What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) is a structured, short-term psychotherapy that aims to change both unhelpful thoughts and behavioral patterns that add to emotional distress.

It’s grounded in the understanding that our thoughts, feelings, and behaviors are connected. This means pessimistic thinking patterns can lead to negative emotions and unproductive or harmful behaviors.

CBT helps individuals manage and reduce symptoms of depression by addressing and altering these patterns

What’s the goal of CBT?

The purpose of CBT is to help individuals identify and change negative thought patterns and behaviors that contribute to emotional distress and mental health issues.

Key goals of CBT

1. Identify negative thought patterns: Recognizing automatic negative thoughts, such as catastrophizing and black-and-white thinking.
2. Challenge and reframe pessimistic thoughts: Learning to replace irrational or unhelpful beliefs with more balanced and realistic ones.
3. Develop coping strategies: Equipping individuals with practical skills to handle stress, anxiety, and emotional challenges.
4. Modify behavioral responses: Encouraging positive behavioral changes that reinforce healthier mental states.
5. Enhance emotional regulation: Teaching ways to manage emotions effectively.
6. Prevent relapses: Providing tools to maintain progress and prevent the recurrence of negative thinking patterns.

It is typically short-term and goal-oriented, focusing on practical solutions rather than deep-rooted past experiences.

Why does CBT work?

1. Targets the root causes of depression (negative thinking and avoidance behaviors).
2. Provides long-term skills to cope with sorrow.
3. Empowers individuals to take an active role in their recovery.
4. It has a strong scientific foundation proving its effectiveness.

How effective is it at treating depression?

1. Studies show CBT is as effective as antidepressant medication for mild to moderate depression, with longer-lasting benefits (Hollon et al., 2005).
2. 60-80% effectiveness rates for anxiety disorders (Hofmann et al., 2012).
3. A meta-analysis found that CBT reduces relapse rates compared to medication alone (Cuijpers et al., 2013).
4. It’s recommended by organizations like the American Psychological Association (APA) and the National Institute for Health and Care Excellence (NICE) as a first-line treatment for depression.

How does CBT work?

1. Identifying and challenging negative thought patterns
   • Depression often involves automatic negative thoughts such as “I’m not good enough,” “Nothing ever works out for me,” or “I’ll never be happy.”
   • In CBT, individuals learn to identify these thoughts and assess their accuracy. By challenging these distorted thoughts, people can replace them with more realistic and balanced perspectives.
2. Replacing negative thoughts with positive or neutral ones
   
   • Once negative thoughts are identified, CBT helps individuals reframe or replace them with positive or more neutral thoughts.
   • For example, instead of thinking “I’ll never succeed,” CBT encourages a balanced thought like, “I may not succeed right away, but I can learn from my experiences and improve.”
   • This change in thinking creates resilience and reduces helplessness.
3. Behavioral activation
   • Mood disorders often cause withdrawal from activities that were once enjoyable or meaningful.
   • This approach uses “behavioral activation” to encourage people to re-engage in positive activities, even if they initially don’t feel like it.
   • This technique helps break the cycle of inactivity and low mood by boosting mood and motivation through participating in enjoyable activities.
4. Building problem-solving skills
   • Struggling with depression can make even small problems feel overwhelming.
   • CBT teaches structured problem-solving skills that allow individuals to break down challenges into manageable steps.
   • Learning to tackle problems typically improves confidence while reducing stress and enhancing resilience.
5. Developing emotional regulation skills
   
   • It helps people understand the link between their thoughts and the emotions they experience.
   • By recognizing how certain thoughts trigger depressive feelings, individuals learn how to regulate these emotions more effectively.
   • Emotional regulation techniques, such as deep breathing or mindfulness exercises, help manage overwhelming feelings in moments of distress.
6. Reducing rumination and negative self-talk
   • Repetitive negative thinking (rumination) is common in depression.
   • CBT provides strategies to interrupt and redirect this cycle of negative thinking.
   • Techniques like mindfulness and distraction help to develop a more positive outlook by reducing the frequency and intensity of rumination.
7. Goal setting and motivation
   • Psychological difficulties often rob people of their motivation and make even small tasks seem daunting.
   • CBT helps people set achievable and realistic goals, breaking them down into small, manageable steps.
   • Success in reaching these smaller goals will boost motivation and self-esteem by building a sense of accomplishment.
8. Improving interpersonal skills
   
   • Depression can strain relationships and lead to isolation.
   • This method often includes training in communication skills, assertiveness, and relationship-building techniques.
   • Strengthening interpersonal skills can improve social support, reduce loneliness, and provide a stronger network to support recovery.
9. Preventing relapses
   • CBT doesn’t just treat symptoms of current depressive episodes but also equips individuals with tools to prevent relapses.
   • CBT empowers people to take proactive steps to manage their mental health over the long term by teaching self-awareness and strategies for recognizing early signs of depression.
10. Increasing self-compassion
    
    • Many people with mental issues struggle with self-criticism and harsh self-judgment.
    • CBT encourages self-compassion, helping individuals replace self-critical thoughts with supportive, kind ones.
11. Developing coping skills
    • It also reduces the likelihood of relapses by educating on practical ways to handle future stressors.
    • Patients learn how to respond to negative emotions more healthily, building resilience for the future.

