Cognitive Behavioral Therapy
By The Recovery Village
Medical Reviewer Danielle Boland | Editor Jonathan Strum
Last Updated: May 16, 2023
Editorial Policy | Research Policy
CBT focuses on looking at irrational thoughts and feelings and how they can influence behaviors. This helps people replace negative behaviors with positive coping mechanisms.
Thoughts and feelings have a lot of power over our behaviors. If you experience a negative feeling or thought, it can lead to behaviors that are not healthy or that you would like to change. Cognitive behavioral therapy explores the relationship between feelings and behaviors and is an effective treatment for many different mental health diagnoses.
What Is Cognitive Behavioral Therapy (CBT)?
Cognitive behavioral therapy (CBT) is a type of behavioral therapy that focuses on the relationship between thoughts, feelings and behaviors. The goal of CBT is to identify and understand false beliefs a person may have, as they can cause the person to use negative behaviors as a coping mechanism.
History of CBT
Psychologist Aaron Beck developed cognitive behavioral therapy in the 1960s. Since its invention, CBT has been researched and used in a large number of psychological studies on many different mental health disorders.
CBT has been shown to be effective in treating depression, anxiety, eating disorders, substance abuse and personality disorders. It has also shown success in helping to treat serious mental disorders like bipolar disorder and schizophrenia. CBT has been adapted into different approaches for children, adolescents, adults, couples and families.
Types of CBT
There are several different types of therapy that combine foundational elements of CBT with other therapeutic approaches. These are often used to treat specific mental health disorders, as they can be more effective than standard CBT for treating certain conditions.
CBT has been a large component in a growing part of psychology called positive psychology. Positive CBT often focuses on changing negative thoughts and emotions to feelings of optimism, gratitude and resilience. Positive CBT shifts the focus on what is going right or working with someone instead of focusing on all their problems. Positive CBT works well in treating depression and anxiety.
Trauma-focused therapy studies the connection between someone’s trauma and subsequent maladaptive behaviors. This type of therapy can create appropriate emotional responses to flashbacks or reminders of trauma and reduce the need to engage in negative coping mechanisms. PTSD is a primary diagnosis for trauma-focused CBT.
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy (ACT) is a behavioral therapy that couples mindfulness and acceptance in regard to life’s painful experiences. ACT challenges someone to focus on positive and meaningful life experiences instead of the ones that are painful or cause anxiety. ACT is called a transdiagnostic treatment type, so it is able to be used across many different mental and physical health diagnoses.
Mindfulness-Based CBT (MCBT)
Mindfulness-based CBT (MCBT) incorporates elements of cognitive behavioral therapy with mindfulness-based stress reduction. The mindfulness-based techniques work to identify negative emotions or moods and stop them before they become overwhelming. The cognitive piece works to develop a healthier relationship with negative thoughts and emotions and modify negative behavior. MBCT is primarily used to treat anxiety and depression.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy (DBT) focuses on changing thoughts and emotions to work toward both acceptance and change. DBT is the primary therapy for borderline personality disorder. DBT focuses on reframing emotions, accepting where someone is at and developing healthier coping mechanisms to encourage change. These skills can also be helpful in managing other mental health disorders, such as depression, anxiety, eating disorders and addiction.
Rational Emotive Behavior Therapy (REBT)
Rational emotive behavior therapy (REBT) helps identify rational versus irrational thoughts and feelings. REBT can help someone distinguish irrational thoughts from the truth and avoid using negative coping mechanisms in response to these thoughts. REBT is a popular treatment type for PTSD, bipolar disorder and substance abuse.
What Is CBT Used For?
CBT can be used for many different physical and mental health symptoms. Each diagnosis may respond better to certain aspects of CBT, and with the right approach, it can be a very helpful therapeutic technique.
Cognitive Behavioral Therapy for Anxiety
CBT is the primary treatment for anxiety, as an estimated 51.1% of people respond positively to the treatment type. Anxiety can cause someone to have thoughts and feelings that are not based in truth or that cause them to catastrophize. CBT can help someone with anxiety reframe their thoughts and feelings to change negative coping mechanisms to healthier ones.
Cognitive Behavioral Therapy for Depression
Studies have shown CBT to be a beneficial treatment modality for depression. With a 49.5% recovery rate, CBT has the highest rate of effectiveness for depression treatment. CBT helps people with depression reframe negative thoughts and emotions that lead to maladaptive behaviors such as isolating, negative self-talk and catastrophizing.
