Experts Describe Just Why Cognitive Behavioral Therapy Works

If you are looking for answers and decide to seek therapy, cognitive behavioral therapy is a direction many people are now going because it is a blend of two psychotherapies: cognitive therapy and behavioral therapy.

"CBT is a short-term, structured form of psychotherapy that focuses on the person's thoughts, beliefs, and behaviors. It can be adapted and used to help people with a wide variety of issues including depression, relationship issues, anxiety, and sleep difficulties. There is also emerging work for people who experience psychotic symptoms like delusions and hallucinations," says Kinsey McManus, client services director at the National Alliance on Mental Illness-NYC Metro.

"Cognitive behavioral therapy is a tool used by therapists in order to promote healthier ways of managing intrusive or maladaptive thinking, which often can lead to maladaptive behaviors," says Dr. Sheila Shilati, COO of Seasons Recovery in Malibu, CA. In other words, it is a road map by which to extinguish the sometimes intrusive thoughts that are played out in our daily lives.

It is great for individuals who keep finding themselves stuck in their lives as though they're in a hamster wheel and nothing will ever feel better. "Sometimes that hamster wheel manifests in anxiety, depression, isolation, or self-sabotage, which ultimately leaves the individual wondering why they keep ending up in the same situations. By using a set of designated assignments and practices offered by a therapist, they can learn to build greater insight in order to 'block' or 'redirect' one's thinking so that the behavior diminishes, leading to better outcomes," Dr. Shilati says.

In this model of therapy, the clinician and the client work as a team to identify the client's dysfunctional and distorted thoughts and beliefs (cognitions) and both challenge and modify those thoughts and attitudes (behavior). "During CBT, the clinician will identify and challenge a client's negative thought patterns. The clinician will also help the client understand the impact those thoughts have on his/her behavior and feelings. By doing this, the clinician and the client will be able to come up with alternative thoughts that lead to more positive feelings and behaviors," McManus says.

CBT is different from many other types of psychotherapies because the sessions are highly structured and goal oriented. "At the beginning of the treatment, the person and their therapist identify specific problems to address with goals and expected outcomes. Goals can include addressing specific symptoms of a mental illness (e.g., anxiety around socializing with others) or life problems (e.g., being unhappy at work)," McManus says.

These problems and their related goals are the core focus of each session. In addition to the work done during sessions, homework is assigned between sessions to promote continuous change. "Homework assignments vary but can include worksheets to track thoughts and mood or guided imagery activities. CBT is also unique when considering the relationship between the person and their therapist," McManus says. Unlike other therapies, where the therapist is viewed as the expert, CBT is designed to create a collaborative partnership between the person and their therapist.

A great deal of research has been done on the effectiveness of CBT. "Clinical trials have demonstrated that CBT can substantially reduce the symptoms of certain mental health conditions," McManus says. These include anxiety disorders, depression, drug or alcohol problems, and other types of personal or relational challenges.

In the short term, CBT has been found to provide symptom reductions similar to medications for people experiencing anxiety or depression. In the long term, research indicates that the benefits of CBT outlast those of medication alone. "As a psychotherapy, CBT can provide real change that goes beyond just symptom reduction through medication. CBT can help a person learn new coping skills, change their behaviors and beliefs, and solve life problems," McManus says.

However, as with every type of therapy, it does not work for all people and is not a cure. Due to the short-term nature of the intervention, CBT is less effective for people who experience more severe and/or chronic mental health symptoms. "The therapist must be particularly skilled and the person participating must be willing to do hard work and make changes," McManus says.

Of course, there's another side to it. "Cognitive behavioral therapy is the insurance companies' answer to how to pay therapists less money for treatment," says Dr. Carole Lieberman, a forensic psychiatrist in LA. CBT is generally time-limited and brief, so it is less expensive than the more effective psychodynamic, insight-oriented talk therapy. "It can be a useful component of treatment for some cases of post-traumatic stress disorder, in that it gives patients a logical way of framing their distress, but the patient still needs insight-oriented talk therapy, as well, in order to get to the root of their problems," Dr. Lieberman says.