Additional CBT techniques to treat depression

• Mindfulness-based techniques
  

• • Many CBT practitioners incorporate mindfulness to help individuals stay present and observe their thoughts without judgment.
  • That can reduce rumination and assist people in managing difficult emotions as they arise rather than becoming exhausted by them.

• Thought records

• • These are organized journaling exercises that aid in recording negative thoughts, the situations that triggered them, and the emotional reactions they invoke.
  • Clients can start noticing patterns and can work on reframing their responses over time by analyzing these entries with a therapist.

• Gradual exposure to avoided situations

• • Depression frequently causes people to avoid situations or people.
  • CBT assists individuals in gradually facing these avoided situations, reducing avoidance behaviors, and increasing positive experiences.

• Self-compassion exercises
  

• • Unfortunately, I can tell from personal experience that mental disorders can involve a lot of self-criticism and doubt.
  • Cognitive-behavioral therapy may include exercises to help individuals treat themselves with kindness, like writing letters to oneself from a supportive perspective or practicing gentle, self-affirming language.

• Building interpersonal skills

• • Depression regularly strains relationships and social interactions.
  • That’s why incorporating social skills training and teaching individuals how to express their needs, set boundaries, and communicate effectively is included at times.
  • This reduces isolation and improves relationships, which often has a positive effect on mood.

• Activity and mood tracking
  

• • Patients might use a daily log to track their activities and mood shifts.
  • This process allows people to see which activities improve their mood and which might make it worse, creating a roadmap for lifestyle adjustments that support their mental well-being.

• Relapse prevention plans

• • Therapists often help clients create personalized relapse prevention plans near the end of treatment.
  • These plans include recognizing early signs of depression, strategies for addressing negative thoughts, and ways to maintain helpful behaviors, allowing clients to manage future episodes proactively.

• Cognitive restructuring for core beliefs

• • Many individuals with depression have deeply held negative beliefs like “I’m unworthy” or “I’ll always fail.”
  • CBT identifies these core beliefs and works to replace them with more balanced, realistic views, often leading to a strong positive shift in self-perception.

• Relaxation Techniques
  

• • Struggling with psychological difficulties creates tension and restlessness.
  • Techniques like progressive muscle relaxation, deep breathing, and visualization exercises are often combined to help people manage physical symptoms and improve overall emotional regulation.

When is it effective?

Cognitive behavioral therapy is most effective when:

1. The person is motivated: CBT requires active participation, including practicing skills outside of therapy sessions.
2. The issues are rooted in negative thinking patterns: It works well for conditions where distorted thinking plays a key role, since it concentrates on changing thoughts and behaviors.
3. The person is open to self-reflection and change: Those willing to challenge their beliefs and try new coping strategies benefit the most.
   
4. The therapist is well-trained: A skilled therapist can tailor these techniques to fit the individual’s specific needs.

CBT is helpful as a standalone treatment and in combination with medication (especially for more severe cases of depression, anxiety, or OCD).

It is also used in individual therapy, group therapy, and self-guided formats, such as online CBT programs.

What are the benefits of CBT?

Cognitive behavioral therapy (CBT) is one of the most effective and widely used forms of psychotherapy.

It helps people identify and change negative thought patterns and behaviors that contribute to emotional distress.

Here are the key benefits of CBT:

1. Scientifically proven and effective
   
   

• • Evidence-based: Research shows CBT is highly useful for conditions like depression, anxiety, PTSD, and OCD.
  • Works as well as medication: In some cases, CBT is as effective as antidepressants for depression and anxiety, with longer-lasting benefits.

2. Provides practical, actionable tools
   CBT isn’t just about talking. It’s about learning skills you can apply daily. It teaches:

• • How to find and combat negative thoughts (“I’m a failure” → “I made a mistake, but I can learn from it.”)
  • Ways to change behaviors that reinforce depression or anxiety, like avoiding social situations.
  • Techniques for problem-solving and decision-making.

3. Helps manage a wide range of issues
   CBT is effective for:
   

• • Depression (mild to severe cases).
  • Anxiety disorders (panic attacks, phobias, OCD, social anxiety).
  • PTSD and trauma.
  • Insomnia (CBT-I is a specialized version for sleep issues).
  • Substance use disorders.
  • Chronic pain and illness-related distress.
  • Eating disorders.
  • Low self-esteem and self-doubt.

