A Quick Guide
What is CBT?1
That is an excellent question and one that a Cognitive Behavioral Therapy (CBT) clinician will routinely and proactively address with a client in a first treatment session or in an introductory call. The model for the therapy involves highlighting the connections between how one feels and the three components of emotion: physical sensations, thoughts and behaviors. Those four domains are in constant interaction and feedback loops. The goal of treatment is to apply tools to modify the patterns that are preventing or limiting the client from reaching their goals.
Does it work?
There is a large body of evidence supporting the efficacy of CBT for a range of behavioral health concerns2 including sustained results for certain conditions including anxiety and depression.3 Identifying specific mechanisms for how the treatment works requires finely-tuned research; some of this research to date has demonstrated that changes in thoughts and behaviors during treatment predict subsequent improvement in symptoms.4
What to expect?
CBT is a skills-based, largely present-focused, collaborative process. Emphasis during sessions is placed on identifying behaviors and beliefs that are interfering with well-being; introducing new or refined ways of thinking, acting and relating to feeling states; and developing practice opportunities for new learning to take place between sessions.
There is a structure to a CBT session including a mood check and measurement of symptoms at the start of session, a brief update of progress/concerns since last meeting, collaborative setting of an agenda for the meeting, discussion of the key topics and developing a homework plan.
It is important to highlight that a CBT therapist will be routinely checking for shared understanding of therapy content and getting feedback on how treatment is going. It is also common for a CBT therapist to frame an end goal of therapy as the client becoming “their own therapist”; that is, the client has their own toolbox of skills to utilize when challenges arise in the future.
Is it for me?
There is ongoing research intended to guide treatment matching for clients and optimize the likelihood of treatment effectiveness.5 For now, I recommend a client focus on fit and finding an empirically supported therapy. Some questions to consider include:
- Are you looking for a therapy that is structured and active?
- Are you willing to monitor your thoughts and behaviors?
- Are you willing to experiment with new techniques between sessions?
- Finally, does a focus on cultivating healthy routines, increasing flexible thinking and reducing avoidance of upsetting emotions or situations seem like a fit for your therapy goals?
Two final thoughts to keep in mind. First, embedded in CBT is the routine measurement of progress towards goals. Second, CBT emphasizes an experimental perspective. As such, you and your provider will be regularly checking in to see if the CBT approach is working for you.
1 CBT can broadly refer to a family of therapies, including cognitive therapy, behavioral activation and third-wave therapies like ACT and DBT, all of which you can find at The Family Institute.
2 Butler AC, Chapman JE, Forman EM, & Beck AT. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, & Fang A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427-440.
3 Cuijpers, P, Hollon, SD, van Straten, A, Bockting, C, Berking, M, & Andersson, G. (2013). Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ OPEN, 3(4).
Rith-Najarian LR, Mesri B, Park AL, Sun M, Chavira DA, & Chorpita BF. (2019). Durability of cognitive behavioral therapy effects for youth and adolescents with anxiety, depression, or traumatic Stress: A meta-analysis on long-term follow-ups. Behavior Therapy, 50, 225–40.
van Dis EAM, van Veen SC, Hagenaars MA, et al. Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online November 23, 2019. doi:10.1001/jamapsychiatry.2019.3986
4 Dimidjian, S, Goodman, SH, Sherwood, NE, Simon, GE, Ludman, E., Gallop, R., et al. (2017). A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women. Journal of Consulting and Clinical Psychology, 85, 26-36.
Lorenzo-Luaces, L, German, RE, & DeRubeis, RJ. (2015). It’s complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review, 41, 3–15.
Niles AN, Burklund LJ, Arch JJ, Lieberman MD, Saxbe D, & Craske MG. (2014) Cognitive mediators of treatment for social anxiety disorder: Comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behavior Therapy, 45, 664–677.
5 Cohen, Z.D., & DeRubeis, R.J. (2018). Treatment selection in depression. Annual Review of Clinical Psychology, 14, 209-36.