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Does Cognitive Behavioral Therapy (CBT) actually work?

Written by Beth Holloway, RN, M.Ed
2022-10-25

Does CBT actually work? The answer is a resounding “Yes!” 

We know this from more than 2,000 studies, performed by many researchers, that support its effectiveness for mental health and medical conditions. 

CBT is recommended as first-choice therapy by many experts and organizations. For example: 

  • The American Psychological Association (APA) endorses it for the treatment of depression and other conditions;

  • The American Academy of Sleep Medicine supports CBT for the treatment of long-term (chronic) insomnia;

  • and the U.S. Veterans Administration/Department of Defense (VA/DoD) recommends CBT for chronic pain.

All said, you can feel good about CBT for many of your mental and physical health problems. 

We know that CBT works, so let’s go over what CBT is, how it developed, and how it’s used today.

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a form of “talk therapy,” or psychotherapy, that helps individuals cope with many conditions, including mental health disorders like depression and anxiety. It’s skills-based, meaning it provides you with ways to make active changes that help lessen symptoms of mental health problems.

In summary, CBT can help you identify and change unhealthy thought patterns that affect both your emotions and behavior. There are three levels of thought that affect your emotions and behavior. They are:

  1. Core beliefs are ways of thinking about yourself, others, the world, and the future. They’re central to your way of thinking and are formed early in life. 

  2. Dysfunctional assumptions follow your core beliefs. They are thoughts that are inflexible and unhealthy (i.e. an assumption may be accepted as true, without any proof). Assumptions also impact your response to experiences and situations.

  3. Negative automatic thoughts are unhealthy thoughts that occur in some situations, without you even realizing it. 

Negative Automatic Thoughts

Negative automatic thoughts can make you feel depressed, anxious, or stressed and keep you from doing the things you want to do.

With Depression

Automatic thoughts often focus on low self-worth, decreased self-confidence, and hopelessness. 

You may have thoughts like “I’m a failure” “Anything I try fails” “I’m worth nothing” “People never like me”

Your thoughts may increase your depression and lead you to withdraw from social activities or give up on work projects.

With Anxiety

Automatic thoughts often minimize coping abilities and magnify risk.

You may have thoughts like, “I can’t take the chance to call my sister. I’ll be too upset” or “If I join that bicycling club, I know I’ll get hurt”

Your thoughts may make you more anxious and stressed and lead you to avoid activities, like making the phone call or joining the club.

CBT

Your thoughts affect both how you feel and what you do, as well as your body’s response. It’s a never-ending cycle. That’s where CBT comes in - it teaches you how to interrupt the cycle. You’ll learn skills to help you change negative automatic thoughts, cope with and lessen upset feelings, and modify unhealthy behaviors.

There are different approaches to CBT. It may be an effective standalone treatment. It may also be part of a treatment protocol with conventional therapies like prescription medications or complementary therapies like nutritional supplements and mind-body exercises. 

CBT may also be part of an integrative approach to care as in Goodpath’s programs. Integrative care combines conventional and complementary therapies.

What are the Standards for CBT?

The standards or principles for CBT are as follows:

  • It focuses on the present (i.e the “here and now”), not the cause of your symptoms.

  • It is specific to a problem (exception: Unified Protocol CBT).

  • It is based on your individual goals.

  • It is skill-based, providing tools to help you change unhealthy thoughts, feelings, and behaviors. 

  • It lasts for a specified period of time (per session and overall program).

  • It is directive (the therapist and/or the program approach direct or guide you).

  • The sessions and content are structured in a certain way.

  • It may be adapted to meet specific population, cultural, and condition needs.

What’s in a Typical CBT Program?

A CBT program or course is provided in sessions over a period of weeks. There is time between sessions to allow you to become familiar with the content and to practice skills. Sessions are often about an hour in length, but may be broken down into smaller modules offered more frequently. 

The order of the content and the way it’s presented also varies. Some subjects may be emphasized more than others. For example, exposure therapy may be emphasized for those with anxiety and behavioral activation for those with symptoms of depression.

In general, your program will include:

  • Psychoeducation: Information to help you understand your problem or problems (e.g. anxiety, depression, or chronic pain.) and the ways CBT can help.