4. Focuses on the present and future
   Unlike some therapies that deeply explore childhood experiences, CBT:

• • Directs on current thoughts and actions.
  • Helps you develop new habits for long-term change.
  • Teaches you skills to manage future challenges

5. Short-term and goal-oriented
   
   

• • CBT is usually short-term (6-20 sessions), making it efficient.
  • It is structured, with clear goals and progress tracking.
  • You learn strategies that continue to help you long after therapy ends.

6. Improves emotional resilience and self-control
   It strengthens your ability to:

• • Regulate emotions and reduce impulsive reactions.
  • Cope with stress and setbacks more effectively.
  • Build self-confidence by overcoming negative self-talk.

7. Can be done in different formats
   
   CBT is flexible and can be done:

• • Individually with a therapist
  • In group therapy
  • Online or via self-help programs
  • Through CBT-based apps and books

What are the limitations, downsides, and potential risks?

While cognitive behavioral therapy (CBT) is beneficial for many people, it’s not a one-size-fits-all approach.

1. Requires active participation and effort
   

• • CBT isn’t a passive form of therapy. You’ll need to engage in exercises, practice techniques, and complete homework assignments between sessions.
  • CBT may be less effective if you’re unwilling or unable to track thoughts, challenge beliefs, and apply abilities.
  • Some people find self-reflection difficult or exhausting, especially at first.

2. Doesn’t work for everyone or every condition
   

• • Limited for some deep-rooted emotional issues: CBT aims at thoughts and behaviors but may not address underlying trauma, deep-seated emotions, or personality disorders as effectively as psychodynamic or trauma-focused therapies.
  • Not ideal for severe mental illness alone: People with schizophrenia, bipolar disorder, or complex PTSD may need additional treatments like medication or other therapies alongside CBT.
  • Doesn’t always work for existential or philosophical concerns: Other forms of therapy (existential or humanistic therapy) may be better if you’re struggling with finding meaning, identity, or deep emotional conflicts.

3. Can be emotionally challenging
   
   

• • CBT requires you to face your negative thoughts and behaviors head-on, which can be uncomfortable.
  • Some people may experience temporary distress when confronting fears (exposure therapy for anxiety).
  • Overanalyzing thoughts may lead to frustration if you struggle to find alternative perspectives.

4. May feel too structured or rigid
   

• • CBT follows a structured, problem-solving approach, which may not suit everyone.
  • Some people prefer a more open-ended, emotional exploration style of therapy, like psychodynamic therapy or person-centered therapy.
  • CBT may feel too logical or “surface-level” if you want to concentrate on processing emotions rather than changing behaviors.

5. Doesn’t always address past trauma in depth
   
   

• • While CBT can help reframe trauma-related thoughts, it does not deeply explore childhood experiences or unconscious conflicts like other therapies do.
  • Trauma-focused CBT (TF-CBT) is more suited for past abuse or deep emotional wounds.
  • Some people may need longer-term therapy to fully handle and heal from traumatic experiences.

6. May not work well without a skilled therapist

• • A bad therapist can make CBT unsuccessful or even harmful.
  • It can feel invalidating if a therapist focuses too much on logic and dismisses emotions.
  • Some therapists apply CBT too rigidly and don’t adapt it to individual needs.

7. Insurance and accessibility issues
   
   

• • Not all insurance plans cover CBT therapy sessions, and private therapy can be expensive.
  • Finding a qualified CBT therapist near you can be difficult, particularly in rural areas.
  • While online CBT options exist, some people prefer in-person interactions.

CBT is highly effective for many mental health issues, but it isn’t perfect for everyone.

It works best for people who are ready to actively engage in the process and prefer a structured, problem-solving approach.

If you’ve tried CBT and it hasn’t worked for you, there are many other types of therapy (psychodynamic therapy, ACT, DBT, EMDR) that might be a better fit.

What problems can it treat?

It is widely used for various mental health disorders and behavioral issues.

1. Mood disorders

• • Depression: Aids in detecting and confronting antagonistic reflections, reducing avoidance behaviors, and building healthy coping strategies.
  • Bipolar disorder: Often used alongside medication to help manage mood swings and prevent relapse.

2. Anxiety disorders

• • Generalized anxiety disorder (GAD): Teaches techniques to challenge excessive worrying and develop relaxation skills.
  • Social anxiety disorder: Helps individuals push through fears of judgment and engage in social situations more confidently.
  • Panic disorder: Reduces panic attacks by teaching breathing exercises and facing catastrophic thinking.
  • Phobias: Uses exposure therapy to gradually reduce fear responses.

