Introduction: Cognitive Behavioral Therapy

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Cognitive behavioral therapy (CBT) is a short-term form of behavioral treatment. It helps people problem-solve. CBT also reveals the relationship between beliefs, thoughts, and feelings, and the behaviors that follow. Through CBT, people learn that their perceptions directly influence how they respond to specific situations. In other words, a person’s thought process informs their behaviors and actions. The goal of treatment is to help clients identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.

Originally called simply “cognitive therapy,” what is now CBT was developed in the 1960s and 1970s by psychiatrist Aaron Beck, who found that helping depressed patients recognize and challenge their automatic negative thoughts had a positive impact on their symptoms. Beck drew on theories developed by psychologist Albert Ellis, the creator of rational emotive behavior therapy (REBT), among others, to develop an approach that was short-term and goal-oriented, in contrast to the dominant modalities of the time. Though it was originally designed to treat depression, since its inception CBT has been found to be effective for a wide range of mental health conditions and day-to-day psychological challenges, and is recommended as the first-line treatment for disorders including depression, anxiety, and insomnia.

Cognitive behavioral therapy is not a distinct treatment technique. Instead, it is a general term which refers to a group of therapies. These therapies have certain similarities in therapeutic methodology. The group includes rational emotive behavior therapy, cognitive therapy, and dialectical behavior therapy.



Cognitive behavioral therapy is grounded in the belief that how a person perceives events determines how they will act. It is not the events themselves that determine the person’s actions or feelings. For example, a person with anxiety may believe that “everything will turn out badly today.” These negative thoughts may influence their focus. They may then only perceive negative things that happen. Meanwhile, they may block out or avoid thoughts or actions that could disprove the negative belief system. Afterward, when nothing appears to go right in the day, the person may feel even more anxious than before. The negative belief system may get stronger. The person is at risk of being trapped in a vicious, continuous cycle of anxiety. 

Cognitive behavioral therapists believe we can adjust our thoughts. This is thought to directly influence our emotions and behavior. The adjustment process is called cognitive restructuring. Aaron T. Beck is the psychiatrist widely considered to be the father of cognitive therapy. He believed a person’s thinking pattern may become established in childhood. He found that certain cognitive errors could lead to depressionogenic or dysfunctional assumptions.

Common cognitive errors and their associated dysfunctional assumptions include:

  • Self-references: “People always focuses attention on me, especially when I fail.”
  • Selective abstraction: “Only my failures matter. I am measured by my failures.”
  • Overgeneralizing: “If something is true in one setting, it is true in every setting.”
  • Excessive responsibility: “I am responsible for every failure and every bad thing that happens.”
  • Dichotomous thinking: Viewing the world in extremes, black or white, with nothing in between.

The cognitive behavioral process is based on an educational model. People in therapy are helped to unlearn negative reactions and learn new ones. These are positive reactions to challenging situations. CBT helps break down overwhelming problems into small, manageable parts. Therapists help people set and reach short-term goals. Then the therapist gradually adjusts how the person in treatment thinks, feels, and reacts in tough situations. Changing attitudes and behaviors can help people learn to address specific issues in productive ways.

CBT integrates behavioral theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of an experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances.

CBT often targets cognitive distortions, or irrational patterns of thought that can negatively affect behavior. Common cognitive distortions include all-or-nothing thinking (seeing everything in black-and-white terms and ignoring nuance), catastrophizing (always assuming the worst will happen), and personalization (believing that the individual is responsible for everything that happens around them, whether good or bad).

For example, someone who is prone to catastrophizing may assume that a friend who doesn’t text them back right away is angry at them, potentially leading them to withdraw socially, lash out at the friend, ruminate, or otherwise behave in a non-productive way. Using CBT, they may learn to recognize their tendency to jump to the worst possible conclusion—and the next time their friend does not return their text, they can remind themselves that the friend has always returned texts in the past and may simply be busy. Such reframing can help someone refrain from engaging in counterproductive behavior.

CBT is rooted in the present, so the therapist will initially ask clients to identify life situations, thoughts, and feelings that cause acute or chronic distress. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so that they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.


