What Is Cognitive-Behavioral Therapy (CBT)?

Shakespeare wrote, “There is nothing good or bad, but thinking makes it so.” Centuries later, this axiom illustrates the concept behind one of the most effective and established theories in modern psychology: cognitive behavioral therapy.

CBT evolved from early 20th-century behaviorism (made famous by the stimulus-response research involving rats, pigeons, and salivating dogs) into a more cognitive approach mid-century. The therapy represents a substantially different direction from the psychoanalytic theories preceding it. While Sigmund Freud and his followers emphasized the importance of early childhood experiences and subconscious drives, CBT pioneers like Albert Ellis and Aaron Beck focused on objective experience in the here and now. And like Hamlet, they recognized that the way we think determines the way we perceive and respond to the world around us.

CBT is often referred to as the gold standard in psychotherapy. Studies support its efficacy in treating a range of mental disorders, including anxiety, obsessive–compulsive disorder, depression, addiction, insomnia, and PTSD. It’s practical, flexible, and non-dogmatic. And many practitioners combine CBT with other modalities, such as mindfulness and exposure therapy, providing something for nearly everyone.

The Minefield in Our Minds

CBT is grounded in a relatively simple premise: Our thoughts and behaviors greatly inform our psychological well-being. The therapy involves replacing dysfunctional thoughts and behaviors with healthier ways of thinking and doing.

CBT also recognizes the role of emotions; in fact, thoughts and feelings are considered symbiotic and bidirectional. For example, I might feel self-conscious, then think everybody’s judging me. Or I might think about an upcoming stressful situation, then feel nervous.

CBT presupposes that these cognitive and emotional processes occur automatically, meaning we tend to be unaware of what we’re thinking or feeling as it happens. Accordingly, one of the first steps in this practice involves learning to notice our thoughts and feelings.

Meditation and other mindfulness techniques can be helpful in teaching us to observe mental and emotional activity in real time.

Meditation and other mindfulness techniques can be helpful in this regard, teaching us to observe mental and emotional activity in real time. Recording thoughts, feelings, and behaviors in a journal may also be useful, particularly because we can then observe patterns and precipitating factors.

Once we become more aware of our thoughts, emotions, and behaviors, we can begin to re-evaluate them.

CBT therapists often ask clients to consider the evidence for and against a particular belief or consider exceptions they may have forgotten. They may explore alternative interpretations of a situation: “Your colleague barely responded when you said hello this morning. You took this to mean she must hate you. Could anything else explain her behavior?” Then, consider how we may be distorting reality through the lens of our own biases (see “Common Cognitive Distortions” below).

The practice also involves learning to avoid mistaking feelings for facts. For example, we might interpret feelings of fear or dread prior to boarding an airplane as proof that air travel is dangerous and should therefore be avoided. Learning to challenge these reflexive assumptions enables us to consider a situation more rationally.

Change Starts With Action

Central to CBT is the notion that how we think and feel about a situation determines how we respond to it. Such responses can range from the relatively benign — feeling bored leads to scrolling through social media for hours — to the downright dangerous, as when thinking that your life will never improve leads to self-harm or even suicide.

Learning to change our response to thoughts and emotions is crucial to the CBT process because that’s the part we can most control: You may not be able to stop feeling sad or thinking about a break-up, but you can choose to call a friend instead of, say, drinking to excess.

Moreover, by reminding us that we have agency, behavior change can fuel motivation and build momentum. For example, a depressed individual who begins washing the dishes after days of letting them pile up in the sink remembers that they feel better when the kitchen is clean. As they take on other neglected tasks, they find the house — and their mood — subtly brightening; this reminded them that they do, in fact, have some control over how they feel.

Learning which behaviors help or hinder our well-being enables us to replace unhealthy responses to difficult situations, thoughts, or emotions with more adaptive coping skills.

Learning which behaviors help or hinder our well-being enables us to replace unhealthy responses to difficult situations, thoughts, or emotions with more adaptive coping skills. Instead of doomscrolling when we feel down, for instance, we might cuddle with a pet. Instead of ruminating over vague remarks from a colleague, we could ask for clarification.

This isn’t always easy. We’re often convinced that a new or different behavior will be too hard or too scary. To grease the wheels, therapists may incorporate role-playing activities, like rehearsing a difficult conversation, as well as relaxation techniques aimed at helping clients calm the mind and body when stressed.

Exposure therapy is also frequently used in combination with CBT. This approach involves facing one’s fears — often starting with less-intense situations then gradually working up to bigger fears — in order to learn we have the ability to manage them.

Getting Started

One of the most well-supported treatments in the field, CBT is familiar to many psychotherapists, and they may incorporate the principles and techniques into their practice. CBT will often appear as a specialization in therapists’ profiles, with some offering treatment targeted toward specific issues or disorders, such as CBT for post-traumatic stress, insomnia, or eating disorders.

Though individuals struggling with severe, debilitating, or urgent mental health issues should always seek professional help, people coping with less-fraught conditions may find CBT to be simple and flexible enough to learn and practice the skills independently.

Simply paying closer attention to your thoughts, emotions, and the behaviors they provoke is a start.

Countless books outline CBT theory and techniques. Many include workbooks, logs, and other customizable tools and resources designed for anyone to use. Some are geared toward specific issues such as OCD or phobias; others combine CBT techniques with complementary modalities, such as mindful meditation.

And there are now apps available that incorporate CBT principles. Most include tools for tracking thoughts, mood, and behaviors, and some offer access to peer or professional support. Others are geared toward specific issues like insomnia or weight loss.

Simply paying closer attention to your thoughts, emotions, and the behaviors they provoke is a start. To riff on the Bard, thinking (and feeling) make things good or bad — and we have the power to decide which to choose.

8 Common Cognitive Distortions

Cognitive distortions are biased, inaccurate, or irrational ways of perceiving ourselves or the world around us. They tend to be subtle and subconscious, making them all the more difficult to recognize. Here are some of the most common.