3. Obsessive-compulsive and related disorders

• • Obsessive-compulsive disorder (OCD): Uses Exposure and response prevention (ERP) to decrease compulsions and intrusive thoughts.
  • Body dysmorphic disorder (BDD): Assists in reframing negative body image perceptions.
    
  • Hoarding disorder: Addresses thought patterns that contribute to the extreme accumulation of items.

4. Trauma and stress-related disorders

• • Post-traumatic stress disorder (PTSD): Helps to process traumatic memories and ease distressing thoughts.
  • Acute stress disorder: Similar to PTSD, but for recent trauma.

5. Eating disorders

• • Bulimia nervosa and binge-eating disorder: Addresses dysfunctional beliefs about food, body image, and self-worth.
  • Anorexia nervosa: Often used in combination with nutritional counseling and medical care.

6. Substance use and addiction
   
   

• • Alcohol and drug addiction: Helps identify triggers, develop coping mechanisms, and prevent relapse.
  • Gambling addiction: Deals with irrational beliefs about winning and losing.

7. Personality disorders

• • Borderline personality disorder (BPD): A form of CBT called dialectical behavior therapy (DBT) is highly efficient in managing emotional instability and impulsivity.

8. Sleep disorders
   
   

• • Insomnia: CBT for insomnia (CBT-I) is the gold standard for treating chronic sleep problems by improving sleep hygiene and reducing sleep anxiety.

9. Chronic pain and health conditions

• • Chronic pain: Supports change in how pain is perceived and improves coping strategies.
  • Irritable bowel syndrome (IBS): Lowers stress-related triggers.
  • Fibromyalgia: Assists in managing pain and improving quality of life.

How to know if it’s right for you

It might be a good fit if:

1. You’re willing to actively participate in therapy and apply strategies outside of sessions.
2. You want a structured, goal-oriented approach to tackling your problems.
3. You prefer practical tools to manage thoughts, emotions, and behaviors rather than a deep exploration of past experiences (though previous events may still be addressed).
4. You struggle with negative thought patterns, like catastrophizing, black-and-white thinking, or excessive self-criticism.
5. You like the idea of learning skills that can be applied long after therapy ends.
6. You’re open to keeping track of your thoughts, feelings, and actions through exercises like journaling or worksheets.

The main types of CBT approaches

Cognitive behavioral therapy (CBT) is an umbrella term for a range of therapies that share a common foundation in cognitive and behavioral principles but focus on specific techniques and approaches.

These are the main types of CBT approaches:

• Traditional CBT (Beck’s model)

1. • The original CBT approach developed by Aaron Beck concentrates on identifying and challenging negative thought patterns and maladaptive behaviors, particularly for depression and anxiety.

• Dialectical behavior therapy (DBT)

• • DBT combines CBT techniques with mindfulness and acceptance strategies.
  • It’s especially helpful for borderline personality disorder (BPD), emotional regulation, and self-harm behaviors.

• Acceptance and commitment therapy (ACT)
  

• • ACT focuses on accepting negative thoughts and feelings rather than changing them.
  • It uses mindfulness and behavioral strategies to help individuals commit to actions aligned with their values, helping manage anxiety, depression, and chronic pain.

• Mindfulness-based cognitive therapy (MBCT)

• • Combining mindfulness practices with cognitive techniques, MBCT helps prevent the return of depression and is also useful for treating anxiety.
  • It emphasizes awareness of thoughts and feelings without judgment.

• Schema therapy

• • Schema therapy centers on identifying and changing deeply ingrained patterns (schemas) that developed in childhood and continue to influence adult relationships.
  • It’s helpful for personality disorders and long-standing emotional difficulties.

• Rational emotive behavior therapy (REBT)
  

• • REBT stresses identifying irrational beliefs and replacing them with rational alternatives.
  • It’s used to cure various mental health issues like anxiety and anger issues.

• Cognitive processing therapy (CPT)

• • Primarily used for PTSD, CPT focuses on challenging and modifying unhelpful beliefs related to trauma.
  • These aid individuals in reframing traumatic memories and reducing distress.

• Exposure therapy

• • Exposure therapy involves gradual exposure to feared situations or stimuli and is often used to treat anxiety disorders and phobias, helping individuals reduce their anxiety over time.

• Trauma-focused CBT (TF-CBT)
  

• • Frequently employed for children and adolescents who have experienced trauma, TF-CBT combines cognitive and behavioral techniques with trauma-sensitive strategies to process traumatic experiences and develop coping skills.

• Behavioral activation (BA)

• • Behavioral activation is mainly used for depression and focuses on increasing engagement in activities that improve mood and reduce avoidance behaviors.

• Metacognitive therapy (MCT)

• • MCT tries to change the way people think about their reasoning patterns and is notably useful for conditions like generalized anxiety disorder and obsessive-compulsive disorder (OCD).

