Cognitive behavior therapy (CBT) is a type of psychotherapy in which patients identify negative thought patterns and replace them with positive ones. It combines techniques used in both cognitive therapy and behavior therapy.

Unlike other types of therapy, CBT focuses on patients' present and future thoughts and behaviors, not their past conflicts. CBT is typically short-term, lasting a few weeks or months. However, it may last longer, depending on a patient’s condition and the psychotherapist’s recommendation.

CBT is used for the treatment of various emotional and mental illnessesmental illnesses including depression, anxiety disorders and phobias. It is also sometimes prescribed for some other problems including pain associated with chronic health conditions, such as arthritis (inflammation of the joints) and cancer.

Generally, most patients begin treatment with weekly visits to a therapist’s office or mental health clinic. CBT may be conducted in one-on-one sessions or 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. Some skills that patients may be taught during CBT include keeping a journal and relaxation therapy.

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.

Cognitive behavior therapy (CBT) programs typically include education, skills acquisition and relapse/maintenance training to help patients retain the information and skills they have learned.

There are various techniques or skills – tailored to each individual patient – that may be taught during CBT sessions, including:

• Cognitive therapy. Techniques to help patients recognize and alter negative emotional responses. Patients are asked to keep track of emotional reactions to events, such as driving in traffic. Common reactions may be anger and frustration, which can lead to increased stress. Patients also keep track of thoughts that occur during events, such as thinking, “I am worthless,” or “This always happens to me.” Patients identify patterns, assumptions and distortions in thought processes and try to reframe them with healthier, more positive ones, such as thinking, “I am deserving of good things in life.” The goal of this technique is to learn to respond, and not react, to stressful or difficult situations.
  
  
• Behavior therapy. Techniques to teach patients how to modify and gain control over their fears, anxieties and unwanted or unhealthy behaviors. Patients gradually learn to cope with difficult situations or stimuli (anything provoking the behavior), typically through controlled exposure to them. The goal of this technique is to give patients a sense of control over their life.
  
  A therapist may also use reinforcement to encourage a particular behavior. For instance, children with attention deficit hyperactivity disorder may receive a gold star every time they stay focused on tasks and accomplish certain daily chores such as school homework assignments. This technique can reinforce and increase the desired behavior by pairing it with a positive outcome. Reinforcement can also be used to gradually do away with unwanted behaviors by imposing negative consequences, also known as punishment and response.
  
  
• Modeling exercises. The therapist and patient engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.
  
  
• Relaxation therapy. Techniques that teach patients how to relax and balance the physical and emotional effects of stress. These include breathing and relaxation exercises that reinforce the connection between mind and body and give the patient more control when reacting to difficult situations.
  
  
• Keeping a diary or journal. Patients record their daily thoughts, feelings and actions when specific situations arise. This can help them identify negative thought and/or behavior patterns that may be reversed with therapy.

Cognitive behavior therapy (CBT) is the most common type of psychotherapy used for the treatment of various emotional disorders and mental illnesses. In many cases, it is part of a treatment plan that also includes medication. CBT may be used to treat the following conditions:

• Major depression. A severe depression that occurs suddenly or gradually and usually lasts several months. It generally requires clinical observation and treatment.
  
  
• Bipolar disorder. A condition that is characterized by alternating periods of mania (episode of great excitability) and depression.
  
  
• Anxiety disorders. Emotional disorders characterized by a debilitating and disruptive anxiety that can interfere with a patient’s daily activities. Types of anxiety disorders include:
  
• • Panic disorder. A condition in which a person regularly experiences panic attacks - sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause symptoms such as a racing heartbeat, heavy perspiration and shortness of breath.
    
    
  • Phobias. Extremely strong and irrational fears of things, people, places, experiences or situations.
    
    
  • Obsessive-compulsive disorder (OCD). A disorder that occurs in patients who have persistent thoughts that they cannot control (obsessions) and/or perform certain actions repeatedly (compulsions).
    
    
  • Post-traumatic stress disorder (PTSD). An anxiety disorder that involves feelings of intense fear, helplessness or horror brought on by experiencing or witnessing an especially traumatic event.
    
    
• Eating disorders. These involve serious disturbances in eating behavior including unhealthy reduction of food intake (anorexia nervosa), severe overeating and/or dangerous methods to prevent weight gain, such as self-induced vomiting (bulimia nervosa).
  
  
• Schizophrenia. A complex and disabling psychiatric disorder that impacts a person’s ability to distinguish between real and imaginary experiences, think logically, have normal emotional responses and behave appropriately in social situations. Schizophrenia is usually treated with medications first. With CBT, patients can learn how to monitor the reality of their thoughts and perceptions, how to ignore auditory hallucinations and how to cope with apathy that can be immobilizing.
  
  
• Borderline personality disorder (BPD). A condition that causes patients to have periods of unstable emotions that seriously affect their lives.
  
  
• Insomnia. The inability to sleep for a reasonable amount of time to maintain adequate restfulness.
  
  
• Relationship problems (e.g., marital problems).
  
  
• Substance abuse. The chronic use of a substance, usually alcohol or drugs (e.g., marijuana), which alters mood or behavior and causes significant impairment in an individual’s life.
  
  
• Impulse control disorders. These include trichotillomania (condition marked by the constant and compulsive pulling of the hair), pyromania and compulsive gambling.

Other uses for CBT, such as treating chronic lower back pain, chronic headache and irritable bowel syndrome (condition in which the large intestine operates improperly), are also being studied. In addition, researchers are currently investigating its efficacy in helping women overcome stress-related infertility.

Preparing questions in advance can help patients to have more meaningful discussions with their therapist regarding their conditions. Patients may wish to ask their therapist the following questions about cognitive behavior therapy (CBT):

1. How experienced are you in treating patients with my condition?
   
   
2. Is CBT the best type of therapy for me?
   
   
3. How will CBT treat my condition?
   
   
4. How successful is CBT for treating my condition?
   
   
5. What happens if CBT doesn’t successfully treat my condition?
   
   
6. Do you recommend any other therapy or medication for treating my condition?
   
   
7. What can I expect during a regular CBT session?
   
   
8. How many CBT sessions will I need?
   
   
9. Will I have CBT as part of individual therapy or group therapy?
   
   
10. Will I notice immediate improvement in my thoughts and behaviors?