  • Cognitive restructuring: Learning to replace unhealthy, negative thoughts with positive, healthy ones.

  • Exposure therapy: Rather than avoiding situations and circumstances that cause anxiety and distress, you’re gradually and safely exposed to them. The process helps to break the pattern of avoidance and fear.

  • Behavioral activation: Increasing participation in enjoyable, healthy, or helpful activities.

  • Relaxation training: Practicing relaxation helps you to cope, or come to terms, with heightened emotions (i.e. anxiety, stress, depressed feelings, or low mood). Relaxation reduces the body’s reaction to stress, thus lowering heart rate, decreasing blood pressure, and slowing breathing.

  • Homework: CBT programs include activities outside of the sessions for you to do at home. You’ll study the concepts and practice the skills. This is part of “being your own therapist,“ which is one way CBT can be described. 

  • Relapse prevention: You’ll learn how to continue using CBT techniques and prevent returning to unhealthy ways of coping. 

How is CBT delivered?

Cognitive behavioral therapy may be delivered in several different ways. It can be led by a variety of trained professionals, including mental health counselors or therapists, psychologists (a Ph.D.), psychiatrists (an MD), health coaches, or other healthcare providers. Some CBT programs are self-led. They are developed so that you can study on your own (i.e. they're self-help based).

You may see a CBT expert face-to-face or attend in-person group sessions led by a therapist, psychologist, or another expert. You can also meet with a therapist through telephone or video meetings. The CBT therapist may also communicate with you via email or text messages.

Your CBT program may also be provided through one, or a combination of, the following: recorded audio or video presentations, online solutions (i.e. from a website), or written materials. Therapists may or may not play a role in these programs.

Application-based CBT

Another type of CBT is app-based. You can download an app on your computer. Or, you can download an app on your smartphone. 

Think about how easy it could be to engage with a program on your phone. You have it with you wherever you are and you check it often. Instead of keeping up with the latest social media, news, online sales, or other things, you can use it to help control your symptoms and improve your mental health. 

Goodpath’s app includes CBT programs for mental health, but also long-term (chronic) insomnia, long-term (chronic) pain, and irritable bowel syndrome (IBS).

We’ve selected CBT to support our members, but, how well does app-based CBT work? 

Here’s some research.

An app-based CBT program was compared to standard CBT in two different studies of individuals with depressive disorders. The app-based CBT, with minimal therapist support, was just as effective as in-person CBT. 

Several analyses of multiple trials also found app-based CBT to be as effective as face-to-face CBT. The analyses found medium-to-large improvements in depression symptoms. The authors noted that the data should be interpreted carefully due to a number of patient/participant and study factors. 

History of CBT

Aaron Beck, MD (1921-2021) has been called the father of CBT. In his long career, he had a profound influence on the field of mental health. 

As a psychiatrist treating patients with depression, he realized that their depressed moods were related to “automatic [unhealthy] thoughts” and beliefs associated with negative life events. In some cases, their thoughts influenced their behavior and reactions to future situations and events.

Dr. Beck was onto something. From his realization, he developed the cognitive theory or model, and from there cognitive behavioral therapy (CBT). Eventually, Dr. Beck and his daughter created the Beck Institute for Cognitive Behavior Therapy to provide training in CBT.

Here’s Beck’s Cognitive Model. To explain, your perception of a particular situation or experience (and your automatic thoughts linked to it) leads to emotional, behavioral, and body (physiological) responses: 

A note on physiological responses

Physiological responses may or may not be included in discussions of CBT. But, think about the effect of feeling anxious, stressed, or depressed. How does your body automatically respond?

Do you feel out of breath? Does your heart beat more rapidly? Do you sweat? Do you have trouble thinking? Do you have diarrhea or trouble with bowel movements? All of these are physiological responses. 

Research supporting CBT

In 1977, the first important study of CBT compared it to medication for the treatment of depression. Results showed it was as effective as antidepressant medication. It was also found to be more effective in preventing depression from recurring. CBT became popular worldwide after a second study confirmed this evidence.

Due to its success in treating depression, CBT was expanded to treat other mental health issues, such as anxiety disorders and stress, substance use, and eating disorders (e.g. anorexia, bulimia).