• Problem-solving therapy (PST)
  

• • A structured approach that’s mostly used to treat stress-related conditions and aids individuals in developing practical problem-solving skills to manage difficulties.

• Eye movement desensitization and reprocessing (EMDR)

• • While not strictly CBT, EMDR includes CBT elements and highlights assisting individuals in processing traumatic memories by using bilateral stimulation (such as eye movements).
  • It’s widely used for PTSD.

• Compassion-focused therapy (CFT)
  

• • This approach helps to develop self-compassion to reduce self-criticism and shame, making it beneficial for people who experience high levels of shame and self-criticism.

• Self-instructional training (SIT)

• • This method is commonly used in children and involves teaching individuals to guide their behavior through internal speech, improving self-regulation and coping skills in the process.

• Functional analytic psychotherapy (FAP)

• • FAP focuses on improving interpersonal functioning by bringing awareness to how clients relate to others, making it useful for relationship issues and social anxiety.

• Cognitive behavioral analysis system of psychotherapy (CBASP)

• • CBASP is developed for chronic depression and concentrates on interpersonal interactions and the consequences of actions.
  • This helps clients understand and change unhelpful behavioral patterns.

How to get started

Getting started can feel vast, but it’s a structured and accessible approach.

Here’s a step-by-step guide to get started.

1. Decide on your approach: Therapist-guided vs. self-help
   

• • Option 1: Work with a CBT therapist
    Find a therapist: Look for a licensed mental health professional trained in CBT. You can search directories like:

• • • Psychology Today.
    • BetterHelp (Online therapy).
    • National Association of Cognitive-Behavioral Therapists.

• • • • Schedule an initial session: Be prepared to discuss your issues and therapy goals.
      • Commit to the process: CBT is short-term (typically 6-20 sessions) and requires active participation, including homework assignments.

• • Option 2: Try self-help CBT
    You can still benefit from self-guided CBT techniques if therapy isn’t an option:

• • • Read CBT books: Some good starting points include:
      • Feeling Good: The New Mood Therapy by David Burns.
      • Mind Over Mood by Dennis Greenberger and Christine Padesky.

• • Use CBT-based apps: Popular apps such as:
    

• • • CBT Thought Diary (helps track and face antagonistic thoughts).
    • Wysa (AI chatbot using CBT techniques).
    • Sanvello (for anxiety and stress management).

• • Start a thought journal: Write down negative thoughts and replace them with more balanced perspectives.

2. Learn the Basics of CBT.
   CBT is based on the idea that your thoughts, feelings, and behaviors are interconnected.

• • Negative thoughts → Influence emotions and behaviors.
  • Unhelpful behaviors → Reinforce negative thought patterns.
  • Challenging thoughts and changing behaviors → Can improve emotional well-being.

Common CBT techniques include

• • Cognitive restructuring: Identifying and confronting distorted thinking (“I’m a failure” → “I made a mistake, but I can learn from it”).
  • Behavioral activation: Taking small steps to re-engage in enjoyable or productive activities.
  • Exposure therapy (for anxiety or phobias): Gradual exposure to feared situations to cut avoidance behaviors.
  • Mindfulness and relaxation: Learning to manage stress through deep breathing, meditation, or grounding techniques.

3. Set personal goals
   
   CBT is goal-oriented, so consider:

• • What specific challenges do you want to address? (Anxiety, depression, self-doubt.)
  • What beliefs or behaviors do you want to change?
  • How will you track progress? (Journaling, mood tracking apps, etc.)

4. Practice daily and apply what you learn
   CBT is most effective when practiced consistently:

• • Write down thoughts and discover patterns (use a CBT journal or app).
  • Dispute harmful ideas with logical evidence.
  • Act: Change behaviors that strengthen negativity.
  • Stay patient: Change takes time, and setbacks are normal.

5. Evaluate progress and adjust as needed
   
   Reflect on the following after a few weeks:

• • Have your pessimistic thought sequences improved?
  • Are you feeling more in control of emotions and behaviors?
  • Do you need professional support to go deeper?

Working with a therapist might help fine-tune your approach if progress on your own feels slow.

How to find a therapist?

1. Identify what you’re looking for
   Before searching, consider:

• • Your needs: Are you dealing with depression, anxiety, OCD, PTSD, or general tension? Some therapists specialize in certain areas.
  • Therapist preferences: Do you prefer in-person or online therapy? Male or female therapist? A certain age group or cultural background?
  • Budget and insurance: Will you pay out of pocket or use insurance? Check your provider’s therapist directory if using insurance.

2. Search for a CBT therapist
   
   
   • Check your insurance provider’s directory

• • • If you have health insurance, go to your provider’s website and look for “behavioral health” or “mental health” services.
    • Call to confirm coverage and out-of-pocket costs.

