How Cognitive Behavioral Therapy (CBT) Works
Cognitive Behavioral Therapy, or CBT, is an effective approach for dealing with many types of mental health challenges, including depression and anxiety. It is especially useful for teens and young adults, though it is not for everyone. That is why I always have an open conversation with each person before starting sessions to make sure it is the right fit for them.
If CBT does not feel like the right approach, that is completely okay. Some people benefit more from emotion focused or relational therapies, which emphasize understanding and processing feelings rather than analyzing thoughts. The most important thing is finding a method that truly fits the person and their needs.
What Is CBT?
CBT is based on the idea that our thoughts, feelings, and behaviors are all connected. When we can recognize and change unhelpful thought patterns, we can influence how we feel and behave, leading to positive changes in many areas of life.
Over time, therapy has moved away from older psychoanalytic models like those developed by Freud, where a client might lie on a couch and discuss childhood memories. Instead, CBT focuses more on the present, on the relationship between what we think, how we feel, and what we do
Where CBT Comes From
CBT has its roots in behavior therapy. Psychologists like B.F. Skinner explored how behaviors are shaped by reinforcement, while Ivan Pavlov’s famous 1906 experiment with dogs showed how learning can occur through association, as the dogs learned to connect the sound of a bell with food.
Later, psychologists Albert Ellis and Aaron Beck developed the cognitive side of the approach. They proposed that conditions like anxiety and depression are often driven by our thoughts. To change how we feel, we need to understand and challenge what we are thinking.
Examining Cognitive Distortions
A big part of CBT involves identifying and challenging cognitive distortions, the automatic and often exaggerated thought patterns that can lead to unnecessary stress or emotional pain.
Some common examples include:
Catastrophizing: expecting the worst possible outcome (“If I mess up this presentation, my career is over.”)
All or nothing thinking: seeing things as completely good or bad (“If I am not perfect, I am a total failure.”)
Overgeneralization: drawing broad conclusions from a single event (“That date went badly, so I will never find anyone.”)
Mind reading: assuming you know what others are thinking (“They must think I am stupid.”)
In therapy, clients learn to spot these distortions in their everyday thoughts and replace them with more balanced, realistic ones. This process helps reduce anxiety and depression by breaking the cycle of negative thinking.
How CBT Works in Practice
CBT combines both cognitive and behavioral techniques. It is goal oriented, structured, and evidence based, meaning it is supported by extensive research and proven results. Clients and therapists work together to identify unhelpful thought patterns and replace them with more constructive ones.
Let’s look at how this might work with anxiety.
Imagine someone who is scared of spiders. When they see a spider, they feel intense fear. Their thoughts might be something like:
“Spiders are dangerous. One might crawl on me.”
If they avoid the spider, they will feel relief in the short term. However, that avoidance actually reinforces their fear over time. Because they never face the spider, they do not get the chance to learn that most spiders are not dangerous. Their avoidance behavior strengthens the belief that spiders must be avoided at all costs.
In CBT, the therapist helps the person examine their beliefs about spiders. They might explore questions like:
How likely is it that a spider will actually harm you?
What would really happen if a spider came near you?
Through this process, the person begins to replace extreme or unrealistic thoughts with more balanced ones. They might also use exposure therapy, a gradual process of facing fears, such as starting by looking at pictures of spiders, then observing one from a distance, and eventually being in the same room with one.
Over time, as the person faces their fears safely, their anxiety decreases and their confidence grows.
The Bigger Picture
CBT helps people break the cycle between unhelpful thoughts, distressing feelings, and avoidant behaviors. It empowers individuals to understand themselves better and take an active role in their healing process.
That said, CBT is not the right approach for everyone, and that is perfectly okay. Some people respond better to emotion focused therapy, psychodynamic work, or other methods that emphasize emotional depth and interpersonal connection. The best therapy is the one that helps a person feel safe, understood, and supported in making lasting change.