Cognitive Behavioral Therapy for Insomnia
CBT-I is a type of CBT that is specifically for treating insomnia. CBT-I focuses on addressing negative feelings someone has about their sleep patterns and quality of sleep. The theory is that someone who spends a lot of time worrying about their sleep is unable to sleep because there is a lot of pressure to sleep well. CBT-I helps create a healthier relationship with sleep and teaches coping skills such as relaxation training, stimulus control and sleep restriction. After three months of consistent CBT-I treatment, one study found that 61% of participants with insomnia were in clinical remission.
Cognitive Behavioral Therapy for OCD
Outside of medication, CBT is the top treatment for obsessive-compulsive disorder. CBT helps those with OCD reframe their negative emotions and feelings about a situation, which can help reduce obsessive and compulsive behaviors. One study found that approximately 75% of people found CBT to be helpful in reducing their OCD symptoms.
Cognitive Behavioral Therapy for Bipolar Disease
Bipolar disorder is characterized as a mood disorder with periods of mania, hypomania and depression. Bipolar can be difficult to treat due to a high rate of noncompliance with treatment. CBT has shown positive results in helping to relieve bipolar symptoms, improve medication management, identify and reduce bipolar episodes and also treat any other mental health disorders someone may have in addition to bipolar.
Cognitive Behavioral Therapy for PTSD
CBT has been found to help treat the symptoms of post-traumatic stress disorder by challenging unhealthy thoughts and emotions that are connected to someone’s trauma. By challenging these, the patient can identify the reality of the trauma apart from the irrational thoughts. In one study, refugees who received CBT treatment for PTSD had a 53% reduction in overall symptoms.
Cognitive Behavioral Therapy and Addiction
CBT works well to help reduce addiction symptoms and maintain overall sobriety. This is because it focuses on changing and regulating negative or harmful thoughts and feelings that can lead to addictive behaviors. CBT can help someone with addiction identify their triggers for substance abuse, improve self-control, develop healthy coping mechanisms and improve overall emotional self-awareness. In a study of people who struggled with addiction and received CBT treatment, 60% maintained their recovery by the one-year mark post-treatment.
Cognitive Behavioral Therapy for Eating Disorders
Eating disorders can lead to a false view of oneself and a distorted view of weight, appearance and relationship with food. CBT can help someone with an eating disorder change their thoughts and feelings associated with their bodies and food, making them less likely to engage in eating disorder behaviors. CBT is especially effective for bulimia nervosa and binge eating disorder and can help create healthier coping mechanisms in this population. CBT has shown a 60% recovery rate for eating disorders.
Other Uses for CBT
CBT is largely used for mental health disorders, but it has also shown to be a useful part of treatment for some physical health diagnoses. These can include:
- Chronic pain
- Chronic stress
What Is CBT Used For?
CBT is one of the most diverse types of therapy techniques and can be used to treat a variety of mental and physical health diagnoses. The principles of CBT can be taken and applied to many mental health disorders by utilizing the parts that are most beneficial to that diagnosis.
CBT is also the base of many types of therapeutic techniques, which makes its framework crucial in the treatment of many mental health disorders. CBT has been shown effective in treating:
- Eating disorders
- Bipolar disorder
There are benefits of using CBT versus other types of therapy. CBT results in a faster reduction of symptoms for a lot of disorders, and it helps patients to feel in control of their emotions and have more power in their recovery. CBT is a goal-oriented and solution-focused intervention, so results for CBT are tangible for patients. CBT is also highly engaging for clients and keeps them motivated and accountable for their own success in treatment.
How Does CBT Work?
Cognitive behavioral therapy is short-term and solution-focused, and it focuses on changing maladaptive thoughts and feelings that lead to negative behaviors. With this approach, a person’s functioning will improve over time as they create healthier coping mechanisms and reframe negative thoughts.
CBT works to teach a person how to better manage emotions so they do not lead to the behavior the person is trying to change. CBT also helps someone create a healthier way to analyze situations that affect their mood down the road. CBT focuses on the present and helps clients identify how their thoughts and feelings interfere with reaching a certain goal.
CBT is a skills-based therapy that teaches clients to cope in healthy ways instead of engaging in negative behaviors. In CBT, someone may learn:
- Diaphragmatic breathing
- Progressive muscle relaxation
- Guided imagery
- Cognitive restructuring
There are many techniques that can be taught in CBT treatment, and the techniques used may vary depending on the individual and what their diagnosis is. These tools are used to evaluate and reframe emotions while changing behavior.
Cognitive Restructuring or Reframing
Cognitive restructuring involves looking at negative thought patterns to identify where they occur the most. Once they are identified, the therapist will help the client reframe these thoughts into more positive and productive ones.