• • Use online therapist directories
    These sites let you search for CBT-trained therapists by location, specialty, insurance, and session type (in-person/online):

• • • Psychology Today: A large directory with therapist bios, specializations, and contact info.
    • BetterHelp: Online therapy platform offering CBT-trained therapists.
    • Talkspace: Offers text, video, and phone therapy with licensed professionals.
    • National Association of Cognitive-Behavioral Therapists (NACBT): Lists certified CBT therapists.

• • Local resources

• • • Community mental health clinics: Lower-cost therapy options are available in many cities.
    • University counseling centers: Your school may offer free or low-cost therapy if you’re a student.
    • Employee Assistance Programs (EAPs): Some workplaces provide free short-term therapy.

3. Check their qualifications and experience
   
   A good CBT counselor should have:

• • A license (LPC, LCSW, LMFT, PsyD, PhD, MD for psychiatrists).
  • Experience with CBT techniques and your specific concerns.
  • Positive reviews or testimonials (if available).
  • A free consultation (some therapists offer this).

4. Reach out and ask questions
   Contact potential therapists via email or phone. Some key questions to ask:

• • Do you specialize in CBT?
  • Have you worked with clients who have your specific issue?
  • What’s your approach to therapy?
  • How long are the sessions, and how often do we meet?
  • What are your fees? Do you accept insurance or offer sliding-scale rates?

5. Schedule a first session and see if it’s a good fit
   
   

• • The first few sessions are about seeing if you feel comfortable with the therapist.
  • A good therapist should help you feel safe, understood, and supported.
  • If it doesn’t feel right, it’s okay to try another therapist. Finding the right one takes time!

Finding the right therapist is the first step to getting started.

Begin by checking directories, asking key questions, and not being afraid to switch psychotherapists if needed.

How long will I need cognitive behavioral therapy?

The length varies depending on your specific needs, the severity of your condition, and how quickly you respond to treatment.

However, CBT is generally designed to be a short-term and goal-oriented therapy.

Typical duration of CBT

1. Short-term CBT (most common):

• • 6 to 20 sessions (weekly or biweekly).
  • Average: 12–16 sessions for many common issues, like depression and anxiety.
  • Can be as short as 4–8 sessions for mild cases.

2. Longer-term CBT (for more complex issues):

• • 20+ sessions for severe or chronic conditions (OCD, PTSD, personality disorders).
  • Some people continue maintenance sessions (monthly or as needed) after the initial therapy.

3. Ongoing CBT (relapse prevention and skills maintenance):

• • Some choose to continue therapy on a long-term or as-needed basis for continued personal growth.
  • Self-help CBT (journaling, apps, books) can help maintain progress after formal therapy ends.

Factors that affect CBT duration

• Your specific issue: Mild depression or anxiety may require fewer sessions, while OCD, PTSD, or personality disorders may take longer.
• How actively you participate: Doing homework and applying techniques speeds up progress.
• Therapist’s approach: Some CBT models, such as traditional CBT vs. schema therapy, take longer.
• Your personal goals: Some want to resolve a specific issue, while others use CBT for general emotional well-being.

When can you stop CBT?

You may be ready to stop when:

• You feel confident using CBT techniques on your own.
• Your symptoms have improved, and you can manage setbacks.
• You and your therapist agree that your goals have been met.

It’s designed to be efficient and time-limited, but there’s no single timeline for everyone.

If you’re seeing progress, even small improvements, stick with it!

What to expect from cognitive behavioral therapy?

It’s natural to wonder what the process will look like if you’re starting cognitive behavioral therapy (CBT).

Here’s a breakdown of what to expect from your first session to ongoing therapy.

1. The first session: Assessment and goal setting
   
   Your first session is mostly about getting to know you and understanding what you need help with.
   Expect:

• • A discussion about why you’re seeking therapy (depression, anxiety, stress, OCD, trauma).
  • Questions about your thoughts, emotions, and behaviors to detect patterns.
  • A review of your personal history, like past mental health treatment, family background, and major life events.
  • Setting clear therapy goals, such as reducing anxiety, improving mood, and handling stress better.
  • Learning about how CBT works and what to expect moving forward.

Be open and honest. Your therapist is there to help, not judge.

2. Weekly or bi-weekly sessions (active therapy phase)
   After the first session, therapy becomes more structured.
   A typical CBT session lasts 45-60 minutes and includes:
   • Identifying negative thought patterns
     Your therapist will help you:

• • • Recognize automatic antagonistic beliefs that contribute to your distress.
    • Understand cognitive distortions (catastrophizing, all-or-nothing thinking, overgeneralization).

