What is Cognitive Behavioral Therapy (CBT)?

You’re driving on the freeway, going 70 miles an hour, and someone cuts you off abruptly. You stomp on the brakes to avoid having a deadly accident. There is a wide range of reactions you could have:

You might think, “That jerk, he almost killed me!” You feel very angry.

You might think, “Thank God we didn’t have a wreck. It would have killed me.” You feel immense gratitude for being alive and safe.

Or might you think something entirely different? Once a fellow therapist told me that whenever he is cut off, he imagines that a woman is giving birth in the back seat. He then feels compassion for the driver who, in a state of panic and urgency, is driving so recklessly. This helps the person I was talking with to keep his blood pressure down.

Most people think that the mere act of being cut off on the freeway makes them feel a certain way. But, as the above examples show, being cut off does not in itself cause an emotion. It is your thoughts about having been cut off that determine your reaction.

“Don’t Believe Everything You Think”

This relationship – an event leads to thoughts, which lead to feelings – is the central premise of cognitive behavioral therapy (CBT). Thoughts also influence physiological reactions, behaviors, and further thoughts.

In the CBT model, negative thoughts in themselves do not cause emotional problems, if those thoughts are realistic. There’s the rub. Many of the things we tell ourselves simply are not true, or their truth is impossible to determine – thoughts like, “I always screw up” or “I’m a bad person” or “I need to do everything right” or “I’ll never feel better.”

Negative beliefs about oneself, others, or life can lead to (or exacerbate) many emotional problems, such as depression, anxiety, and even suicidal thoughts. So, the major goals of CBT are for people to learn to recognize their unhealthy thoughts, challenge them, change them, or observe them without believing and acting on them.

CBT thoughts feelings These goals are harder to achieve than it might appear at first glance. One challenge is that you often are unaware of the thoughts that come before your moods and behaviors. Another challenge is that if you have strong negative thoughts about yourself, you have probably had these thoughts tens of thousands, perhaps even millions, of times in your life. You almost certainly treat these thoughts as facts. It takes a lot of practice to unlearn or otherwise disarm what you have regarded to be truths for many years.

Evidence and Criticisms of CBT

CBT is one of the very few treatments that has been shown to reduce suicidal behavior. In a major study, people who received CBT following a suicide attempt were half as likely to attempt suicide again as those who did not receive CBT.

CBT helps with many other problems, too. Over the past 40 years, research with thousands of people has shown that CBT often helps a person recover from a long list of emotional troubles, including depression, anxiety, post-traumatic stress disorder (PTSD), eating disorders, schizophrenia, and many more.

Despite CBT’s strong record of effectiveness, it has its critics. The most common criticisms are that CBT therapists practice in a rote, mechanistic, unempathic, shallow fashion, and that they do not delve into what underlies a person’s pain and emotional problems. In my opinion, this criticism is well founded if the CBT therapist is not a good therapist.

A good CBT therapist practices excellent foundational counseling skills, listening empathically, gaining a full understanding of the client’s pain or other problems, helping the client to feel understood, and using flexibility in his or her approach to meet the client’s needs. And good CBT often, if not always, involves uncovering the underlying origins of painful beliefs. Learning how beliefs formed is one way to discover how they are wrong or harmful. At the same time, CBT therapists know that it is not necessary for a client to unearth every hurt from the past before undergoing healing and growth. With CBT, change can begin immediately.

(To read one particularly harsh critique of CBT, check out this essay, “The Limits of Cognitive Psychotherapy: Are People Really as Stupid as They Seem?” But please be sure, too, to read the rebuttal, “Cognitive Behavioral Therapy: Proven Effectiveness.”)

You Can Be Your Own CBT Therapist

If you don’t want to go into psychotherapy, or if you want to do extra work on top of psychotherapy, you can benefit from excellent self-help books that incorporate CBT techniques, including worksheets and activities. Here is a list of some of the best of those books:

Feeling Good: The New Mood Therapy, by David Burns. This book also has a workbook to accompany it: The Feeling Good Handbook.

Mind over Mood: Change the Way You Feel by Changing the Way You Think, by Dennis Greenberger and Christine Padesky

The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program, by William Knaus and Albert Ellis

Thoughts and Feelings: Taking Control of Your Moods and Your Life, by Matthew McKay, Martha Davis, and Patrick Fanning