Cognitive behavioral therapy (CBT) is a form of psychotherapy that emphasizes the importance of how our thoughts and emotions affect our behavior. During cognitive behavioral therapy, people are asked to focus on their thoughts, beliefs and attitudes and understand how these relate to problematic behaviors. By working through this process, a person can learn healthy ways to deal with difficult emotions and challenging life situations. Cognitive behavioral therapy can help someone lead a happy, fulfilling life by changing the way they think and behave.
Table of Contents
What Is Cognitive Behavioral Therapy?
As opposed to other therapeutic strategies, cognitive behavioral therapy focuses on a person’s current, rather than past, life situation. Cognitive behavioral therapy highlights that individuals can learn to be their own therapist by developing coping skills for working through challenging thoughts and emotions.
Since the 1960s, cognitive behavioral therapy has become one of the most common and useful therapeutic models for treating mental health conditions and substance use disorders. Research studies suggest that cognitive behavioral therapy leads to significant improvements in behavior and quality of life.
Origins and History of Cognitive Behavioral Therapy
Dr. Aaron Beck, a psychiatrist at the University of Pennsylvania who specialized in the study and treatment of depression, was the first to develop the principles of cognitive behavioral therapy.
In the 1960s, the mental health field was dominated by the theories of psychoanalysis, which held that thoughts, behaviors and feelings arise from needs and urges buried deep in the subconscious. To correct dysfunctional behaviors, the psychoanalyst uses an intensive therapeutic process to delve into a patient’s memories and past experiences.
While studying the effectiveness of psychoanalysis, Beck found that in most cases, depression arose from the patient’s dysfunctional thought patterns, rather than from subconscious conflicts.
By helping patients learn to recognize those thoughts and replace them with more constructive beliefs, Beck found that he was able to help them feel better, function more effectively and view the world in a more positive light.
Types of Cognitive Behavioral Therapy
Cognitive behavioral therapy is considered a family of interventions. Over the years, different types of cognitive behavioral protocols have been developed to better address a variety of disorders, including post-traumatic stress disorder, obsessive-compulsive disorder and social anxiety disorder.
Each protocol uses different therapeutic techniques, although they share essential features. The main shared feature is the belief that harmful thoughts can lead to emotional distress. Altering the unhealthy thoughts decreases psychological pain and destructive behaviors.
The types of cognitive behavioral therapy include:
- Acceptance and Commitment Therapy (ACT): utilizes a set of techniques to gain awareness and acceptance of negative emotions and thoughts rather than trying to change them
- Cognitive Therapy: emphasizes recognizing and changing problematic thinking patterns, emotional responses and behaviors
- Dialectical Behavioral Therapy (DBT): highlights that patients can improve their response to emotional stimuli by accepting their life challenges; exercises encourage the development of skills that help the patient observe and describe their thoughts non-judgmentally
- Mindfulness-Based Cognitive Therapy (MCBT): emphasizes focusing on the present moment and increasing awareness of how automatic reactions lead to emotional distress; patients are encouraged to gently recognize and accept their thoughts and feelings with an open mind
- Multimodal Therapy: focuses on treating seven different sides of someone’s personality, including behavior, affect, sensation, imagery, cognition, interpersonal relationships and drugs or biology
- Rational Emotive Behavior Therapy (REBT): focuses on changing irrational views into balanced views to shift dysfunctional emotions and behaviors into functional ones
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): a structured program that focuses on the treatment of single or multiple traumas and their subsequent negative emotions and behaviors
How CBT Works
Cognitive behavioral therapy principles hold that obstructive thought processes and learned patterns of unhelpful behavior contribute to psychological problems. An individual has the power to make positive changes in his or her life by actively working to understand and modify these destructive thoughts and behaviors.
During cognitive behavioral therapy, a patient and therapist work together to understand the patient’s difficulties and develop a treatment plan aimed at changing problematic thoughts, feelings or behaviors.