Example:

• • • Thought: “I always mess things up, so I’ll never succeed.”
    • Reframed: “I made a mistake, but that doesn’t mean I always fail.”

• • Learning and practicing CBT techniques
    
    CBT is hands-on, so expect to learn practical skills such as:

• • • Cognitive restructuring: Confronting and replacing negative views.
    • Behavioral activation: Engaging in enjoyable or productive activities to improve mood.
    • Exposure therapy (for phobias, OCD, PTSD): Gradually facing fears in a controlled way.
    • Relaxation and mindfulness: Breathing exercises, meditation, grounding techniques.
    • Problem-solving and coping strategies: Developing tools for handling stress, conflict, and uncertainty.

Example:

• • • CBT may involve role-playing conversations or practicing real-life interactions if you struggle with social anxiety.

• • Homework between sessions
    
    CBT requires active participation, so your therapist will likely assign homework such as:

• • • Keeping a thought journal to track destructive judgments and reframe them.
    • Practicing exposure exercises (gradually facing a feared situation).
    • Trying relaxation or mindfulness techniques.
    • Implementing new coping strategies in daily life.

Homework makes the therapy more efficient by helping you apply CBT techniques in real situations.

3. Measuring progress and adjusting therapy
   Every few sessions, your therapist will:

• • Review your progress toward therapy goals.
  • Adjust techniques or goals as needed.
  • Spot any barriers or difficulties in applying CBT skills.
  • Decide if additional support, such as medication or group therapy, is needed.

Your therapist may modify the approach to better suit your needs if you’re not making progress.

4. Ending therapy and maintaining progress
   
   CBT is typically short-term (6-20 sessions), but the goal is to help you become your own therapist.
   Expect to be able to do the following toward the end of therapy:

• • Review progress and skills learned.
    • Develop a relapse prevention plan (what to do if symptoms return).
    • Learn how to maintain CBT techniques on your own.
    • Discuss whether occasional booster sessions or ongoing therapy might be beneficial.

CBT is most effective when you actively participate, practice skills outside of sessions, and remain open to change.

How much does cognitive behavioral therapy cost?

The cost varies depending on factors such as location, therapist qualifications, session format, and whether you use insurance.

These are the typical costs:

1. Private therapy (without insurance).
   If paying out-of-pocket, expect:

• • $100 – $250 per session: The average cost in the U.S.
  • $50 – $150 per session: In smaller cities or with less experienced counselors.
  • $200 – $400 per session: In major cities like New York, Los Angeles, or with highly specialized therapists.
  • Sliding Scale Fees: Some psychotherapists offer reduced rates based on income.

2. Therapy with insurance
   
   

• • Many insurance plans cover CBT under mental health benefits.
  • Copay typically ranges from $20 – $50 per session.
  • Some plans cover a set number of sessions per year, like 10-20 sessions, for instance.

How to check coverage:
Call your insurance provider and ask:

• • “Do you cover CBT therapy sessions?”
  • “What is my copay or out-of-pocket cost?”
  • “How many sessions are covered?”

Search your insurance company’s therapist directory for in-network providers.

3. Online therapy options (more affordable)
   
   Online therapy platforms present CBT at a lower price:

• • BetterHelp: $60-$90 per week (billed monthly).
  • Talkspace: $69-$109 per week, including messaging and video calls.
  • Online-Therapy.com: Starts at $50 per week and contains worksheets in addition to exercises.

These platforms are convenient but may not be covered by insurance.

4. Low-cost and free CBT options
   If private therapy is too expensive, try:

• • Community mental health clinics: Offer CBT at reduced rates or for free.
  • University counseling centers: Free or low-budget therapy for students.
  • Nonprofits and support groups: Some organizations provide CBT-based programs.
  • CBT self-help books and apps: Free or cheap resources to practice CBT independently.

Summed up:

• With insurance: $20-$50 per session (copay).
• Without insurance: $100-$250 per session.
• Online therapy: $50-$100 per week.
• Cheaper options exist if you need financial help.

CBT exercises and worksheets

I created some CBT exercises and printable worksheets specifically designed for treating depression.

These emphasize challenging negative thoughts, increasing positive behaviors, and improving mood regulation.

1. Daily mood tracker worksheet

Use this to: Track daily emotions, identify mood patterns, and recognize triggers.

• • Write down mood ratings (1-10) for each day.
  • Discover events, views, or behaviors that influence your mood.
  • Recognize patterns over time.

Download: Daily Mood Tracker.

2. Activity scheduling and behavioral activation worksheet

Use this to: Break the cycle of depression by participating in positive activities.

• • List activities that once brought joy (even if you don’t feel like doing them).
  • Schedule one small activity per day, like taking a walk or listening to music.
  • Track how you feel before and after doing the activity.

Download: Behavioral Activation Worksheet.