CBT is a structured form of psychotherapy that can occur in a relatively short period of time—often between 5 and 20 weekly sessions, generally around 45 to 50 minutes each. CBT usually starts with one or two sessions focused on assessment, during which the therapist will help the client identify the symptoms or behavior patterns that are causing them the most problems and set goals for treatment. In subsequent sessions, the client will identify the negative or maladaptive thoughts they have about their current problems and determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, the client will learn skills that help them challenge and ultimately change their thinking patterns so they are more accurate with respect to a given situation. Once the client’s perspective is more realistic, the therapist can help them determine an appropriate course of action.

CBT usually concludes with a session or two of recapping, reassessing, and reinforcing what was learned. If necessary, someone may return to therapy for periodic maintenance sessions. Along the way, clients will most likely be given “homework” to do between sessions. That work will typically include exercises that will help them learn to apply the skills and solutions they came up with in therapy to real-world situations in their day-to-day life.

While cognitive behavioral therapy may sound simple—CBT therapist Seth Gillihan writes that he tells clients that the things he’ll ask them to do are “stupidly obvious”—it can be quite challenging in practice. Our patterns of thinking are often deeply entrenched and habitual—and as with any long-standing habit, it can be an arduous process to replace one thought pattern with a new, healthier one. And while clients undergoing CBT will likely not spend a large amount of time exploring their childhood or past, they may still be asked to examine thoughts and behavior patterns that they may find embarrassing or shameful. As in all types of therapy, it is important to work with a therapist with whom one can be open and candid.


Cognitive behavioral therapy involves more than sitting and talking about what comes to mind. This structured approach keeps the therapist and the person in treatment focused on the goals of each session. This ensures the time spent in therapy is productive. The person in therapy benefits from a collaborative relationship. They can reveal personal issues without fear of judgment. The therapist helps them understand the issues at hand. However, they do not tell the person in therapy which choices to make. 

CBT techniques incorporate many different therapeutic tools. These tools help people in therapy evaluate their emotional patterns and states. CBT therapists may employ common techniques such as:

  • Journaling
  • Challenging beliefs
  • Mindfulness
  • Relaxation
  • Social, physical, and thinking exercises. These may help someone become aware of their emotional and behavioral patterns.

Homework is completed by the person in treatment. It might include practical exercises, reading, or writing assignments. This helps reinforce the therapy. The homework is done outside of the scheduled time for therapy. Homework is a crucial aspect of many CBT treatment plans. It challenges the person to continue working on their own, even after therapy comes to an end.

Most people who receive cognitive behavioral therapy do so for an average of 16 sessions. Each of these lasts about an hour. People in treatment learn new coping skills to handle their issues. They develop more positive beliefs and behaviors. Some even resolve long-standing life problems.


Psychology Today Article
  • Beck, J. S., & Fleming, S. (2021). A Brief History of Aaron T. Beck, MD, and Cognitive Behavior Therapy. Clinical Psychology in Europe3(2), 1-7.

  • Beck Institute of Cognitive-Behavioral Therapy.
  • Hupp SDA, Reitman D, Jewell JD. Cognitive-Behavioral Theory. Handbook of Clinical Psychology. Vol. 2. Children and Adolescents. 2008 John Wiley & Sons, Inc.
  • Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review. January 2006;26(1):17-31. [Abstract]
  • Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The efficacy of cognitive-behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research. October 2012;36(5):427-440.
  • Wood J, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M. Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry. March 2006;45(3):314-321.
  • Wood J, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M. Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry. March 2006;45(3):314-321.
Good Therapy Article
  • Liebert, R. M. & Spiegler, M. D. (1998). Personality: Strategies and issues (8th ed.). Pacific Grove, California: Brooks/Cole.
  • National Association of Cognitive-Behavoral Therapists. (2014). CBT certifications. Retrieved from
  • National Health Service. (2014). Cognitive behavioural therapy. Retrieved from
  • Prochaska, J. O. & Norcross, J. C. (2003). Systems of psychotherapy: A transtheoretical analysis (5th ed.). Pacific Grove, California: Brooks/Cole.
  • Royal College of Psychiatrists. (2013). Cognitive behavioural therapy. Retrieved from


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