Cognitive behavior therapy (CBT) is a type of psychotherapy used to treat emotional disorders and mental illnesses, including depression, anxiety disorders and phobias.

CBT is based on the theory that an individual’s thoughts – not the environment or other people – determine their behavior. Therefore, distorted thinking leads to damaging behavior. CBT focuses on changing present and future attitudes and behaviors. Some other forms of therapy, such as psychodynamic psychotherapy, address a patient’s past conflicts.

CBT combines techniques used in two other types of psychotherapy – cognitive therapy and behavior therapy.

Cognitive therapy involves identifying distorted patterns of thinking, which are called maladaptive schemas. These are fundamental core beliefs or assumptions that are part of the perceptual filter people use to view the world. An example of a maladaptive schema is a statement such as “The world is an evil or dangerous place.”

These negative thought patterns are often responsible for maladaptive (inappropriate or counterproductive) behaviors. During therapy, patients try to replace these negative patterns with more constructive or positive ones (cognitive restructuring).

Some common patterns of negative thinking include:

• Catastrophizing. Always anticipating the worst.
• Filtering. Exaggerating the negative aspects of an experience and minimizing the positive ones.
• Personalizing. Automatically accepting blame when something bad occurs.
• Generalizing. Viewing troubling events as the beginning of a never-ending cycle.
• Polarizing. Viewing situations as all good or all bad (black or white). Not recognizing the middle ground.

The focus of behavior therapy (also called behavior modification) is to replace undesirable behaviors with healthier ones. Some techniques used in behavior modification include:

• Positive reinforcement. A technique in which positive behavior is rewarded.
  
  
• Desensitization (also called exposure therapy). A technique in which patients confront situations that cause discomfort, fear or anxiety and overcome negative emotions. Desensitization may occur gradually over time (graduated exposure) or rapidly (flooding).

Prior to CBT, a mental health professional will perform an evaluation to assess the patient’s emotional and mental status. During the evaluation, the therapist will gather information about the type and severity of problems the patient is experiencing and discuss treatment goals with the patient.  

CBT may be conducted in one-on-one sessions between a patient and a mental health professional, such as a psychiatrist, psychologist, psychotherapist or clinical social worker. It may also be conducted as part of group therapy. Although it is typically administered in an outpatient setting, depending on the patient’s needs, CBT may also be incorporated while a patient is receiving inpatient psychiatric care.  

CBT may be short-term, lasting only a few weeks or months, or may last for longer periods of time. The duration of treatment depends on a patient’s needs and the psychotherapist’s recommendation. Generally, most patients can expect to begin treatment with weekly visits to a therapist’s office or mental health clinic.

Benefits of CBT include:

• Decreased psychological stress
  
  
• Increased self-efficacy (confidence in oneself, especially in one’s ability to deal with challenges)
  
  
• Improved quality of life and functioning

CBT has a high success rate for certian conditions and patients are often able to maintain their improvement after they have finished with their therapy. However, CBT is more effective for some conditions than others and some patients treated with CBT may experience relapse. This occurs because patients tend to forget information or discontinue skills learned over time. Relapse can be treated with follow-up therapy sessions.