Plans to modify current cognitive patterns include:
- Learning to recognize and accept harmful thoughts and emotions
- Understanding other people’s incentives
- Gaining self-confidence
- Learning how to cope with stressful situations properly
Strategies to modify problematic behaviors include:
- Learning how to face fears
- Practicing how to remain calm in challenging situations
Cognitive Behavioral Therapy Techniques
A range of techniques utilized during cognitive behavioral therapy include:
- Cognitive restructuring: the process of identifying and challenging negative thoughts and beliefs
- Mindfulness: focusing on the present moment while gently accepting feelings and thoughts
- Relaxation: visualization, breathing techniques, massage and medication (if necessary)
- Problem-solving: learning how to work through daily life problems in a constructive way
- Exposure therapy: gradual exposure to fearful situations in a safe environment
- Role-playing: acting out situations that cause distress while discussing the accompanying harmful thoughts and emotions with the therapist
- Homework: reading or writing assignments that reinforce the topic of each therapy session
- Skills training: learning specific social, communication and assertiveness skills that can help someone successfully cope with difficult life situations
What to Expect During a CBT Session
Cognitive behavioral therapy treatment is short-term, compared to some other forms of treatment. A cognitive behavioral therapist will usually dedicate the first few sessions to evaluating the concerns or problems causing the client’s distress. The client and therapist will then devise a treatment plan and a list of goals for the sessions.
The number of sessions will vary, but could last up to 16 weeks (assuming one session per week). Most cognitive behavioral therapy sessions are around 60 minutes in length, depending on the therapist’s recommendation. When someone attends a cognitive behavioral therapy session, there is often an agenda with a structure. For example, the therapist may wish to focus on specific techniques or skills to unlearn destructive habits and come up with healthier alternatives. Cognitive behavioral therapy sessions can be one-on-one or in a group setting with other patients or family members.
A person will spend time both identifying and analyzing thoughts, feelings and circumstances that lead to destructive thoughts. This functional analysis during cognitive behavioral therapy might identify areas where there are still barriers or coping issues.
Without identifying and addressing these issues, a person may face a higher risk of future problems. Gradual exposure to fearful situations may also be used during cognitive behavioral therapy sessions to help the client slowly master such situations without experiencing negative thoughts or emotions. Homework assignments, which can include reading assignments, writing projects or tasks are used alongside therapy sessions to reinforce and build upon the focus of each week.
Goals and Benefits of CBT
Cognitive behavioral therapy will help individuals develop coping skills that can be used both immediately and in the future to deal with destructive thoughts, emotions and behaviors. Each therapy session may have both short-term and long-term goals tailored to the individual’s unique challenges.
By the end of the therapeutic course, individuals will be able to take more control of their behaviors, using their newfound way of thinking to deal with challenging thoughts and feelings. The goal of cognitive behavioral therapy is to resolve the problematic thoughts and behavior, improve functioning and achieve remission.
After cognitive behavioral therapy, an individual can expect a reduction in their symptoms. The coping skills gained through cognitive behavioral therapy can also prevent future episodes of emotional distress. Because cognitive behavioral therapy focuses on acquiring practical coping skills, many people see positive results quickly.
For individuals who have lost the ability to care for themselves, hold down a job or manage their finances, cognitive behavioral therapy can provide valuable tools for rebuilding their lives.
Effectiveness of Cognitive Behavioral Therapy
Research has shown that cognitive behavioral therapy improves treatment success for a variety of mental health disorders across a wide range of people.
In some cases, cognitive behavioral therapy is more effective than other psychotherapeutic approaches. Cognitive behavioral therapy is also successful when used in combination with necessary medications, helping patients achieve a significant reduction in symptoms.
The use of cognitive behavioral therapy in treating substance use disorders has been growing for more than 30 years and is now one of the most widely studied psychosocial interventions for addiction treatment.
Clinical studies have consistently shown that the coping strategies of cognitive behavioral therapy can increase a patient’s chances of achieving long-term recovery. A comparative analysis of 53 clinical studies indicated that cognitive behavioral therapy was effective at treating a wide range of addictive disorders, including alcoholism, drug abuse, nicotine addiction and many other conditions.
Both the National Institute on Drug Abuse and the National Association of Cognitive Behavioral Therapists recommend cognitive behavioral therapy as an addiction recovery treatment. When patients undergo cognitive behavioral therapy, they learn to recognize situations in which they are most likely to use drugs again and formulate appropriate coping mechanisms for a wide range of problems and emotions.
