Everything You Need to Know About Cognitive Behavioral Therapy

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Photo: Will & Deni Mcintyre/Getty Images/Science Source

Though the word is often used broadly, not all forms of therapy are alike. Many people, when they refer to a therapist, are talking about traditional psychotherapy, or talk therapy — the type where, the joke goes, the therapist asks “and how do you feel about that?” after everything you say. Though the scientific support for talk therapy’s efficacy is mixed, many people find it extremely helpful, particularly when attempting to locate and/or work through longer-term problems and feelings.

By contrast, cognitive behavioral therapy  (CBT) is usually a shorter-term, more solutions-oriented form of therapy, usually intended to help patients manage or change specific behavioral and/or thought patterns.

Whether you’re considering CBT for yourself (or someone else), or you’re just looking for more information about it, here’s what you need to know.

What is CBT?

“Cognitive Behavioral Therapy, briefly stated, is a solution focused therapy that proposes the model that our thoughts, our emotions, and our behaviors are synchronized in such a way that our belief will be associated with emotions that we experience, and our behaviors will be aligned with those,” says Allen R. Miller, a CBT clinician and trainer at the Beck Institute. “If we make changes in the way that we think about something or the way that we feel about something or the way that we act, then those other components will be affected.”

Whereas traditional talk therapy might be more circuitous, and shift in topic depending on whatever’s on your mind when you go in for your appointment, CBT is generally more structured, and relies on a plan developed by the therapist and the patient when they first meet.

“I think there’s a little bit more focus on goal setting,” says Aleta Angelosante, a cognitive behavioral therapist at NYU Langone Health. “It’s a little less like I am this unknowable expert and object and you are the patient. There’s a little bit more teamwork and collaboration.” Whereas traditional talk therapy is often aimed at helping patients discover what their issues are, CBT is directed more toward patients who know what they want to change, says Miller.

CBT can help with fears and phobias.

Firstly, think of CBT like an umbrella — there are a number of subtypes that fall underneath it. One common form is exposure therapy, typically used to treat acute fears and phobias. “Exposure therapy is slowly and gradually, fully with patient consent, and as a collaborative model, exposing the person to the thing that they are scared of or are fearful of,” says Angelosante.

To give a common example, Miller describes what the process would be like for a patient who’s afraid of spiders. In CBT, he says, “We would expose [the patient] in small increments — maybe to a picture of a spider, and then a spider 50 feet away, then ten feet away, then having them hold a harmless spider.” By changing the behavioral pattern the patient has associated with the triggering stimulus (usually, avoidance), therapists are able to help patients form different thought processes and emotions around it, making it easier to further change one’s behavior.

“Exposure therapy helps you learn new things,” says Angelosante. “You learn that it wasn’t as bad as you thought, that nothing terrible really happened, and that you can handle it.”

There are many other issues CBT can help with, too.

“The evidence for CBT has been established for a wide range of things, from depression and anxiety, to substance-abuse problems, to personality disorders, to eating disorders, to treatment for medical problems,” says Miller. Indeed, meta-analyses of CBT studies have shown that this form of therapy is generally very effective. According to Angelosante, the success rate is usually somewhere between 60 to 75 percent, and typically on the higher end. “Usually two-thirds to three-quarters is what we quote,” she says.

Unlike talk therapy, CBT mostly deals with the present.

When you’re deciding whether CBT is the right kind of therapy for you, says Angelosante, it’s important to consider your motives. “Are you sort of wanting to get a deeper understanding of yourself, and just want to talk to someone?” she says. If so, “that’s more of a traditional psychotherapy route.” But if you have a clear problem you want to address, and you’re not necessarily looking for the root of — whether it’s social anxiety, or a fear of flying, or OCD, CBT might be a better option.

“CBT is also a more present-oriented kind of treatment, meaning that we deal with the problems that a person is having in the here and now,” says Miller. “And depending on what it is, we don’t have to go back to a person’s childhood and resolve problems of childhood in order to resolve the problems that they’re having right now.” There are exceptions, of course — trauma-focused CBT is a subtype which likely would require patient and therapist to look to the patient’s history — but for the most part, CBT deals in the immediate subconscious: something you’re aware affects you every (or almost every) day.

CBT is shorter-term than traditional therapy — typically, 10–20 sessions.

While traditional talk therapy can go on indefinitely, and its duration is often left to the patient to decide, CBT more often has a fixed timeline. Because CBT is more easily researched than other therapies (because of said timeline, but also because behavioral changes are easier to study than, say, psychological ones), cognitive behavioral therapists can work from a body of evidence when developing a patient’s treatment schedule, knowing what has worked for similar issues in the past. “Most standard CBT in a research setting is somewhere in the order of 10 to 20 sessions,” says Angelosante. This is the range she’ll often present patients with when they come in — and usually, she says, those sessions will be spread over four to six months, on average.

There are, of course, outliers to that range, says Miller. People with personality disorders typically take longer to treat, as do those with volatile living situations, such as victims of domestic violence, who may have difficulty changing their behaviors, or attending sessions consistently. But many patients will complete CBT treatment within a year, though some might want additional rounds at a later date. Angelosante, who works primarily with children and young adults, says, “I might see a kid when they’re 8, and we deal with their anxiety or whatever it is at that time, and then I hear back from them when they’re 12 or 15, because things have changed, or something else has popped up. Then we can kind of start all over again, or we can just do some booster sessions, depending on what they need.”

Not all therapists are equally qualified to do CBT.

When you’re trying to find a CBT therapist, says Angelosante, it’s important to ask a lot of questions. “What I find when people are looking for a therapist, and they ask someone if they do CBT, a lot of people will say yes, but they’ll say yes because they did a two-day workshop on CBT, or they incorporate pieces of CBT,” she says. This is not to say that those therapists are unqualified to do therapy, but rather that the therapy they practice is more likely to look like traditional talk models. There is no universal certification for CBT, says Angelosante, but she suggests a few ways to find out if a potential therapist fits the bill — the first being to ask what their training background and preferred approach are.

Angelosante also recommends using the Association for Behavioral and Cognitive Therapies (ABCT)’s “find a therapist” option to find a CBT therapist. “If someone is a member of that organization, they typically have had good training and really adhere to CBT,” says Angelosante. The American Board of Professional Psychology offers a post-doctorate certification in CBT training, so if a therapist has that, you can feel certain they’re qualified, says Angelosante — but it’s also not essential: “Just because they don’t have that doesn’t mean they couldn’t be an excellent CBT therapist.” More important is for patient and therapist to have a conversation about their approach and their goals.

CBT, like all therapy, is a relationship, and it’s normal to have to do a little shopping around before you find the right match.

For more resources on CBT, see the Beck Institute’s website.

A Beginner’s Guide to Cognitive Behavioral Therapy