Cognitive behavioral therapy

Overview

Cognitive behavioral therapy, also called CBT, is a common type of talk therapy. This type of talk therapy is also called psychotherapy. During CBT, you work with a mental health professional such as a psychologist or other licensed therapist in a structured way. You attend a limited number of sessions. CBT helps you become aware of thinking patterns that may be creating issues in your life. Looking at the relationship between your thoughts, feelings and behaviors helps you view challenging situations more clearly and respond to them in a more effective way.

CBT can be a very helpful tool in treating many mental health conditions, such as depression, anxiety, post-traumatic stress disorder, also called PTSD, or an eating disorder. Sometimes CBT is the only treatment needed. Other times it's used along with other therapies or treatments such as medicines.

You don't need to have a mental health condition to benefit from CBT. CBT can be an effective way to learn how to better manage stressful life situations.

Why it's done

Cognitive behavioral therapy is used to treat a wide range of mental health concerns. It's often the preferred type of psychotherapy because it can quickly help you learn about and cope with specific challenges. CBT generally includes fewer sessions than other types of therapy and is done in a structured way. CBT often involves homework as a way to practice your skills.

CBT is a useful tool for learning ways to deal with emotional challenges. For example, CBT may help you:

• Manage symptoms of mental health conditions.
• Keep symptoms of mental health conditions from coming back.
• Treat a mental health condition when medicines aren't a good option.
• Learn techniques for coping with stressful life situations.
• Learn ways to manage emotions.
• Deal with relationship conflicts and learn better ways to communicate.
• Cope with grief or loss.
• Overcome emotional trauma related to abuse or violence.
• Cope with a medical condition.
• Manage long-term physical symptoms.

Mental health conditions that may get better with CBT include:

• Depression.
• Anxiety.
• Phobias.
• Post-traumatic stress disorder, also called PTSD.
• Trouble sleeping.
• Eating disorders.
• Obsessive-compulsive disorder, also called OCD.
• Substance use disorders.
• Bipolar disorders.
• Schizophrenia.
• Sexual problems.

For some people, CBT is most effective when it's done along with other treatments, such as taking antidepressants or other medicines.

Risks

In general, there's little risk in getting cognitive behavioral therapy. But you may feel emotions that aren't comfortable at times. This is because CBT can cause you to explore painful feelings, emotions and experiences. You may cry, get upset or feel angry during a challenging session. You also may feel physically drained. These reactions tend to get easier to tolerate over time as you practice your skills.

With some forms of CBT, such as exposure therapy, you may need to face situations you'd rather avoid, such as airplanes if you have a fear of flying. This can lead to short-term stress or anxiety.

However, working with a skilled therapist can lower any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.

How you prepare

You may decide on your own that you want to try cognitive behavioral therapy. Or a healthcare professional or someone else may suggest CBT to you. Here's how to get started:

• Find a therapist. You can get a referral from a healthcare professional, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs, also called EAPs. Or you can find a therapist on your own. A good place to start is with a local or state professional association. You also may try your local health department or search the internet for healthcare professionals who practice CBT.
• Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a set number of therapy sessions a year. Also, talk with your therapist about fees and payment options.
• Review your concerns. Before your first appointment, think about what issues you'd like to work on. Let the therapist know how you experience your distress, such as troubling thoughts, emotions and behaviors. While you also can sort this out with your therapist, having some idea in advance can help when starting therapy.

Check for a qualified therapist

Psychotherapist is a general term. It isn't a job title and doesn't suggest a specific type of education, training or licensure. Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, and other licensed professionals with mental health training.

Before seeing a psychotherapist, check:

• Background and education. Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master's or doctoral degree with specific training in mental health counseling. Medical doctors who specialize in mental health, called psychiatrists, can prescribe medicines and some may offer psychotherapy.
• Certification and licensing. Make sure that the therapist you choose meets state certification and licensing requirements for the professional role. This means that the mental health professional has had education and professional training, passed national board exams, and met state requirements to practice.
• Area of expertise. Ask whether the therapist has the knowledge and experience treating your symptoms or your area of concern, such as eating disorders or PTSD.

The key is to find a skilled therapist who can match the kind of therapy with your needs.

What you can expect

Cognitive behavioral therapy may be done one-on-one or in groups with family members or with people who have like issues. Online resources are available that may make getting CBT possible even if you live in an area with few local mental health resources.

