There’s no one-size-fits-all fix to treating insomnia, depression, anxiety, drug addiction, eating disorders, and other psychological problems. But there does seem to be a common starting place most psychologists and other therapists rely on: cognitive behavioral therapy (or “CBT” as it’s commonly referred to).
CBT falls under the broader category of psychotherapy. (Psychotherapies differ from other types of therapy, such as medications, in that they involve a psychologist or other trained professional working with an individual or group to identify a problem and develop solutions. Usually that process involves a lot of talking and thinking.)
The American Psychological Association (APA) recognizes CBT as an effective form of psychological therapy and psychiatric medications. And based on the evidence suggesting it works when it comes to managing anxiety disorders, bulimia, insomnia, personality disorders, stress management, some researchers consider CBT the gold-standard of psychotherapies in the field.
Exactly how CBT is delivered varies from one individual to another, based on each person’s needs, as well as other problems he or she may be dealing with — such as age, and the environment that person lives in. The common thread underpinning all CBT, however, is the goal of changing unhelpful or problematic ways of thinking in order to change unwanted or unhealthy behaviors.
“It’s trying to help you change your thoughts, your behaviors, and your feelings to give you better strategies to cope in day-to-day living and better overall health,” explains Thomas H. Ollendick, PhD, University Distinguished Professor and Director of the Child Study Center in the Department of Psychology at Virginia Tech. (His research and clinical work primarily focuses on children and adolescents, but he’s worked with adults, too.)
Our thoughts, our feelings, and our behaviors all exist in a very interrelated ménage à trois. One affects the other affects the other affects the other, and so on, in an endless loop, Ollendick says. The theory behind CBT is that by reframing your thinking, you learn how to reframe behaviors and emotions, too. It addresses all three of those components.
CBT is direct and problem-solving in its approach of coming up with the ways to handle what’s wrong that you can use your everyday life, Ollendick explains. Other forms of psychotherapy take a less direct approach, he says. Psychoanalysis, for example, aims to promote better functioning more indirectly by encouraging emotional awareness and personality change.
“[With CBT] you’re learning and developing coping strategies — and ways to control and manage your thinking and emotions,” Ollendick says.
What to expect in a CBT session
CBT always addresses unhelpful thinking styles and learned patterns of behavior, but in practice it differs from patient to patient because it should be applied in a way that meets that specific patient’s needs wherever they’re at, explains Lindsey Giller, PsyD, a clinical psychologist at the Child Mind Institute in New York City. “There’s a lot of flexibility,” she says.
The therapy (whether it’s delivered over one session or several) starts with both the therapist and patient collaboratively identifying the problem and problematic thinking. Then the therapist and patient make an effort to change those thinking patterns in the patient by replacing them with more helpful ways of thinking about the problem.
When he works with children, Ollendick likes to refer to CBT as a type of “thought-ectomy,” he says. “I’m going in and helping you remove a thought that is stuck in your head.” (He’s not trying to tell you the thought is wrong. It’s about swapping out the thought entirely with one that can help you engage in healthier behaviors and feelings, he says.)
We’re training individuals to be their own therapists, so they’re able to think through things differently when they’re outside of the session.
Then it’s time for the patient (with the support of the therapist) to face whatever is triggering the problem. (For a military veteran dealing with PTSD, it might mean watching footage of war. For someone trying to manage social anxiety, it might mean going outside of the therapist’s office and meeting someone new or interrupting someone to ask a question.)
“You try to recreate the problem you have in the therapy session, so that it can be worked on,” Ollendick adds. That’s part of what makes CBT different from other types of psychotherapy. With CBT, you bring the problem in and you deal with handling it directly — rehearsing the newly learned coping skills for managing the problem in the therapy session, rather than just talking about it. (Another big difference is that CBT can often be delivered in fewer sessions than other talk therapies — in most instances, no more than 20.)
Finally, CBT calls for out-of-session practice (or “homework”). After the individual learns how to reframe their thinking in a given situation, they’re tasked with practicing using that strategy out in the real world.
That practice out in the real world is when the real healing happens, Giller explains. “We’re training individuals to be their own therapists, so they’re able to think through things differently when they’re outside of the session,” she says.
Why the CBT approach can help with so many problems
The CBT formula: identify the issue, reframe your thinking, develop a way to cope, face the trigger and practice.
The CBT formula (identify the issue, reframe your thinking, develop a way to cope, face the trigger and practice) can help people with a seemingly large range of problems — from insomnia to depression to PTSD to gambling problems to opioid addiction to biopolar disorders and much more — because they all have something pretty basic in common.
It’s a simplistic explanation, but all of these issues involve thinking, feeling and behaving, Ollendick says. And because CBT addresses thinking, feeling and behaving, the approach can help with all of these issues, he says. “It’s an intervention that can [he stresses, CAN] potentially address that reverberation within the dynamic system.”
It’s important to note that for some people, CBT alone can help an individual manage a mood disorder, anxiety disorder, addiction, insomnia, schizophrenia or PTSD. But others are best treated with a combination of CBT and medication, or CBT and another therapy, Ollendick says.
What you should know about how to get CBT
If CBT sounds like something that might help with something you’re dealing with, there are a few things you should know about how and where to find it:
1. Double check that your provider can and will deliver CBT.
Because it’s so effective for helping with so many problems, more and more mental health providers are trained in how to deliver the therapy to patients (social workers, counselors and other therapists can be trained in CBT, too, in addition to psychiatrists) — but not all of them, Giller says.
If you want to try CBT, ask your mental health care provider if he or she is trained in delivering it. (You can also check the Association for Behavioral and Cognitive Therapies’ directory to search for a provider.) “It’s important to know if that’s what you want that you’re actually going to get that,” Giller says. “It’s often on the consumer to find out.”
2. Ask what to expect.
CBT is personalized for every individual. CBT for insomnia will look very different from CBT for a phobia of spiders. In some cases, CBT may require sessions that take place out of the office. CBT in general is a quicker approach compared with other therapies. But it’s up to the provider in terms of delivery.
Some CBT might span a dozen sessions, while some newer approaches that can be delivered in a single session have been found to be just as effective as longer ones, Ollendick says. Ask ahead of time what you’re signing up for.
CORRECTION (May 17, 2019, 11:57 a.m. ET): An earlier version of this article mischaracterized how CBT is viewed by researchers. Some consider it the gold standard of psychotherapies in the field, but not all do.
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