assumptions, you’ll conduct real-life experiments to see if your thoughts or predictions come true; you’ll often find that your fears are unfounded.
Imagery Rescripting: To change the emotional response to distressing memories, you’ll visualize distressing situations and reimagine them with a different, more positive outcome.
These methods are often combined with mindfulness work and basic humanistic approaches, such as narrative therapy, to provide a powerful effect. While CBT is a structured course of therapy, your actual experience will be unique to you and the challenges you’d like to overcome.
Process Detail:
- Assessment and Goal Setting: The process begins with us collaboratively identifying the client’s concerns, symptoms, and goals. This helps establish a clear focus for the therapy and allows me to understand your unique challenges.
- Identifying Negative Thought Patterns: You learn to recognize automatic negative thoughts and cognitive distortions contributing to emotional distress. These thoughts are often habitual and automatic, so our goal is to increase awareness.
- Challenging Negative Thoughts: I help you challenge and question the accuracy and validity of their negative thoughts. This involves evaluating evidence for and against these thoughts and considering more balanced or realistic perspectives.
- Restructuring Thought Patterns: We’ll work towards alternative, more balanced, and rational ways of thinking. This process is often referred to as cognitive restructuring. The aim is to replace irrational or negative thought patterns with healthier, more adaptive ones.
- Behavioral Techniques: In addition to addressing thoughts, CBT also focuses on behaviors. You’ll learn to identify behaviors contributing to your difficulties and develop strategies to modify them. This might involve practicing new coping skills, facing feared situations gradually (exposure therapy), or implementing behavioral experiments.
- Homework Assignments: I often given homework assignments between sessions. These assignments might involve practicing new skills, challenging negative thoughts, or engaging in exposure exercises. Homework reinforces the learning process and helps you apply what you’ve learned in real-life situations.
- Gradual Progression: The therapy sessions follow a structured progression, starting with foundational concepts and moving toward more complex challenges. As you build skills and confidence, you’ll tackle more difficult situations.
- Relapse Prevention: Towards the end of therapy, you’ll learn strategies to prevent relapse and maintain your progress. This involves identifying triggers and creating plans for managing potential setbacks.
CBT Treatment Resources
CBT treatment continues to be a prominent part of my practice due to its durable positive effects and wide range of potential benefits. You can read more about my therapy approach and overall training and preparation or schedule a call to discuss whether cognitive-behavioral treatment is for you or whether my approach can help you with your unique goals. For more information on CBT treatment, there is a good overview of information from the American Psychological Association and the specific ways it is used from Science Direct.
Cognitive-Behavioral Treatment Example
The following example of cognitive-behavioral treatment (CBT) is designed to help you decide whether this approach may suit you. The example is not based on any specific client, of course, but rather an example of how it might be used for a made-up client who is suffering from social anxiety. Please get in touch with me anytime to discuss how Cognitive-behavioral therapy or a combination approach that includes CBT might help with your unique goals and challenges.
I also have an example in another post of CBT for social anxiety.
CBT Treatment Initial Steps
CBT treatment starts with steps designed to ensure that this is the best approach for you and then to design a treatment plan around your hopes and goals for therapy. This client, Julie, is a 25-year-old woman facing social anxiety, which affects her dating life, and some fear of public speaking in her new job.
Initial Assessment
We will begin by making sure I fully understand her concerns, symptoms, and triggers related to social anxiety. We reviewed specific situations that caused her social distress and how she hoped therapy would help. Next, we go over how she feels physically during these times, the anticipatory anxiety that prevents her from being fully social, and the negative thoughts associated with social interactions.
Given what she says in the initial conversation, we collaborate to set specific and achievable goals. These goals are not necessarily what she will do immediately but rather the longer-term goals that will show that therapy worked. They include attending casual social events without overwhelming anxiety, being able to engage in small talk on a date, giving feedback in work meetings, and presenting confidently in front of a small group.
Identifying Negative Thoughts
Once we have a solid treatment plan, it’s time to do the core task with CBT: Identifying and challenging negative thought patterns. These thoughts are often exaggerated or irrational, and they happen automatically. For Julie, we realize she has irrational thoughts of people evaluating her negatively about how she speaks and whether she is “up to the task” at her new job. She also fears embarrassing herself by saying something wrong or “unintelligent.”
