Developed in the 1960s, cognitive behavioral therapy (CBT) helps many people who live with mental illness, substance issues, and eating, sleep, or sexual disorders change negative patterns of thought to better manage stressful life situations. Many physicians have combined this form of talk therapy with other treatments to promote positive outcomes.

Chand SP, Kuckel DP, Huecker MR. Cognitive behavior therapy. In: StatPearls. StatPearls Publishing; 2022.

 

Unlike many other forms of therapy, CBT can be adapted to serve people of all ages, including adolescents and children. CBT may also be used when counseling couples and families; the treatment’s versatility is part of what makes it an effective tool for many patients.

 

Basics of CBT

It helps patients recognize the relationships between three separate aspects of cognition: automatic thoughts, underlying beliefs, and cognitive distortions.

Automatic thoughts refer to a person’s immediate, unplanned interpretations of events happening in the world around them. These thoughts provoke an emotional response while directing an individual’s response to the event. Within the context of CBT, automatic thoughts may be dysfunctional—that is, they may be mistaken, distorted, unrealistic, or exaggerated.

Cognitive distortions are also common among patients with mental illnesses and other disorders. These patients may arrive at incorrect conclusions due to errors in logic. Individuals may present with one or more cognitive distortions, such as:

• Catastrophizing

• Dichotomous thinking

• Disqualifying the positive

• Emotional reasoning

• Fortune-telling or mind-reading

• Overgeneralization

These beliefs may be viewed as the templates for information processing underlying layers of automatic thoughts. Consisting of both core and intermediate beliefs, CBT helps patients understand how their underlying beliefs shape their perception of the world and its events.

Commonly administered by psychologists, psychiatrists, counselors, and other mental health experts, CBT enables patients to learn more about their condition and practice coping mechanisms such as assertiveness, relaxation, and stress management.

Cognitive behavioral therapy. Mayo Clinic.

During treatment, patients are encouraged to discuss their thoughts and feelings, especially situations viewed as troubling.

 

In many cases, CBT focuses on one specific problem at a time, establishing treatment goals that patients can meet incrementally. Treatment length varies according to the patient’s individual needs, but most treatment courses range from 5 to 20 sessions.

 

Comparing CBT to other treatments

A 2018 paper published in Frontiers in Psychiatry concluded that “if gold standard is defined as [the] best standard we have in the field at the moment, then we argue that CBT is, indeed, the gold standard.”

David D, Cristea I, Hofmann SG. Why cognitive behavioral therapy is the current gold standard of psychotherapy. Front Psychiatry. 2018;9:4.

The authors attributed this conclusion to the following factors:

 

• No other psychotherapy has been shown to be systematically superior.

• CBT is researched more than any other psychotherapy.

• The theoretical models of CBT line up with current mainstream human mind and behavior paradigms.

A 2018 study published in Psychology Research compared CBT with other forms of treatment including dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), and hypnosis.

Yager E. Comparing overall success rates of cognitive-behavioral therapy, eye movement desensitization and reprocessing, Dialectical behavior therapy and hypnosis. Psych Res. 2018;8(6):231–250.

According to that research, CBT resulted in a final success rate of 40.5% after reviewing data from 4,085 subjects. DBT success rates hovered around 22% (217 subjects), while the final success rate of EDMR was 49.4% (689 subjects). The success rate for hypnosis, which used information from 1,504 study subjects, was 39.2%.

 

 

Expanding CBT’s role in the digital age

According to a 2020 paper, 59% of individuals meeting diagnostic criteria for psychiatric illness have not received treatment in the past year.

Wilhelm S, Weingarden H, Ladis I, et al. Cognitive-behavioral therapy in the digital age: Presidential address. Behavior Therapy. 2020;51(1):1–14.

Barriers to receiving mental health treatment often include cost, transportation issues, inability to take time off work, lack of child care, and the stigma surrounding mental illness.

 

For example, a psychiatrist may engage with a patient in person and supplement their treatment using smartphone apps.

Thousands of mental health-related smartphone apps are currently available, and many apply the principles of CBT to help patients make positive changes. Some apps focus on single skills, such as mindfulness, to restructure negative thought patterns. Others provide a convenient method of monitoring symptoms, while still more are designed as standalone therapies.

Patients may not be as engaged as they would be during in-person therapy sessions. More intensive support may be necessary to help CBT be truly effective. Additionally, some apps may not be user-friendly or include core features that support the patient’s goals. And the lack of an evidence base may mean some of these apps are not actually benefiting patients; in some cases, they could contain misinformation and actually be unsafe.