Cognitive-behavioral therapy (CBT): what is it and what does it work for?

You get invited to a networking event where you could meet some important people for your career growth—understandably, you're feeling nervous about going. You wake up on the morning of the event and think, "I can't do this. I'm not going to make a good impression. What if they all hate me? I'm not good enough."

These thoughts continue, making you feel worse and worse about yourself. By the time the event rolls around a few hours later, you've spiraled into a mess of negative thoughts and feelings, and you decide not to go to the event. You may even feel so badly that it starts to affect your performance at work.

This scenario is just an example of what cognitive-behavorial therapy (CBT) aims to help. CBT is all about helping you break the cycle of negative thoughts and feelings that often lead to unhealthy behaviors.

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There is no single definition for cognitive behavioral therapy. Also, CBT techniques vary depending on an individual's situation. But we can grasp its meaning by taking it apart. 

The Latin root for the word "cognitive" means "to get to know" or "to recognize" (Online Etymology Dictionary, n.d.). In cognitive therapy, you're taught how to recognize and form a clear view of your thoughts, attitudes, and expectations. In behavioral therapy, you learn strategies to change your behaviors (National Center for Biotechnology Information, 2016).

One key principle underlies CBT: Our psychological problems are rooted partly in faulty or unhelpful thoughts, and we can change our negative thinking patterns and learn to cope better. In CBT, a trained therapist will use several techniques and exercises to teach you how to (American Psychological Association, 2017):

• Recognize that your distorted thinking causes problems

• Face fears, calm your mind, and relax your body

• Develop confidence in your abilities

• Reevaluate your thoughts in the face of reality

• Understand the behaviors and motivations of other people

Not all types of CBT focus on each of those learnings. But along the way, you will be taught problem-solving and coping skills, typically through role-playing designed to prepare you for interactions with other people (American Psychological Association, 2017). A critical goal of CBT is that you can rely on these coping skills after formal treatment ends (Gillihan, 2016). 

Cognitive-behavioral therapy is not psychoanalysis. Psychoanalysis aims to dig deep into your childhood experiences, as with psychodynamic psychotherapy. By contrast, CBT focuses on finding solutions for current problems (National Center for Biotechnology Information, 2016).

Among the more impressive aspects of cognitive-behavioral therapy is the wide array of disorders and other conditions it's been shown to treat effectively. Here are some of the most common conditions for which CBT has been deemed useful by various studies and institutions (UpToDate, 2021; American Psychological Association, 2017):

• Addictions to alcohol, smoking, or other drugs

• Anxiety disorders

• Bipolar disorders

• Depression 

• Eating disorders (anorexia, bulimia, binge-eating)

• Insomnia

• Obsessive-compulsive disorder (OCD) 

• Panic disorder

• Phobias

• Post-traumatic stress disorder (PTSD)

• Sex disorders

• Smoking addiction

CBT has also been used as an additional treatment for chronic pain, tinnitus, and rheumatism, as well as attention-deficit/hyperactivity disorder (ADHD) (Cima, 2014; National Center for Biotechnology Information, 2016; CHADD, n.d.). In addition, it might be useful for schizophrenia (Morrison, 2009; NYU Langone Hospitals, n.d.). Some research indicates it can help with autism; one study found CBT helped children with autism better deal with their sadness and anger (Spain, 2020; Weiss, 2018).

People can also use it to deal with grief or stress that's not necessarily part of a diagnosed mental condition or help a person manage emotions better, resolve conflict in relationships, or overcome emotional trauma.  

However, even for the conditions it treats well, CBT may not be for everyone. It tends to work best if you're a problem solver. You'll need to be motivated to make it work and get comfortable with the idea of observing, analyzing, and correcting your own beliefs and behaviors. For any psychotherapy to be effective, you'll need to be an active participant and view your therapist as a partner. That means being honest in sharing your thoughts and doing the homework you're given (Mayo Clinic, 2016; UpToDate, 2021).

CBT is also not a cure-all, even when it's effective. Depending on your condition or conditions' severity, your provider may recommend medications along with your therapy (UpToDate, 2021).

Cognitive-behavioral therapy can be done via one-on-one sessions in a therapist's office or clinic, in group sessions, via telehealth services, or even online (more on that below). 