3. Negative thought record worksheet
   
   

Use this to: Contest antagonistic notions that add to depression.

• • Pen down a negative thought (“I’m a failure”).
  • Identify cognitive distortions, such as all-or-nothing thinking or overgeneralization.
  • Replace with a balanced, realistic thought.

Download: Negative Thought Record Worksheet.

4. Self-esteem journal worksheet

Use this to: Improve self-worth by highlighting positive qualities and accomplishments.

• • Write down three positive things about yourself each day.
  • Track small wins or moments of success.
  • Reflect on how others see you positively.

Download: Self-Esteem Journal.

5. Gratitude journal worksheet
   
   

Use this to: Shift focus from negative thoughts to positive experiences.

• • Write three things you’re grateful for each day.
  • Note why they matter to you.
  • Over time, see a pattern of positive moments.

Download: Gratitude Journal.

6. Problem-solving worksheet

Use this to: Address real-life problems that contribute to depression.

• • Define a specific problem.
  • Brainstorm possible solutions.
  • Choose the best course of action and create a plan.

Download: Problem-Solving Worksheet.

7. Self-care plan worksheet
   
   

Use this to: Develop healthy habits that support emotional well-being.

• • List activities for physical, emotional, and mental self-care.
  • Schedule regular self-care practices.
  • Track how they improve your mood.

Download: Self-Care Plan.

8. Laddering worksheet (overcoming lack of motivation)

Use this to: Set small, achievable steps to break out of inactivity.

• • Identify a goal (exercising, socializing).
  • Break it into tiny steps, like putting on workout clothes → stretching → short walk, for instance.
  • Increase the difficulty as your motivation builds.

Download: Laddering Worksheet.

9. The “catch-it, check-it, change-it” worksheet

Use this to: Catch negative thoughts, challenge them, and replace them with positive alternatives.

• • Catch it: Pen down the harmful belief.
  • Check it: Ask yourself, “Is this thought accurate or helpful?”
  • Change it: Reframe the idea into a balanced, realistic perspective.

Download: Catch-It, Check-It, Change-It Worksheet.

10. “What would you say to a friend” worksheet
    
    

Use this to: Build self-compassion by responding to negative self-talk as if helping a friend.

• • Write down a self-critical belief.
  • Imagine a close friend expressing this same thought.
  • Respond with kind, encouraging words.
  • Apply the same compassion to yourself.

Download: Self-Compassion Worksheet.

11. The rumination worksheet

Use this to: Break the habit of overthinking and rumination.

• • Recognize a repetitive, destructive idea.
  • Challenge it: “Is this thought helpful or just a loop?”
  • List alternative ways to cope (distraction, mindfulness, problem-solving).

Download: Rumination Worksheet.

12. The “opposite action” worksheet

Use this to: Overcome depressive behaviors by intentionally acting against them.

• • Identify a negative feeling or behavior, such as isolating yourself.
  • Choose an opposite action (texting a friend).
  • Track how you feel afterward.

Download: Opposite Action Worksheet.

13. Strengths and values worksheet
    
    

Use this to: Reconnect with your strengths and what matters to you.

• • List your strengths, like creativity, kindness, and resilience.
  • Classify your core values (family, growth, health).
  • Set minor goals aligned with your values.

Download: Strengths and Values Worksheet.

14. “5-4-3-2-1 grounding” worksheet

Use this to: Shrink feelings of sadness or dissociation by aiming at the present.

• • 5 things you see.
  • 4 things you can touch.
  • 3 things you hear.
  • 2 things you smell.
  • 1 thing you taste.

Download: Grounding Techniques Worksheet.

15. “Self-soothe box” worksheet
    
    

Use this to: Create a personalized toolkit of comforting and uplifting items.

• • Collect items that bring comfort, like scented candles, music, and photos.
  • Use the worksheet to list items for each sense (sight, touch, smell, taste, sound).
  • Keep the box ready for difficult moments.

Download: Self-Soothe Box Worksheet.

Free CBT apps for depression

• MoodTools: Depression self-help app (Android/iOS).
• CBT Thought Diary: Tracks and challenges negative thoughts (Android/iOS).
• Woebot: AI-based CBT chatbot for depression support (Android/iOS).
• Happify: Science-backed CBT games for mood improvement (iOS/Android).
• Sanvello: CBT-based self-help for depression and anxiety (iOS/Android).
• Reflectly: AI-powered CBT journaling app (iOS/Android).

These worksheets provide practical ways to work through depression.

Final note

CBT is a practical and evidence-based approach that helps treat depression by focusing on skills and strategies that empower individuals to take control of their thoughts and behaviors.

Its structured and problem-focused methods provide individuals with tools that can help manage depression not only during treatment but in their everyday lives moving forward.