CBT in Addiction and Mental Health Treatment
Studies on the success of cognitive behavioral therapy have demonstrated that cognitive behavioral therapy is effective for treating mental health conditions. Cognitive behavioral therapy is used to treat many mental health conditions, including:
- Anxiety disorders
- Schizophrenia and other psychotic disorders
- Bulimia and other eating disorders
- Personality disorders
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder
- Substance use disorders
- Pregnancy-associated disorders
- Anger management disorders
- Attention-deficit hyperactivity disorder (ADHD)
Cognitive behavioral therapy can also be used to treat addiction to:
In individual counseling sessions, a therapist can use cognitive behavioral therapy to help a person identify the automatic thoughts that keep them stuck in a cycle of addictive behavior or that contribute to their mental health disorder.
In group counseling, individuals can actively practice their interpersonal skills and coping strategies with their peers. In relapse prevention training, they can learn how to identify their substance abuse triggers and recognize the early warning signs of a potential relapse.
The skills learned in cognitive behavioral therapy offer a practical way to replace destructive thoughts with positive, self-affirming beliefs. For people in recovery or those with mental health conditions who have lost their sense of control over their own lives, cognitive behavioral therapy offers the hope of freedom from the cycle of destructive behavior.
In substance abuse and mental health disorder treatment, cognitive behavioral therapy empowers patients by:
- Giving them simple, practical tools for changing negative beliefs
- Strengthening their confidence and sense of self-determination
- Helping them visualize the future in a positive way
- Helping them develop stronger, more trusting relationships
- Teaching them practical ways to prevent relapse
- Helping them cultivate sober activities to replace substance use
Although cognitive behavioral therapy is an essential component of mental health and substance use disorder treatment programs, therapy alone may not be not enough to help everyone achieve their recovery goals. Combining cognitive behavioral therapy with other treatments can produce even better outcomes than therapy alone.
A study published in the Journal of Consulting and Clinical Psychology, for example, found that relapse prevention training based on the principles of cognitive behavioral therapy was most effective when combined with other approaches, like medication.
Finding Cognitive Behavioral Therapy Near Me
To find a cognitive behavioral therapist near you, start by:
- Talking with a primary care doctor
- Ask trusted friends for recommendations
- Use a treatment locator tool
- Call The Recovery Village
At The Recovery Village, we utilize cognitive behavioral therapy to help our patients achieve healthy, meaningful lives. If you or someone you love is struggling with a substance use disorder, we can provide the tools you need to recover. You can receive comprehensive treatment from one of our facilities located throughout the country.
To learn more about treatment programs or get started with rehab for a drug or alcohol addiction and co-occurring mental health disorder, call The Recovery Village to speak with a representative today.
American Psychological Association. “What is Cognitive Behavior Therapy?” (n.d.) Accessed June 7, 2019.
Hofmann, Stephan; Asnaani, Anu; Vonk, Imke; Sawyer, Alice; Fang, Angela. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.” Cognitive Therapy and Research, October 1, 2012. Accessed June 7, 2019.
Hofmann, Stephan; Sawyer, Alice; Fang, Angela. “The empirical status of the “new wave” of cognitive behavioral therapy.” Psychiatric Clinics of North America, September 2010. Accessed June 6, 2019.
Lazarus, Arnold. “Multimodal Therapy.” Annual Meeting of the American Psychological Association, August 2002. Accessed June 7, 2019.
Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program. “Trauma-Focused Cognitive Behavioral Therapy.” (n.d.) Accessed June 7, 2019.
David, Daniel; Cotet, Carmen; Matu, Silviu; Mogoase, Cristina; Stefan, Simona. “50 years of rational‐emotive and cognitive‐behavioral therapy: A systematic review and meta‐analysis.” Journal of Clinical Psychology, September 17, 2017. Accessed June 6, 2019.
The National Association of Cognitive-Behavioral Therapists. “What is Cognitive-Behavioral Therapy (cognitive behavioral therapy)?” May 16, 2016. Accessed June 7, 2019.
Magill, Molly; Ray, Lara. “Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials.” Journal of Studies on Alcohol and Drugs, July 2009. Accessed June 7, 2019.
The National Institute on Drug Abuse. “Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine).” January 2018. Accessed June 7, 2019.
Carroll, Kathleen; Kiluk, Brian. “Cognitive Behavioral Interventions for Alcohol and Drug Use Disorders: Through the Stage Model and Back Again.” Psychology of Addictive Behaviors, December 2017. Accessed June 6, 2019.
McHugh, Kathryn; Hearon, Bridget; Otto, Michael. “Cognitive-Behavioral Therapy for Substance Use Disorders.” Psychiatric Clinics of North America, September 2010. Accessed June 7, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.