A therapist will start by asking about your current problems and past events and emotions contributing to your condition. Here's what you can expect from there (Chand, 2021): 

• You'll talk about what's bugging you, what you are feeling.

• The focus will be on specific problems. 

• You'll have homework (reading or activities) to reinforce and apply what you learn.

Typically, you’ll have one 60- to 90-minute session per week for eight to 12 weeks (Coffey, 2015).

Telehealth is emerging as an effective way to lead CBT sessions. A review of research on the topic found CBT via telehealth generated high satisfaction among patients and helped reduce anxiety, stress, and depression (Dent, 2018). A more recent study, focused on just one condition, found telehealth CBT could be as effective as face-to-face sessions for treating insomnia (Arnedt, 2021).

A large body of research and evidence from using the technique shows CBT is, generally speaking, for the conditions it aims to treat, at least as effective as psychiatric drugs and other types of psychotherapy. We also know that CBT can improve the quality of life and the ability to function (American Psychological Association, 2017).

Studying the effectiveness of mental health treatments is complicated. So rather than focus on the result of any single study, it’s better to consider high-quality research efforts that review the extensive scientific literature and sort the best studies from those that have poorer methods. So here you go:

A 2016 review of more than 100 randomized clinical trials evaluated CBT to treat major depression, generalized anxiety disorder, panic disorder, and social anxiety disorder. The researchers concluded that "CBT is probably effective" in treating all four, especially compared to control groups that were put on waiting lists and got no actual treatment, but less so when control groups received other care or a placebo pill (Cuijpers, 2016).

Even though scientists are in broad agreement on the value of CBT, there are lingering questions as to whether it's the absolute best approach. Of course, that will always depend on an individual's symptoms and needs. But to address any controversy, a trio of researchers argued in the journal Frontiers in Psychiatry that while many CBT studies are small and of low quality, the results of the best studies add up to CBT being the current gold standard in psychotherapy, for three reasons (David, 2018):

• CBT is backed by more research than any other psychotherapy.

• No other psychotherapy has been shown to be superior.

• The theories behind CBT are well-studied and in line with the latest scientific thinking on the human mind and behavior.

Remember, however: CBT is best used to solve specific problems. Don't expect to gain deep insight into what childhood traumas or other experiences might be behind your problems. That’s what psychoanalysis is for (National Center for Biotechnology Information, 2016).

Depending on your condition and symptoms, any of several other psychotherapies, also known as talk therapies, might be recommended in place of CBT (Mayo Clinic, 2016):

• Psychodynamic psychotherapy

• Acceptance and commitment therapy

• Motivational interviewing

• Interpersonal psychotherapy

• Supportive psychotherapy

• Dialectical behavioral therapy 

Studies on the effectiveness of doing cognitive behavioral therapy online or with a book or video as a guide are mostly small and inconclusive, and most of them are relatively old. One small study of college students found that those who tended to ruminate a lot developed more depressive symptoms, instead of fewer, after engaging with self-help workbooks (Haeffel, 2010).

Even when self-help interventions might be effective, one review of the research determined that self-help CBT programs for depression work best when there's some human support, whether face-to-face, or by phone or email (Kuroda, 2021). Another such review of internet-based cognitive behavioral therapy (iCBT) for depression found it more effective than no treatment but especially effective when guided by a professional (Karyotaki, 2021).

Here are a few examples of studies that suggest the potential.

• Military personnel suffering insomnia benefited from online CBT compared to a control group who got no treatment, but the in-person CBT proved more effective than the online variety (Taylor, 2018).

• People with gambling addiction saw significant improvement in their gambling habits through a self-help CBT program, which also curbed their related mental-health symptoms of depression, anxiety, and stress (Oei, 2018).

• A review of 33 studies on self-help CBT books, videos, and online programs found they reduced anxiety symptoms (Hirai, 2006).

• The conclusions of one study echo those of several others: "It is clear that self-help has a place within a healthcare framework, but more work is needed to clarify where and how it should be delivered" (Ridgway, 2006).

Because there are so many types of CBT to treat so many different conditions, as well as competing therapies and potentially complementary treatments, step one is to seek an evaluation with a primary care provider or a psychiatrist. 

But if you have any lingering concerns about whether it works, rest assured that ample research has proven it to be effective for many people with a wide range of mental health needs.

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Current version

June 10, 2021

Written by

Robert Roy Britt

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.