What is cognitive behavioral therapy and how does it work?

By Sarah DiGiulio

There’s no one-size-fits-all fix to treating insomnia, depression, anxiety, drug addiction, eating disorders, and other psychological problems. But there does seem to be a common starting place most psychologists and other therapists rely on: cognitive behavioral therapy (or “CBT” as it’s commonly referred to).

CBT falls under the broader category of psychotherapy. (Psychotherapies differ from other types of therapy, such as medications, in that they involve a psychologist or other trained professional working with an individual or group to identify a problem and develop solutions. Usually that process involves a lot of talking and thinking.)

The American Psychological Association (APA) recognizes CBT as one of the most effective forms of psychological therapy and psychiatric medications. And based on the evidence proving it works when it comes to managing anxiety disorders, bulimia, insomnia, personality disorders, stress management, and more, CBT is considered the gold-standard of psychotherapies in the field.

Exactly how CBT is delivered varies from one individual to another, based on each person’s needs, as well as other problems he or she may be dealing with — such as age, and the environment that person lives in. The common thread underpinning all CBT, however, is the goal of changing unhelpful or problematic ways of thinking in order to change unwanted or unhealthy behaviors.

“It’s trying to help you change your thoughts, your behaviors, and your feelings to give you better strategies to cope in day-to-day living and better overall health,” explains Thomas H. Ollendick, PhD, University Distinguished Professor and Director of the Child Study Center in the Department of Psychology at Virginia Tech. (His research and clinical work primarily focuses on children and adolescents, but he’s worked with adults, too.)

Our thoughts, our feelings, and our behaviors all exist in a very interrelated ménage à trois. One affects the other affects the other affects the other, and so on, in an endless loop, Ollendick says. The theory behind CBT is that by reframing your thinking, you learn how to reframe behaviors and emotions, too. It addresses all three of those components.

CBT is direct and problem-solving in its approach of coming up with the ways to handle what’s wrong that you can use your everyday life, Ollendick explains. Other forms of psychotherapy take a less direct approach, he says. Psychoanalysis, for example, aims to promote better functioning more indirectly by encouraging emotional awareness and personality change.

“[With CBT] you’re learning and developing coping strategies — and ways to control and manage your thinking and emotions,” Ollendick says.

What to expect in a CBT session

CBT always addresses unhelpful thinking styles and learned patterns of behavior, but in practice it differs from patient to patient because it should be applied in a way that meets that specific patient’s needs wherever they’re at, explains Lindsey Giller, PsyD, a clinical psychologist at the Child Mind Institute in New York City. “There’s a lot of flexibility,” she says.

The therapy (whether it’s delivered over one session or several) starts with both the therapist and patient collaboratively identifying the problem and problematic thinking. Then the therapist and patient make an effort to change those thinking patterns in the patient by replacing them with more helpful ways of thinking about the problem.

When he works with children, Ollendick likes to refer to CBT as a type of “thought-ectomy,” he says. “I’m going in and helping you remove a thought that is stuck in your head.” (He’s not trying to tell you the thought is wrong. It’s about swapping out the thought entirely with one that can help you engage in healthier behaviors and feelings, he says.)

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