Cognitive Behavioral Therapy (CBT)

What is CBT?

Cognitive behavioral therapy (CBT) is a form of psychotherapy based on the idea that thoughts, feelings, physical sensations and actions are interconnected — and that unhelpful patterns in thinking and behavior can keep emotional difficulties going. CBT helps you notice these patterns and practice new ways of responding.

CBT is practical and present-focused. While it may explore how patterns developed, most of the work centers on what is happening now and what you can do differently.

How CBT works

A CBT therapist works collaboratively with you to:

• Identify problems and set goals you want to work toward.
• Notice thought patterns, such as catastrophizing or all-or-nothing thinking, and examine how accurate or helpful they are.
• Test beliefs through experiments, gathering real-world evidence rather than relying on reassurance.
• Change behaviors that maintain problems, such as avoidance or withdrawal.
• Build skills — problem-solving, relaxation, planning activities — that you can use independently.

What CBT can help with

CBT has strong research support for many conditions, including:

• Anxiety disorders, including panic disorder, social anxiety and phobias
• Depression
• OCD (using exposure and response prevention)
• PTSD (using trauma-focused CBT approaches)
• Insomnia (using CBT-I — see sleep disorders)
• Eating disorders

It is also used alongside medical care for chronic pain and other health conditions.

What to expect

CBT is typically structured and time-limited — often somewhere around 6 to 20 weekly sessions, depending on the concern. You’ll usually be asked to practice skills between sessions, sometimes called “homework.” Progress is often tracked with brief questionnaires so you and your therapist can see what is working.

CBT works well by video, and many therapists on online platforms such as BetterHelp and Sesame list it among their approaches.

Types of CBT

• Exposure therapy and exposure and response prevention (ERP) for anxiety and OCD. See exposure therapy.
• Behavioral activation for depression.
• CBT for insomnia (CBT-I).
• Trauma-focused CBT and cognitive processing therapy for PTSD.
• Related “third-wave” therapies such as DBT and acceptance and commitment therapy (ACT).

Limitations

CBT requires active participation, and it may not suit everyone’s preferences or needs. Some people benefit more from other approaches, from medication, or from a combination. If you are not noticing progress after a reasonable period, it’s worth discussing with your therapist.

Core CBT techniques in plain language

CBT is practical, so it helps to know the tools you may be taught. Your therapist will tailor these to your goals:

• Thought records. You write down a situation, the automatic thought that came up, how it made you feel, and then look at evidence for and against the thought before writing a more balanced alternative.
• Identifying thinking traps. Common patterns include all-or-nothing thinking, catastrophizing, mind reading, and “should” statements. Naming the trap can loosen its grip.
• Behavioral activation. For low mood, you schedule small, achievable activities that bring a sense of pleasure or accomplishment, even when motivation is low, and track how they affect mood.
• Behavioral experiments. You test a belief in real life, such as “If I speak up in the meeting, everyone will judge me,” then compare the prediction with what happens.
• Graded exposure. For fears and avoidance, you face feared situations step by step. See exposure therapy.
• Problem-solving. A structured way to break a problem into steps, list options, choose one and review the result.
• Relaxation and breathing skills, which help you manage physical tension; see how to calm your mind.

A typical course of CBT

CBT is usually structured. A first session or two covers assessment and goal-setting. Later sessions often follow a pattern: a quick check-in on mood, reviewing the last week’s homework, agreeing an agenda, working on a skill and setting new practice tasks. Many people see benefit within 8 to 16 sessions for common problems such as anxiety and depression, although the length varies with the problem and its severity. Homework matters: the more you practice outside sessions, the more likely the skills are to stick. Progress is usually tracked with short questionnaires so you and your therapist can see what’s working.

CBT for specific conditions

• Depression: CBT is well supported for mild to moderate depression and can reduce relapse. See therapy for depression and depression.
• Anxiety disorders: CBT is a first-line treatment for generalized anxiety, social anxiety, panic and phobias. See therapy for anxiety.
• OCD and PTSD: Exposure and response prevention and trauma-focused CBT are among the most effective treatments. See OCD and PTSD.
• Insomnia: CBT for insomnia (CBT-I) is a first-line treatment; see sleep and mental health.
• Other problems, including eating disorders, chronic pain and health anxiety, have adapted forms of CBT.

CBT compared with other therapies

CBT focuses on the present and on specific problems, whereas some other therapies, such as psychodynamic therapy, explore longer-standing patterns and early experiences. DBT grew out of CBT and adds acceptance and emotion regulation skills; see our comparison of CBT vs. DBT. Acceptance and commitment therapy (ACT) is a related “third wave” approach that teaches you to relate differently to thoughts rather than challenge them. Research suggests many therapies help, so the quality of the relationship and the therapist’s training matter alongside the method. See psychotherapy for an overview.

Doing CBT online or with self-help

Studies suggest that CBT delivered by video or through guided online programs can be as effective as face-to-face CBT for many people with mild to moderate depression and anxiety. Self-help books and apps based on CBT may help with milder symptoms, and tend to work better with some human support. If you use an online therapy service, ask whether your therapist is trained in CBT and how they use homework and measurement. See online therapy and our guide to finding the right therapist.

Questions to ask a CBT therapist

1. What training do you have in CBT, and for my kind of problem?
2. What will a typical session look like?
3. How will we track progress, and how will we know when to stop?
4. How much homework will there be?
5. What happens if CBT doesn’t seem to be working?

When CBT may need support from other treatment

CBT is highly effective but isn’t the right or only answer for everyone. People with severe depression, active suicidal thoughts, psychosis or unstable bipolar disorder may need medication or more intensive care alongside it. If you’re in crisis, see Get Help Now. If you’ve tried CBT and found it didn’t fit, that doesn’t mean therapy can’t help; a different approach or therapist may work better.