CBT often includes:

• Learning about your mental health condition.
• Learning techniques such as relaxation, coping, resilience, stress management and assertiveness.
• Practicing ways to deal with worry and with thoughts that keep coming back and are upsetting and hard to stop.
• Learning how to approach and tolerate situations you have been avoiding.

Your first therapy session

At your first session, your therapist gathers information about you and asks what concerns you'd like to work on. The therapist asks you about your current and past physical and emotional health to get a deeper understanding of your situation. Your therapist may talk with you about whether you might benefit from other treatment as well, such as medicines.

The first session also is a chance to interview your therapist to see if you and the therapist are a good match. Make sure you understand:

• The therapist's approach.
• What type of therapy is best for you.
• The goals of your treatment.
• The length of each therapy session.
• How many therapy sessions you may need.

It might take a few sessions for your therapist to fully understand your situation and concerns and to decide on the best course of action. If you don't feel comfortable with the first therapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from CBT.

During CBT

Your therapist encourages you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and feel more comfortable sharing.

CBT generally focuses on specific issues, using an approach that sets goals. As you go through the therapy process, your therapist may ask you to do homework. Homework may include activities, reading or practices that build on what you learn during your regular therapy sessions. This encourages you to apply what you're learning in your daily life. The homework is designed to help you reach your treatment goals.

Your therapist's approach depends on your situation and what you want. Your therapist may mix CBT with another approach. For example, your therapist may add interpersonal therapy that focuses on your relationships with other people.

Steps in CBT

CBT typically includes these steps:

• Talk about troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental health condition. You and your therapist may spend some time deciding what issues and goals you want to focus on.
• Become aware of your thoughts, emotions and beliefs about these issues. Once you know the issues to work on, your therapist encourages you to share your thoughts about them. This may include looking at what you tell yourself about an experience, sometimes called self-talk. You also may look at what you think a situation means and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.
• Become aware of thinking patterns that may be creating issues. Your therapist may ask you to do a self-monitoring task to pay attention to your physical, emotional and behavioral responses in different situations. This can help you see patterns of thinking and behavior that may be adding to your issues.
• Challenge thinking patterns that may be creating issues. Your therapist can teach you ways to ask whether your view of a situation is based on facts or just feelings. This step can be very hard. You may have long-standing ways of thinking about your life, yourself and others. With practice, you can think in new or different ways. Learning more helpful thinking and behavior patterns can become a habit and won't take as much effort.

Length of therapy

CBT is generally short-term therapy. It may range from about 5 to 20 sessions. You and your therapist can talk about how many sessions may be right for you. Factors to think about include:

• Your condition or situation.
• How severe your symptoms are.
• How long you have had your symptoms or have been dealing with your situation.
• How quickly you make progress.
• How much you practice skills between sessions.
• How much stress you're having.
• How much support you receive from family members and other people.

Privacy

Except in very specific circumstances, talks with your therapist are confidential. That means they're kept private between you and your therapist. A therapist may break confidentiality if there is a current threat to safety or when required by state or federal law to report concerns to authorities. These situations include if you:

• Plan to harm yourself or take your own life.
• Plan to harm or take the life of another person.
• Abuse, exploit or neglect a child or a vulnerable adult. Vulnerable adults are over age 18 and not able to care for themselves or protect themselves because of age or disability.
• Can't safely care for yourself.

Results

Cognitive behavioral therapy may not cure your condition or make a situation that's not pleasant go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself, your life and your future.

Getting the most out of CBT

CBT doesn't work for everyone. But you can take steps to get the most out of your therapy and help make it a success.

• Think of therapy as a partnership. Therapy is most effective when you actively take part and share in decision-making. Make sure you and your therapist agree about the major issues and how to work on them. Together, you can set goals that matter to you and measure your progress over time.
• Be open and honest. Success with therapy depends on how willing you are to share your thoughts, feelings and experiences. Success also depends on being open to new insights and ways of doing things. If you're not sure you want to talk about some things because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know why you're concerned.
• Follow your treatment plan. If you feel down or don't feel like working toward your goals, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to talk about.
• Don't expect instant results. Working on emotional issues can be painful, and it's hard work. Sometimes it's common to feel worse during the first part of therapy as you begin to face past and current conflicts. You may need several sessions to build up new coping habits before you start to make progress.
• Do your homework between sessions. Follow through if your therapist asks you to read, keep a journal or do other activities outside of your regular therapy sessions. Doing these homework assignments helps you apply what you've learned in therapy.
• If therapy isn't helping, talk to your therapist. If you don't feel that you're making progress from CBT after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach.

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