Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy, commonly referred to as CBT, is a treatment that focuses on changing thoughts and behaviors. Traditional CBT often involves directly challenging distressing thoughts – the kinds of thoughts that make a person feel sad, angry or afraid. For example, a therapist might help someone with a public-speaking phobia to explore all of her catastrophic thoughts about making a fool of herself in public. This is the “cognitive” part of the therapy. Using a carefully crafted, systematic approach, the therapist unravels exaggerated belief, after exaggerated belief, until the person is left with a much calmer and more realistic perspective on what is likely to happen when she speaks in front of a crowd. In addition, the therapist might teach the client strategies for reducing physical symptoms of nervousness such as sweaty palms and rapid heartbeat. This is the “behavioral” part of the therapy, involving new actions the person performs (like learning to slow her breath) in order to bring about beneficial physical and emotional changes. Traditional CBT often uses textbooks, manuals and/or worksheets with highly structured exercises to augment treatment and to allow the client to carry out therapeutic homework tasks. Cognitive-behavioral therapy is sometimes delivered in packages of 8 or 12 or more sessions, but it can also be individually tailored to meet the needs of each client. It is considered to be a standard component of the treatment of obsessive-compulsive disorder (OCD) and is frequently used in the treatment of excoriation disorder (skin picking) and other habit disorders, body-dysmorphic disorder, depression, PTSD, phobias and anxiety. Since its original development, there have been innovations to traditional CBT including a modality called “Mindfulness-Based Cognitive Therapy” (MBCT) which incorporates stress-reducing elements from mindfulness meditation.


There are many other forms of cognitive-behavioral therapy that do not follow the traditional, structured format. In fact, any therapy that results in positive changes in cognitions (thoughts and beliefs) and behaviors is a form of CBT. For this reason, almost all therapists claim that they do some form of CBT within their clinical practice. For instance, some therapists do “talk therapy,” allowing clients to explore their thoughts, feelings and experiences in weekly therapy sessions. Through the process of discussion and feedback, clients may come to change dysfunctional thoughts and beliefs and be able to do things they weren’t able to do in the past.


Indeed, there are many other therapeutic modalities that also result in profound changes in thoughts and behaviors. For example, all types of “EFT and Energy Psychology” therapies lead to deep changes in thoughts, beliefs, feelings and behavioral tendencies, as do therapies like, “Emotionally Focused Therapy,” “EMDR” and “Ego-State Therapy” among many others. Parenting, couples and other relationship therapies also utilize a variety of techniques that result in significant cognitive and behavioral changes.


Because all therapies impact thoughts, feelings and behavioral tendencies, therapy itself is sometimes considered to be synonymous with CBT. Consequently, a doctor may prescribe medication and/or CBT for a patient’s mental health problem (such as a mood issue or anxiety). Traditional CBT as described above is far from the only type of therapy that may be helpful and clients themselves may prefer a different style of counseling. However, there are some conditions (like OCD for example) for which the highly structured form of traditional CBT, IS the preferred modality.


A qualified mental health professional will be able to help a prospective client choose an appropriate form of treatment for his or her issue, clarifying the training and expertise required to treat that issue. In most cases, there are many different types of therapy that can help when delivered by qualified professional therapists. One of the most important factors in achieving a positive therapeutic outcome is that the client feels comfortable with both the therapist and the therapeutic approach.