This can be used for many different situations. For example, someone may have intense feelings of failure or self-hatred if their weight is not a certain number. Restructuring can help the person stop seeing their weight or body as an indication of worth.
Exposure therapy is used to help someone overcome their fears or a phobia. A trained therapist will slowly and safely expose someone to the thing or situation that causes them fear and anxiety. While doing this, the therapist helps the person cope and navigate the feelings of anxiety. Eventually, the situation that caused anxiety or fear will no longer have the same effect as before.
As an example, this technique works with a fear of bugs. By slowly exposing someone to bugs and working through the feelings of anxiety it causes, the person will gradually become less afraid of bugs.
Journaling is a great way to keep track of positive and negative thoughts that occur during therapy sessions. It can also be helpful in identifying situations that cause certain thoughts and feelings that lead to a maladaptive behavior.
If someone keeps a journal of their week and notices that they felt anxious five times, they can look at what they were doing when they felt anxious to see what triggered their feelings. This can help them create a plan to cope with their anxiety in those situations rather than let it lead to a negative behavior.
Guided discovery is meant to help someone see their experience from the viewpoint of the therapist. A therapist will put themselves in the client’s position in order to provide an alternative perspective to what they believe is true. This can help challenge inaccurate thoughts a client is having and push them to reframe their thoughts and feelings about the situation that causes a behavior.
If someone says that everyone dislikes them and that is why they isolate, a therapist can take an example of their client in a social situation and challenge them to look at the reality of what happened. Were people actually ignoring them, or did they choose to isolate because they were worried no one would like them? This helps give clients the power to change their behavior and experience the alternative scenario.
Role playing is beneficial to clients because they are able to walk through scenarios that cause them anxiety, but they are in a safe space and have their therapist to help guide them through it. Role playing can help with:
- Problem-solving skills
- Social skills
Someone with anxiety may push off doing certain activities or being in certain scenarios because it causes them distress. By scheduling these activities and getting a plan to participate in them, it takes away the hardest step, which is deciding to commit to it. Scheduling activities can take away some of the anxiety about doing something and helps clients follow through. If someone is afraid of going to the dentist, scheduling their cleaning and deciding to go can help take some of the anticipatory fear away.
Mindfulness is a technique that helps keep someone in the moment and allows them to truly experience what is happening. People with symptoms of anxiety may have a very hard time staying in the moment and worry about what has happened or what is to come.
Someone who is anxious about starting a new job can practice mindfulness to stay in the moment of what they are doing in the present. They remind themselves they have no control over what will happen in the future, and all they can control and focus on is what is happening right now.
Skills training helps someone work through social deficits they may have due to a mental health disorder. Skills training generally occurs through modeling, role playing and direct instruction. These skills can be taught in CBT sessions with a therapist and also in a group setting. Common skills that are worked on through skills training are:
- Social skills training
- Assertiveness training
- Communication training
What To Expect During a CBT Session
A CBT session can seem intimidating if you do not know what to expect. A typical CBT session will begin with a therapist asking about what is going on in your life that is causing you anxiety or stress. They will also ask about any behaviors that you want to change and that are a result of your thoughts and feelings.
The therapist may ask about past experiences and behaviors to help identify any patterns. There are exercises a therapist can walk through to help identify patterns and explore thoughts, feelings and behaviors. Homework or exercises will also be assigned for the time between therapy sessions to help implement and practice new skills. The therapist will follow up on these activities to see if changes need to be made.
CBT has been found to be effective in both in-person sessions and teletherapy settings. Teletherapy occurs via telephone or through video chat and has the same structure as in-person CBT. A study found that 69% of participants in an eight-week online CBT program were very satisfied with the structure. There was also a reduction in symptoms overall, and 42% of participants were considered clinically recovered at the end of the eight-week period.
Online support can be a crucial part of someone’s recovery, and tools like The Nobu App allow for someone to have effective support at their fingertips. The Nobu App has tools such as mindfulness practices, journaling prompts and mental health lessons. For an additional fee, you can even connect with a licensed mental health professional who specializes in CBT.
Cognitive Behavioral Therapy at The Recovery Village Cherry Hill at Cooper
The Recovery Village Cherry Hill at Cooper is a drug and alcohol addiction treatment center that utilizes CBT throughout its various programs. We integrate CBT at all levels of care, including inpatient and outpatient treatment, to help those with addiction evaluate the relationship between their thoughts and feelings and how that may lead to their addictive behaviors.
If you or a loved one is struggling with substance abuse and addiction, CBT can be a helpful tool in working toward recovery. Contact us today to learn more about the facility and find out how to get started with addiction treatment.
Our Recovery Advocates are ready to answer your questions about addiction treatment and help you start your recovery.
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