Cognitive behavioral therapy is a specialized type of psychotherapy that is present-focused, structured, short-term, and goal-oriented. It is among the most studied forms of mental health treatment, with thousands of studies finding CBT to be effective for a wide range of mental health and physical health problems, including depression, anxiety disorders, eating disorders, insomnia, and substance use disorders, among many others.

CBT was designed based on the idea that how people feel depends more on their perception or interpretation of a situation rather than the situation itself. Especially when distressed, a person's perception of a situation may be distorted. CBT is designed to help clients first become aware of their distorted or unhelpful thoughts and behavior patterns in a given situation. They then learn to modify these thoughts and behaviors. People start feeling better once their thought patterns and behaviors change to be more realistic and/or more useful to them.

Cognitive behavioral therapists are therapists who have received specialized training in cognitive behavioral therapy. A well-trained CBT therapist is able to expertly tailor CBT to your needs and goals so that your treatment plan is personalized to you. They do this by creating something called a "case conceptualization" at the start of treatment. The case conceptualization outlines the hypothesized mechanisms that cause and maintain the current symptoms or problems you're experiencing. Essentially, the conceptualization will work as an individualized roadmap for treatment. At the start of treatment, a CBT therapist will also make sure to understand your values and aspirations and help you set specific treatment goals. Before proceeding with treatment, a CBT therapist will explain their suggested treatment plan for getting you to your desired outcomes at the end of therapy and make sure you're both on the same page about how to best proceed.

During the course of therapy, CBT therapists will help you make progress toward those goals and improve the quality of your life by teaching you different skills and techniques to apply outside of therapy. The specific interventions or techniques that a therapist may use in treatment will of course depend on what someone may be struggling with; however, some of the most common techniques that CBT therapists use include (but are not limited to):

• Identifying automatic negative thoughts or negative thought patterns

• Evaluating thoughts based on their validity and/or utility using cognitive restructuring and/or behavioral experiments

• Scheduling activities that are pleasurable and/or result in a sense of mastery or achievement

• Graduated goal setting, which involves identifying goals and breaking them down in to more easily achievable steps

• Problem solving

• Improved self-awareness, especially of thoughts, emotions, attitudes, and behaviors

• Effective decision making

• Effective communication or assertiveness skills, using techniques such as role play of difficult interpersonal situations

• Coping skills to better tolerate distressing emotions

• Coping strategies to better manage difficult situations

• Tools for relaxation

• Mindfulness techniques

The goal of a CBT therapist is to eventually make themselves obsolete; that is, their goal is to teach you the skills and techniques you'll need to eventually become your own therapist. CBT focuses on teaching you these techniques and making sure you apply them in your real life outside the therapy sessions. To facilitate this, at the end of each session, you and your therapist will work together to set an "action plan", which outlines tasks to work on before your next session.

In addition to what happens within sessions, across sessions, a CBT therapist will also be measuring your progress. This often includes completing questionnaires that measure your symptoms, functioning, or other related issues and/or asking you to report on these things in session. Measuring progress objectively in these ways is helpful to make sure therapy is progressing in the right direction.

Although cognitive behavioral therapy was initially designed to address depression, it has since been adapted and shown to be effective for a wide range conditions. This includes several mental health conditions, namely:

• Depression

• Anxiety disorders, including social anxiety disorder, panic disorder, generalized anxiety disorder, health anxiety

• Eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and/or eating disorder

• Obsessive-compulsive disorder and related conditions, including body dysmorphic disorder and hoarding disorder

• Post-traumatic stress disorder

• Personality disorders, and

• Schizophrenia and psychosis

It has also been shown to be effective for a range of medical conditions, including:

• Irritable bowel syndrome

• Chronic pain

• Fibromyalgia

• Sexual dysfunction

• Chronic fatigue syndrome

• Migraines

Lastly, the effectiveness of CBT has also been demonstrated in the context of treating other issues that impair a person's quality of life or compromise their well being, such as:

• Sleep problems, especially insomnia

• Relationship problems

• Problematic anger

• Women's issues

• Stress

Note: this is not an exhaustive list. The research on CBT continues to expand, with mounting evidence continuing to support it's use for the issues noted above as well as other issues not explicitly included here. If you're interested in CBT, don't hesitate to reach out to a licensed therapist who specializes in CBT to discuss whether it may be a good option in your case.

Although CBT is among the most effective and well-researched psychotherapies we have currently at our disposal, some aspects of CBT won't appeal to everyone. Here are a few things to consider if you're deciding whether CBT makes sense for you:

• CBT is a structured and goal-oriented approach. CBT is designed to be a time-limited therapy. That doesn't mean the therapy is rushed but instead focused on helping people experience relief and improvements in their lives as effectively and efficiently as possible. The goal-oriented and structured nature of CBT helps ensure significant and meaningful progress occurs quickly and consistently. Some individuals may view therapy as a long-term pursuit that is less designed to address problems or produce change and instead more exploratory -- if this is the case for you, then CBT would not be a good fit.

• Homework is a mainstay of the treatment. One thing that I always tell my any prospective client is that I am not magic. (To be frank, in my opinion, no therapist is magic.) Talking to me (or any other therapist) for 50 minutes a week may make you feel a bit better in the moment sometimes, but it won't be enough to get you to your treatment goals. (I wish it were! But, if they did teach us how to do that in graduate school, I must have been absent that day.) The real work happens outside of session. So, in CBT, homework outside of session where you work on applying what we discuss in session is critical. This can involve things like self-monitoring (e.g., tracking your thoughts, behaviors, emotions), applying new skills, or engaging in different behaviors than you're used to and monitoring the effects. Homework should never be 'busy work' -- it has a clear purpose and it will be something that you and your therapist decide on makes sense together. Nevertheless, it can be time-consuming at times. Changing patterns that are causing you distress isn't always easy -- so homework can also be a bit challenging at times. Afterall, challenge is necessary for change. The goal isn't to have the tasks be so challenging that they overwhelm you. A well-trained CBT therapist will often try to find a sweet spot of challenging enough to result in progress but not so challenging that it's too overwhelming to complete. If completing tasks outside of session like this is a deal breaker for you, then CBT may not be the best fit.

• Therapist training and expertise matter. Unfortunately, not all therapists who say they implement CBT are well-trained in the treatment. Someone's level of training and expertise in the approach matters a lot because it's not always an easy intervention to implement well. Some clinicians may implement aspects of CBT, but because they have not received adequate training, often are unable to implement the treatment fully as intended. This usually compromises how well the treatment works, leaving many people feeling discouraged. The effectiveness of CBT treatment relies heavily on your therapist's training in evidence-based treatment, especially CBT, as well as their experience with your particular concerns or difficulties. Before you schedule an intake appointment, ask if the therapist offers free consultation calls (many do). During that time, I'd encourage you to ask questions about their training, specifically in CBT. You can use the information I described above about what a CBT therapist does to get a better sense about their knowledge of the intervention -- for instance, what's their perspective on homework in therapy? do they monitor progress and, if so, could they share information about their typical outcomes?