Julie also has exaggerated thoughts when in social situations that the person or people she is with do not like something about her but do not say anything. She also fears saying the wrong thing and often leaves social situations obsessing about something she said.
CBT Treatment and Cognitive Reframing
It’s now time to help Julie more clearly see that these thoughts are irrational or exaggerated in real time. We start by having her do “behavioral experiments” to test the accuracy of negative thoughts. For Julie, this involves going as far as she is comfortable in social and work situations and noticing whether there is evidence to back her thoughts. Her homework will be to keep a thought journal to track negative thoughts and associated emotions and then see if there are signs that she was right about her fears.
Cognitive-Behavioral Therapy Adjunctive Steps
Julie is enthusiastic but fearful about the above steps, and we want to make sure that therapy goes at a pace she is comfortable with. One way to help is by teaching her relaxation techniques to manage anxiety. We will also go over coping strategies like deep breathing, progressive muscle relaxation, and mindfulness to manage anxiety symptoms in real time.
CBT Treatment Later Steps
As Julie progresses in therapy, she will work on gradually exposing herself to feared social situations or practicing specific social skills. Her progress is continually assessed in treatment, and positive changes are reinforced while challenges are explored, focusing on comfortable solutions. We continually work together to evaluate what strategies are working and make adjustments as needed. For example, Julie found that CBT techniques were challenging at first because her mind was racing, so I taught her some basic meditation techniques that helped her clear her mind.
More Homework
As we get closer to ending the CBT treatment course, I will assign even more homework to ensure the gains will stick and give her a toolbox she can use as necessary going forward. We’ll discuss what exercises she can do to maintain her gains and continue practicing learned skills outside therapy sessions.
Review and Progress Evaluation:
In the last few sessions, we will thoroughly review Julie’s progress toward her goals and what worked and what didn’t. We’ll talk about the stressors that may arise in the near term and how she can proactively use her new skills and knowledge to ensure she handles them well. We’ll focus on her new strengths and how she worked hard to overcome the barriers that were in place.
Termination and Relapse Prevention:
In the last session, we will continue talking about relapse prevention strategies and ensure she has the tools to continue her progress independently. We’ll review everything again and focus on how she can maintain her progress in the future. I’ll ensure she has multiple ways to contact me should she want a reminder or boost. I’ll let her know there is no charge for quick contacts designed to help maintain progress.
CBT Outcomes
Julie has made significant progress and can now quickly identify negative thoughts, challenge them, and fully believe they are inaccurate. This has led to her seeing improvements in her social life, work performance, and enjoyment. She is excited about taking even more steps forward, not that CBT has given her ideas and strategies. Specifically, she has found that CBT treatment helped with:
- Symptom Reduction: CBT treatment reduced her anxiety by addressing irrational thoughts and gradually exposing her to feared situations. She now feels more comfortable socially and in public speaking.
- Increased confidence: Julie’s gains in CBT treatment helped her feel more competent to make new and lasting improvements even after therapy concluded. She now has the general coping skills to deal with life stressors, difficult situations, and emotional challenges.
- Increased self-awareness and understanding: CBT treatment helped her understand the connections between their thoughts, emotions, and behaviors, fostering self-awareness and insight.
- Workplace performance: CBT treatment specifically helped Julie feel more competent and confident at work. She feels less stressed, more confident, and more able to use effective coping mechanisms.
This is a broad example of how this therapy might work on a fictitious person; CBT is highly individualized and adaptable to each person’s unique needs and circumstances. The ultimate goal is to empower individuals to manage their thoughts and behaviors more effectively, improving their mental health and well-being.
Your unique situation may feel similar to this one or quite different, but I hope this CBT treatment example shows you the power and flexibility of this type of treatment. I have used CBT as a standalone approach and in combination with other approaches to help people of all ages manage stress, feel more content, and improve performance.
My work
Much of my work either centers around cognitive-behavioral treatment or at least borrows some of the techniques and strategies of this approach. I also offer metacognitive therapy which is a close cousin to CBT.
If you feel that CBT is an approach that might benefit you, feel free to get in touch, and we can discuss this further. As with all specific techniques, we can also look at a combination of therapies that will include cognitive-behavioral treatment but also a humanistic or psychodynamic approach to understand better how and why the anxiety started in the first place. Contact me or schedule a consultation to see how cognitive behavioral therapy may be helpful to you.
