What Is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a structured, goal-focused form of talk therapy. It helps a person identify thinking and behavior patterns that are unhealthy or ineffective, and then work on changing them. CBT is usually active and practical: sessions center on specific problems, and the work continues between meetings with small exercises or observations. It is one of several approaches a licensed therapist might use, and it is offered for depression, anxiety disorders, PTSD and other concerns.

What CBT is and how it works

CBT starts from the idea that thoughts, feelings and actions affect one another. A person who feels anxious might notice a quick thought like “they will judge me,” feel more nervous, and then avoid the situation. CBT helps make that loop visible and gives the person ways to test it. The therapist and client work together to name a goal, look at what is keeping the problem going, and practice something different.

There is no formal approval process for psychotherapies like the FDA’s for medications, as NIMH explains. A therapist may describe their work as CBT while drawing on several methods. Asking what a therapist actually does in session is fair and useful.

CBT can be delivered individually, with a partner or family, or in a group. It is used with children and adults. Therapy sessions in general are typically held once every 1-2 weeks for about 30 to 50 minutes, according to the American Psychiatric Association.

What a CBT session looks like

A CBT session tends to be more structured than some other kinds of therapy. The exact format varies by therapist and by what the person is working on, but common elements include:

• A brief check-in and agenda. The therapist and client decide what to focus on that day, often building on the previous session.
• Working on a specific problem. The session might focus on a recent situation, a thought pattern, a behavior the person wants to change, or a skill to practice.
• Collaborative exercises. The therapist may ask the person to walk through a recent moment, examine the evidence for a thought, or plan a small step for the coming week.
• Practice between sessions. CBT usually includes something to try outside the session, often called homework. It might be a thought record, a short activity, or a planned exposure. The next session often starts by reviewing how it went.
• Review of progress. Goals and progress are discussed along the way. The patient and therapist decide together how long and how often to meet.

A first session usually includes questions about what brought the person in, what they hope will change, and what therapy will involve. Psychologists are expected to explain the nature and expected course of therapy, fees and the limits of confidentiality early on, under the American Psychological Association’s Ethics Code.

CBT techniques you may hear about

CBT is a family of methods rather than a single script. Some common techniques include:

• Thought records. Writing down a situation, the automatic thought that came with it, the feeling, and what else might be true.
• Behavioral activation. Planning and gradually returning to activities that matter, even when motivation is low.
• Problem-solving. Breaking a practical problem into steps and trying one.
• Exposure. Facing a feared situation in a planned, gradual way instead of avoiding it.
• Skills practice. Learning and repeating a new response until it feels more natural.

These techniques are tools, not a checklist. A therapist should explain why a particular method is being suggested and what it is meant to address.

Exposure therapy as a type of CBT

Exposure therapy is a type of CBT used for anxiety disorders, as NIMH describes. It involves approaching a feared situation, memory or sensation in a planned and repeated way, rather than avoiding it. The aim is to learn to manage fear and to reduce the hold avoidance has on daily life. Exposure is usually built up gradually and agreed on with the person beforehand. It is not about being thrown into the hardest situation first.

For PTSD, prolonged exposure (a form of exposure therapy) is one of the approaches the American Psychological Association’s guideline for adults strongly recommends, along with CBT, cognitive processing therapy and cognitive therapy. The VA’s National Center for PTSD names cognitive processing therapy, EMDR and prolonged exposure as the talk therapies that work best for PTSD. Those are descriptions of what the approaches involve and what guidelines say, not a promise about what will happen for any one person.

What CBT is used for

NIMH describes CBT as a treatment for depression and anxiety, among other concerns. For depression, treatment typically involves psychotherapy, medication, or both, and CBT is one of the evidence-based therapies used. For generalized anxiety disorder, treatment typically involves psychotherapy, medication, or both, and CBT is commonly used. For PTSD, the main treatments are psychotherapy, medication, or both.

CBT is also used for other problems, and a therapist may combine it with other approaches. The choice of therapy should be made with a mental health professional, who can talk through the options and what each involves.

CBT compared with a few other approaches

This table is a rough comparison, not a ranking. Many therapists draw on more than one approach. A person can ask which approach a therapist plans to use and why.

Who offers CBT

Many licensed mental health professionals offer CBT, including psychologists, clinical social workers, professional counselors, marriage and family therapists, psychiatrists and psychiatric mental health nurse practitioners. Each state sets its own licensing rules, titles and supervised-hour requirements, so the letters after a therapist’s name vary. A person can check a license on the state licensing board’s website.

CBT is not limited to one license type. What matters is whether the therapist has training and experience in the approach and whether the fit feels right. Rapport and trust are essential, and a person should feel comfortable with the therapist.

How to ask whether a therapist is trained in CBT

A short, direct question works best. NIMH suggests asking about a therapist’s credentials, experience and any specialty, the approach and its rationale, the goals of therapy, and whether a time frame or number of sessions is recommended. For CBT specifically, a person might ask:

• “Do you use CBT, and what does a typical session with you look like?”
• “What training have you had in CBT, and do you use it for the problem I want to work on?”
• “Will there be practice between sessions, and what would that involve?”
• “How will we decide whether it is helping?”
• “Do you offer exposure therapy, and how do you decide when to use it?”

It is also reasonable to ask about fees, insurance and whether a sliding scale is available. If therapy has gone on for what feels like a reasonable time without improvement, NIMH suggests talking with the therapist about it; it may make sense to explore other professionals or approaches.

What goes wrong with CBT

CBT asks for active participation, and that is where people often get stuck.

• Expecting it to be passive. CBT is not mostly listening and nodding. The person is expected to bring problems, try things in session and report back. That can feel uncomfortable at first, and a good therapist will explain why the work is set up that way.
• Skipping the practice between sessions. The between-session work is often where change gets tested. Skipping it is common, especially when life is busy or the task feels hard. It is better to say so than to quietly stop; the therapist can adjust the task.
• Treating CBT as a lecture. A therapist should not simply tell a person their thinking is wrong. CBT is collaborative, and the person’s own observations matter.
• Assuming one approach fits everything. CBT is one option among several. Some people do better with a different structure or a different focus, and that is useful information, not a failure.
• Stopping without a conversation. If something is not working, talking it through with the therapist is the next step. A therapist can explain what is being tried and why, or help think about another direction.

Where CBT fits among the options

CBT is one of many kinds of therapy. Some people come to it for a specific problem, such as anxiety or depression, and some use it alongside medication or other treatment. Psychotherapy can be used instead of or alongside medication, and the treatment plan should be decided with a mental health professional.

For a broader look at how CBT sits alongside other approaches, see types of therapy explained. If anxiety is the main concern, therapy for anxiety covers CBT, exposure and other approaches. For depression, therapy for depression describes what helps and how to start. And if the idea of accepting thoughts rather than changing them appeals more, acceptance and commitment therapy explains a different route.

If you are in crisis or thinking about suicide, call or text 988 in the US (the 988 Suicide & Crisis Lifeline), or call 911 in an emergency.