From the Beck Institute, “since then over 2,000 studies have found CBT to be an effective treatment for many mental health challenges and medical problems with psychological components.”

Types of CBT

Unified Protocol CBT for Mental Health

The Unified Protocol (UP) is a transdiagnostic type of CBT. Transdiagnostic means across diagnoses. So the UP is a treatment that can be applied to many mental health problems. It is different than standard CBT, which focuses on one disorder (e.g. depression or anxiety). 

After introductory materials covering emotions and improving motivation, Unified protocol CBT includes five modules that cover: 

  1. Emotional awareness

  2. Adaptability of thoughts (cognitions)

  3. Emotional avoidance

  4. Emotional-related body sensations

  5. Emotion-focused exposures (internal, i.e.body sensations, and external, i.e. situations or experiences)

The Unified Protocol Institute at Boston University says that UP “helps patients learn new ways of responding to uncomfortable emotions; this reduces symptoms across a patient’s range of problems.”

CBT for Insomnia (CBT-I) 

CBT-I (“I” for insomnia) is specifically tailored for people with chronic insomnia. It combines cognitive therapy, behavioral treatments, and educational interventions. It is highly recommended by experts (e.g. The American Academy of Sleep Medicine) as the first choice of treatment for those with insomnia.

CBT-I will help you better understand your sleep patterns and become more mindful of your emotions, thoughts, and behaviors regarding sleep. 

CBT for Chronic Pain

CBT can help people manage and cope with long-term (chronic) pain. It may be offered as a standalone treatment or combined with other treatments. It can help change the way you sense pain and manage destructive thoughts, unhealthy actions, and negative emotions associated with pain.

CBT for Irritable Bowel Syndrome (IBS)

CBT can help those with irritable bowel syndrome (IBS) and other digestive issues. IBS and some other digestive conditions are considered functional - there are problems with the way the gastrointestinal (GI) system works or functions. 

Functional GI disorders are affected by the brain-gut connection (or the “gut-brain connection"). This is the communication system between your brain, nervous system, and gut - the GI tract. Your brain (i.e. thoughts and emotions) influences the health of your GI tract while the health of the GI tract impacts your thoughts and emotions. CBT provides the necessary skills to help improve the function of your brain-gut connection.

CBT for Other Conditions

CBT is a powerful tool for the treatment of mental health problems like depression, anxiety (including panic disorder and phobias or fears, such as agoraphobia), sleep problems, long-term (chronic) pain, and irritable bowel syndrome (IBS). CBT has also been adapted for specific groups and conditions:

  • CBT for specific groups: children, teens, students, families, older adults, and specific cultures

  • CBT for specific conditions: autism, phobias, bipolar disorder, relationship problems, smoking cessation, tic disorders, severe mental health conditions (e.g. schizophrenia, where CBT may be added to medication)

  • CBT for groups with certain conditions: family-based CBT for obsessive-compulsive disorder (OCD); CBT for military personnel with post-traumatic stress disorder (PTSD)

How Long Does it Take for CBT to Work?

You may start to feel better early in your CBT program - or it may take several weeks to months. As with any form of psychotherapy, it varies from person to person and depends on many factors. 

For example, individual differences, like your motivation and ability to make changes; condition differences like the type and severity of your symptoms or condition; and program differences like the type of CBT or frequency of sessions can impact your progress.

Related Article: Role of the therapist in mental health

When Shouldn’t CBT be used?

There aren’t any specific reasons against using CBT. However, it may be challenging with certain people. For example, someone with:

  • Severe personality disorders

  • Cognitive or mental disabilities

  • Severe depression

CBT has also been adapted to meet the needs of people with specific mental health conditions like obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

Goodpath’s CBT Programs

Goodpath offers CBT as part of our integrative approach to care. We offer our members Unified Protocol CBT for mental health conditions, CBT-I for sleep problems (chronic insomnia), CBT for chronic pain associated with musculoskeletal problems, and CBT for irritable bowel syndrome (IBS).

Our integrative programs also include nutritional supplements; over-the-counter medicines, products, and devices; exercise therapy; nutritional support; and mind-body solutions (in addition to CBT). Each of our members also has the support of a dedicated Goodpath health coach. Book a demo to learn more about how Goodpath mental health support can help your team.