CBT is one of the most popular psychotherapies. Here's why – and why it might be right for you.
When it comes to psychotherapies, people seeking mental healthcare have no shortage of options to choose from. Talk therapy – also referred to as counseling – is the most popular and traditional option and consists of an individual or couple meeting with a mental health professional to verbally sort through thoughts, concerns, attitudes, feelings or behaviors in order to understand what may be causing them and to learn coping mechanisms and strategies.
Other sought-after therapies include eye movement desensitization and reprocessing (EMDR), exposure therapy, music therapy, integrative therapy and hypnotherapy.
But none of these match the proven benefits and universal acceptance of what may be the most commonly recommended form of therapy over the past two decades: cognitive behavioral therapy, or CBT.
What is CBT?
CBT is a form of therapy that was developed by renowned psychiatrist Aaron Beck in the early 1970s as a way of helping patients understand the relationship between their behaviors and their thoughts, fears and feelings. "His model was validated in 1977 and has been shown to be effective in numerous research studies and through practitioners applying the model in clinical settings," says Joanne Broder, a practicing psychologist, fellow of the American Psychological Association and the co-founding editor of the peer-reviewed journal "Psychology of Popular Media."
She explains that CBT works by first helping a patient understand what's happening between an event or situation and their resulting emotions or behavior.
As an example, she says you can imagine being insulted by an insensitive comment or rude slur coming from another person and then evaluate whether your initial response is wanting to return an insult of your own, ignore them completely or escalate the situation through a physical altercation. "Your belief system will help you make that choice," she says, "so the goal of CBT is to create a healthy belief system that can be foundational for making good decisions."
This is often referred to as cognitive restructuring and is rooted in replacing irrational or destructive thoughts with realistic, balanced and positive ones.
Usually in a time-limited and structured manner, CBT-trained professionals often also introduce behavioral experiments, share helpful tools and techniques such as mindful meditation or relaxation breathing, introduce new approaches to problem solving and encourage self-monitoring practices to help patients keep track of their behaviors, symptoms and progress.
"The process increases self-awareness and self-understanding, which can lead to improved self-control," says Juanita Guerra, a clinical psychologist in New Rochelle, New York. She adds that CBT "can also increase a person’s self-esteem and help them feel more empowered."
Broder agrees, noting that the benefits of CBT include the patient’s improved ability to make mindful decisions that align with their value system, as opposed to making impulsive decisions or following the crowd. "They have a heightened sense of self-awareness to control negative thoughts and to make better behavioral choices," she says.
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Who is CBT for?
Cognitive behavioral therapy has been shown to be helpful in a variety of circumstances and across many groups of people but is especially useful "in treating anxiety and depression symptoms," says Elizabeth Hoge, a psychiatrist and the director of the Anxiety Disorders Research Program at Georgetown University.
She says it's also useful in helping a person overcome something they're afraid of. "For example, if a person fears heights, the therapist might have them slowly (over weeks) put themselves in higher and higher floors of a building to get used to the feeling of fear, which then usually subsides," she explains.
Guerra says the therapy has also proven to be helpful in treating hoarding disorder, PTSD, obsessive-compulsive disorder and addiction.
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Does CBT have downsides?
CBT is not generally controversial the way other psychotherapies are. But Guerra says one limitation is that CBT is very structured and time-consuming and requires a lot of work and individual exercises. "If the client is not consistent in doing their work, the treatment will not be effective," she cautions.
She adds that CBT is also not as effective in people with severe personality disorders such as antisocial personality disorders or in individuals with character pathology who have skewed perceptions of reality, as the treatment relies on reality-based logic and exercises.
Another downside that Hoge points to is that some insurance companies don't cover the treatment. CBT can also be emotionally uncomfortable and may not work for everyone – even if someone is willing to put in the time and effort required. "Therapy is not a one-size-fits all process for everybody," says Broder. "There might be other forms of therapy that could work better than CBT for some people."
To explore if CBT is the right option for you, Guerra suggests having a consultation with a CBT-trained mental health professional. "That way you can make an informed decision as to whether cognitive behavioral therapy is the appropriate or best treatment approach for your mental health concerns and desired outcomes," she says.