What is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy (CBT) is based on the psychological construct that individuals’ interpretations of situations influence their reaction (emotional, behavioral, physiological), more so than the situation itself. It rests on several core principles: psychological problems are based, in part, on faulty or unhelpful ways of thinking and learned patterns of unhelpful behavior. People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
CBT is an umbrella term for many different therapies that share some common elements. It is an approach for which there is ample scientific evidence that the methods developed actually produce change. Since CBT was developed in the 1960s and 1970s, this treatment has been found to be effective in over 2000 clinical trials for a wide range of mental disorders, psychological problems, and medical conditions with psychological components.
Origins & Lineage
Precursors of certain fundamental aspects of CBT have been identified in various ancient philosophical traditions, particularly Stoicism, with Aaron T. Beck’s original treatment manual for depression stating, “The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers”. Another example of Stoic influence is Epictetus on Albert Ellis.
Two of the earliest forms of Cognitive Behavioral Therapy were Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s. In the early 1950s, Ellis founded rational psychotherapy, which ultimately evolved into rational emotive behavior therapy (REBT). The first version of REBT was announced to the public in 1956. Ellis developed Rational Emotive Behavior Therapy (REBT), which focused on identifying and challenging irrational beliefs contributing to emotional distress.
Cognitive therapy was developed by psychoanalyst Aaron Beck in the 1950s, with Beck conducting free association sessions in his psychoanalytic practice in the late 1950s. Beck’s first articles on the cognitive theory of depression appeared in 1963 and 1964 in the Archives of General Psychiatry. Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania and is regarded as the father of cognitive therapy and cognitive behavioral therapy (CBT). Dr. Beck is globally recognized as the father of Cognitive Behavior Therapy (CBT).
How It’s Practiced
A CBT session is generally between 45-60 minutes and sessions are usually done in person, face-to-face, but they can also be done virtually using telehealth communication platforms. CBT is grounded in a collaborative partnership between the therapist and the client through collaborative empiricism, which entails the exploration of the client’s experiences, thoughts, and behaviors in a non-judgmental and curious manner.
Early in treatment, CBT therapists help clients identify their aspirations and values and set specific goals they want to achieve as a result of treatment. They start each session by collecting information so they can work with clients to figure out what to do for the rest of the session and identify a specific goal the client would like to work on. The session opens with a mood check where the therapist asks how you’ve been feeling since last time, often using a brief rating scale, then you set the agenda together, deciding what to actually work on today.
Therapists collect data about the goal or problem and look out for inaccurate or unhelpful thoughts or beliefs the client may be having, then they work with the client to evaluate interfering thoughts and beliefs, plan a strategy, and create an “Action Plan” for the client to work on between sessions. Cognitive restructuring involves identifying and challenging cognitive distortions and replacing them with more balanced and adaptive thoughts.
Skill acquisition and homework assignments are what set CBT apart from “talk therapies.” Homework is where CBT actually happens—the in-session work builds understanding; the between-session practice is where new patterns get encoded. At the end of each session, therapists ask clients for feedback, which helps them understand and respond to clients’ questions and concerns about therapy or the therapist.
Cognitive Behavioral Therapy Today
CBT remains the most widely researched and practiced form of psychotherapy. Seekers encounter it through individual therapy with licensed mental health professionals, group therapy programs, and intensive outpatient settings. CBT is designed to be short-term. Brief CBT is the compression of CBT material and the reduction of the average 12-20 sessions into four to eight sessions.
Digital formats have expanded access significantly. Computerized CBT platforms, smartphone apps, and telehealth sessions now deliver evidence-based interventions to people who might not otherwise access treatment. Self-help resources—particularly books and workbooks—allow motivated individuals to learn and apply CBT techniques independently, sometimes with intermittent professional guidance.
CBT training has become standard in graduate programs for clinical psychology, counseling, and social work. Specialized certifications exist through organizations like the Beck Institute for Cognitive Behavior Therapy and the Academy of Cognitive and Behavioral Therapies. Many practitioners integrate CBT techniques within broader therapeutic frameworks rather than offering strict protocol-based treatment.
Common Misconceptions
One of the most common criticisms leveled at CBT is its tendency to oversimplify human psychology; by focusing primarily on thoughts and behaviors, critics argue that CBT may neglect the crucial role of emotions in mental health. This model appears to confuse the symptoms (i.e., negative self-concepts) of depression with its cognitive causes.
CBT is not simply “positive thinking.” The therapy does not ask people to replace negative thoughts with cheerful affirmations but rather to examine the evidence for and against specific beliefs and develop more accurate, balanced interpretations. Some argue that this approach may place too much burden on the individual, potentially overlooking the impact of systemic issues or external circumstances on mental health.
CBT is not a one-size-fits-all solution. CBT’s effectiveness is questionable for some disorders, suggesting that CBT techniques need to be further improved. It works best for individuals with identifiable thought patterns contributing to distress and who are willing to engage in between-session practice. Those dealing with severe trauma, complex relational issues, or conditions requiring exploration of unconscious processes may benefit from additional or alternative approaches.
How to Begin
Feeling Good: The New Mood Therapy is a book written by David D. Burns, first published in 1980, that popularized cognitive behavioral therapy (CBT). It was named one of the top ten behavioral science books of 1980 by the journal Behavioral Medicine and is the book most frequently recommended for depressed patients by mental health professionals in the United States. Evidence from six studies suggests that reading Feeling Good as a form of self-directed bibliotherapy had a large helpful effect on treating depression.
For formal treatment, seek a licensed therapist with specific CBT training or certification. Organizations like the Association for Behavioral and Cognitive Therapies maintain directories of credentialed practitioners. Initial sessions typically focus on assessment, psychoeducation about the CBT model, and collaborative goal-setting. Come prepared to discuss specific problems you want to address and be willing to complete homework assignments between sessions—practice outside the therapy room is essential to outcomes.