CBT: What to Expect From Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of therapy developed by Aaron Beck in the 1960s. It assumes that people’s thoughts affect their emotions, which in turn affect their behaviors. So identifying and changing negative thoughts can lead to healthier emotions and more desirable behaviors. 

Since it was developed, CBT has been studied extensively and has been found to help with a wide range of health conditions. It has even been adapted for use with children, teens, couples, and families.

What is cognitive behavioral therapy?

CBT is considered the first-choice therapy for many conditions. It focuses on how your thoughts, emotions, and behaviors affect each other. And it helps you learn skills to better manage your mental health.

The core principles of CBT are:

• Mental health problems are due in part to negative thinking patterns.

• Mental health issues can also be traced to learned behaviors.

• People with mental health problems can learn new ways to cope with these issues in ways that benefit their well-being.

What can cognitive behavioral therapy treat?

CBT can help treat mental health conditions such as:

• Major depression 

• Anxiety disorders

• Eating disorders

• Substance use disorders

• Bipolar disorder

• Schizophrenia 

• Post-traumatic stress disorder (PTSD)

• Obsessive-compulsive disorder (OCD)

CBT isn’t just for mental health conditions, though. It can also help with stressful life changes or relationship issues. And CBT has been found to help improve certain physical health issues such as:

• Chronic pain

• Migraine

• Arthritis

• Fatigue

• Irritable bowel syndrome (IBS)

• Epilepsy

• Chronic obstructive pulmonary disease (COPD)

CBT is effective for adults and children and can be offered online or in person. It is also effective as an individual therapy or group therapy.

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How does cognitive behavioral therapy work?

CBT is based on what’s called the cognitive model or CBT triangle. According to the cognitive model, a situation causes you to have an automatic thought. Automatic thoughts are thoughts that immediately pop up in response to a situation. Based on that automatic thought, you will experience a reaction. This typically involves an emotion, behavior, and bodily response. 

You can also picture a triangle, with the corners of the triangle representing your thoughts, feelings, and behaviors. Each point affects the others, and changing one point can impact the others.

Here’s a good example of how this works: 

• Situation: You wave at your friend across the street, but they don’t wave back.

• Automatic thought: “They’re mad at me; I’m a bad person.”

• Emotional response: You feel hurt and rejected. 

• Body response: Your cheeks flush, and you have a sinking feeling in your stomach.

• Behavioral response: You ignore your friend and wait for them to talk to you first.

Your CBT therapist will help you recognize and track your automatic thoughts and reactions. From there, you can start adjusting your thoughts and actions in ways that will help you feel better.

During CBT, your therapist will also help you:

• Set goals and break them down into smaller parts

• Identify your values

• Problem solve

• Learn mindfulness and other coping skills

• Learn communication skills

• Plan positive and pleasurable activities

What are the benefits of cognitive behavioral therapy?

CBT offers many potential benefits. It can help you:

• Change negative beliefs about yourself, others, and the world

• Handle stressful situations and problems when they arise

• Participate in more positive activities

• Set and work toward goals

• Develop healthier coping behaviors

As a result of CBT, you may experience a:

• Decrease in emotional symptoms

• Improved sense of well-being

• Decrease in negative behaviors, such as substance misuse

• Improved ability to cope with stress

• Change in your physical health

What are the risks of cognitive behavioral therapy?

CBT is considered to be a safe form of treatment for a range of mental health disorders. Generally, the side effects of CBT are less severe than other forms of treatment, like medications. But there are still some potential risks. 

Some people who participate in CBT may experience:

• Increased distress

• Worsening of emotional symptoms

• Increased strain in family relationships

Talking about uncomfortable thoughts and feelings can be hard. And many therapists will tell you that sometimes therapy makes you feel worse at first. But as you work through your feelings, you should feel better over time. 

If you experience negative effects from CBT, tell your therapist what you are feeling. They can talk to you more about what to expect and possibly adjust your treatment.

How do you prepare for cognitive behavioral therapy?

Before starting CBT, you may want to:

• Learn more about CBT and how it works.

• Determine if CBT is a good fit for you or is the type of help you are looking for.

• Identify your goals for therapy.

• Consider your budget for therapy.

• Determine if your health insurance will cover CBT (if applicable).

• Look for a therapist (more on this below).

What can you expect during cognitive behavioral therapy?

A typical individual session of CBT is around 45 to 60 minutes. While each therapist will differ somewhat in their approach, most CBT sessions will share common features. 

During a session of CBT, you can expect your therapist to do one or more of the following:

• Help you identify negative automatic thoughts 

• Reflect on how your thoughts affect your emotions and responses

• Challenge your thoughts by asking specific questions

• Encourage you to consider more helpful thoughts

• Teach stress management, relaxation, communication, and other coping skills

• Discuss your progress toward meeting your goals

• Assign homework for you to complete in between sessions

Over the course of therapy, your therapist will likely use different combinations of the above in each session, depending on your concerns and goals. 

How long does it take to see results from cognitive behavioral therapy?

A typical course of CBT is 8 to 12 sessions, with one session occurring each week. But many therapists will encourage you to continue therapy longer if you feel like it is helpful and you have additional goals that you would like to work on. 

When you start CBT, you may feel relief right away, or may it take longer to notice improvements. Every person is different. 

Signs that CBT is working include:

• Identifying and challenging negative automatic thoughts on your own

• Feeling less stressed, anxious, and depressed

• Using more healthy coping behaviors and refraining from unhelpful behaviors

• Communicating more effectively

How to find a CBT therapist near you

If you think CBT might be helpful for you, you can: 

• Search for a therapist online.

• Contact your insurance company.

• Ask for a referral from your healthcare provider.

You can also search the Association for Behavioral and Cognitive Therapies therapist directory or seek out a Beck Institute certified CBT therapist through its clinician directory.

You can also try these other therapist databases: 

• Good Therapy

• Choosing Therapy

• Therapy Den

• Psychology Today

• Gaylesta (LGBTQ+ therapists)

• InnoPsych (BIPOC therapists)

• Open Path Psychotherapy Collective (low-cost therapy)

When you find a potential therapist, you can ask them about their treatment approach and if they have experience with CBT. Usually a therapist’s website or directory profile will mention their therapeutic approach, so you can get an idea of whether they might be a good fit for you.

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Written by:

Emily Guarnotta, PsyD

Emily Guarnotta, PsyD, is a licensed clinical psychologist and certified perinatal mental health professional with over 10 years of clinical experience.

Edited by:

Renée Fabian, MA

Renée Fabian is the senior pet health editor at GoodRx. She’s worked for nearly 10 years as a journalist and editor across a wide range of health and well-being topics.

Reviewed by:

Mona Bapat, PhD, HSPP

Mona Bapat, PhD, HSPP, has 15 years of clinical experience providing therapy. She is a licensed clinical psychologist in Indiana and Illinois with treatment experience in individual, couples, family, and group therapy modalities.

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