Who doesn’t dwell on their mistakes or perceived flaws from time to time? We’ve likely all had moments where we’ve felt unworthy or tried to ignore that inner voice telling us we’re simply not good enough. And while these negative thought pattens may not stop you from going about your daily routine, they can erode your self-esteem and chip away at your overall quality of life.
But one highly effective treatment for a wide range of mental health issues can help just about anyone feel better and improve their well-being: cognitive behavioral therapy (CBT).
Research suggests that CBT can help “re-wire” the brain, change how people think, and adjust unhealthy or negative thought patterns. The technique has been highly effective in treating conditions, such as depression and anxiety, but anyone working to cope with stressors, adjust unhelpful self-talk, or manage a variety of challenges may benefit from it.
“It sounds almost too good to be true that CBT could work for almost everything, but it turns out that the research has been solid pretty much across the board,” says Jesse Wright, MD, PhD, director of the depression center and professor at the University of Louisville School of Medicine in Louisville, Kentucky.
How CBT helps people think differently
The brain contains roughly 100 billion neurons. Over time, these brain cells form connections in relation to certain topics, themes, or situations.
CBT, which has been around since the 1960s, is based on the idea that thoughts, emotions, and behavior are not only interconnected, but also that mental health problems or life’s challenges may change your thinking and behavior in an unhelpful way. For example, discouraging or self-critical thoughts may set up a cycle of avoidance of enjoyable activities that perpetuate negative thinking patterns. Because many of life’s problems are at least partly based on learned patterns of thinking and behavior, un-learning them can help you feel better.
“CBT is a very widely used and deeply researched therapy. It has a framework that looks for patterns of troubling thoughts or behaviors, helps to teach you about them, and builds skills to reverse these patterns,” explains Wright who is also the founding president of the Academy of Cognitive Therapy.
CBT is commonly used to treat a broad range of mental health conditions like depression, anxiety, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders. It’s also helping in managing emotional trauma, relationship conflict, low self-esteem, and stressful life situations, including grief, divorce, or problems at work.
CBT is also more effective than medication for insomnia, which affects 30 to 40 percent of U.S. adults each year. And unlike some sleeping pills, CBT does not carry a risk for addiction, Wright points out. People living with various medical conditions like diabetes, chronic pain, fibromyalgia, or IBS may also benefit from this type of therapy.
“CBT can help people understand, cope with, and manage their illness,” Wright says. “It’s not the treatment for a medical illness, but it can be very valuable as an add on to standard medical treatment, to help people have less distress and better quality of life.”
Almost anyone who gets trapped in negative thinking patterns could potentially benefit from CBT. For example, if you tend to imagine the worst, think everything is your fault, or feel like you never do anything right, CBT is a tool that could help you interrupt this rumination and feel better.
What a CBT session might look like
Unlike psychoanalysis or other types of talk therapy, CBT doesn’t primarily deal with understanding past events and underlying explanations for behavior. Instead, it focuses on current stressors or life problems, and what you can do to help yourself.
So, instead of looking back and analyzing previous experiences, CBT would help you:
- Identify negative or inaccurate thought patterns and help you recognize how they may affect your physical, emotional, or behavioral responses to certain situations (and vice versa)
- Build awareness about your self-talk, and how you interpret situations, people, and events in your life
- Learn how to determine if your thoughts are truly realistic or accurate
- Build habits that can reshape your thinking and behavior, and increase your confidence in your abilities
CBT is generally a shorter-term therapy. Sessions last about an hour, once a week. The number of sessions needed ranges broadly from about five to 20 sessions, depending on the severity and type of problem involved, and other factors, including whether the person has supportive relationships. Some people start to feel better after just a few sessions.
CBT can be done one-on-one with a therapist, or in a group setting. Some techniques that may be used:
- Role playing and practicing potentially problematic situations
- Learning ways to calm your mind and relax your body
- Scheduling enjoyable activities that boost your sense of accomplishment
- Breaking down fear- or anxiety-inducing tasks into more manageable steps
Like learning most new skills, the more you practice CBT, the better you get. For this reason, CBT therapists often assign “homework,” like reading between sessions, writing your thoughts in a journal, or doing relaxing exercises, such as deep breathing.
Keep in mind, exploring thoughts, emotions and experiences may feel uncomfortable or even painful, and could affect your relationships, especially when you first start CBT. Some forms of CBT use exposure to situations that may cause temporary anxiety. Be sure to discuss any uncomfortable or troubling feelings with your healthcare provider (HCP).
Many therapists also offer virtual CBT sessions, using telemedicine. As always, however, it’s important to confirm that the provider you choose is a state-certified and mental health professional licensed in treating your area of concern. Call their office or look at their website to see what conditions they treat, and if they take your insurance. It’s also a good idea to confirm that your health insurance covers CBT sessions—and if so, how many.
How to do CBT at home
People who have severe symptoms that affect their day-to-day functioning should work with a trained professional. But self-directed CBT may be an effective option for those with mild to moderate symptoms, according to a 2021 study published in JAMA Psychiatry. The analysis of 39 randomized controlled trials that included nearly 10,000 people found that self-guided internet CBT was associated with significantly improved symptoms of depression.
If you don’t have a trained CBT therapist in your area or don’t have time in your schedule, online CBT resources like apps and computer programs are available.
“Computer programs or apps may help someone get the skills quicker by practicing some of the things on their own so that they may not need to spend as much time with the therapist,” Wright says, noting that reading a self-help book may also be “very helpful” for some people.
“Overall, I think it’s better if you have a clinician who can help guide you through this,” Wright adds. “But if you could not get to therapy, a good self-help book is certainly worthwhile. I recommend self-help books to most of my patients, as well as apps and other things that are available electronically.”
The Association for Behavioral and Cognitive Therapies provides a list of self-help books that they’ve given a “seal of merit.”
Changing thought pattens over time
The skills gained through CBT can be used to help manage everyday stresses, or when life changes. You can learn new strategies to help you question troublesome thoughts, gradually face your fears, try out something new, and feel more grounded in the present.
Studies show that people who complete CBT tend to maintain their progress over time. A 2020 meta-analysis of 69 randomized controlled trials published in JAMA Psychiatry found that symptoms of generalized anxiety disorder, social anxiety disorder, or PTSD remained significantly improved 12 months after completing CBT.
Depending on the condition or circumstance, people often benefit from booster sessions after completing an initial course of CBT. These follow up sessions usually take less time, and fewer are needed, Wright points out.
“The behavioral part is helping the person chip away at these problems with skill-based training that helps them reverse the kind of behavior that may be part of a downward spiral,” he says. “With CBT, you’re teaching somebody skills that they may use for a lifetime to help them stay well. If they get back into an episode, they can already have some knowledge about how to manage it.”
