Is cognitive behavioural therapy effective
Overview - Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.
It's most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.
How CBT works
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a negative cycle.
CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts.
You're shown how to change these negative patterns to improve the way you feel.
Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past.
It looks for practical ways to improve your state of mind on a daily basis.
Uses for CBT
CBT has been shown to be an effective way of treating a number of different mental health conditions.
In addition to depression or anxiety disorders, CBT can also help people with:
- bipolar disorder
- borderline personality disorder
- eating disorders – such as anorexia and bulimia
- obsessive compulsive disorder (OCD)
- panic disorder
- post-traumatic stress disorder (PTSD)
- sleep problems – such as insomnia
- problems related to alcohol misuse
CBT is also sometimes used to treat people with long-term health conditions, such as:
- irritable bowel syndrome (IBS)
- chronic fatigue syndrome (CFS)
- chronic pain
Although CBT cannot cure the physical symptoms of these conditions, it can help people cope better with their symptoms.
What happens during CBT sessions
If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks.
The course of treatment usually lasts for between 6 and 20 sessions, with each session lasting 30 to 60 minutes.
During the sessions, you'll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.
You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful, and to determine the effect they have on each other and on you.
Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life and you'll discuss how you got on during the next session.
The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.
This should help you manage your problems and stop them having a negative impact on your life, even after your course of treatment finishes.
Pros and cons of CBT
Cognitive behavioural therapy (CBT) is effective in treating some mental health problems, but it may not be successful or suitable for everyone.
Some of the advantages of CBT include:
- it can be completed in a relatively short period of time compared with other talking therapies
- the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and online
- it teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished
- it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviours)
- it can be as effective as medicine in treating some mental health problems and may be helpful in cases where medicine alone has not worked
Some of the disadvantages of CBT to consider include:
- you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
- attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
- it may not be suitable for people with more complex mental health needs or learning difficulties
- it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable
- it does not address any wider problems in systems or families that may have a significant impact on someone's health and wellbeing
Some critics also argue that while CBT addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
How to find a CBT therapist
You can get psychological therapies, including CBT, on the NHS.
You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.
Or your GP can refer you if you prefer.
If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies. It usually costs £60 to £100 per session, but lower rates may be available to those on lower incomes.
There is a register of all accredited therapists in the UK on the British Association for Behavioural and Cognitive Psychotherapies (BABCP) website.
There's also a directory of chartered psychologists on the British Psychological Society (BPS) website, some of whom specialise in CBT.
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Animated video explaining self-referral to psychological therapies services for stress, anxiety or depression.
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Cognitive behavioral therapy - Mayo Clinic
Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.
CBT can be a very helpful tool ― either alone or in combination with other therapies ― in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. But not everyone who benefits from CBT has a mental health condition. CBT can be an effective tool to help anyone learn how to better manage stressful life situations.
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Why it's done
Cognitive behavioral therapy is used to treat a wide range of issues. It's often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way.
CBT is a useful tool to address emotional challenges. For example, it may help you:
- Manage symptoms of mental illness
- Prevent a relapse of mental illness symptoms
- Treat a mental illness when medications aren't a good option
- Learn techniques for coping with stressful life situations
- Identify ways to manage emotions
- Resolve relationship conflicts and learn better ways to communicate
- Cope with grief or loss
- Overcome emotional trauma related to abuse or violence
- Cope with a medical illness
- Manage chronic physical symptoms
Mental health disorders that may improve with CBT include:
- Anxiety disorders
- Sleep disorders
- Eating disorders
- Obsessive-compulsive disorder (OCD)
- Substance use disorders
- Bipolar disorders
- Sexual disorders
In some cases, CBT is most effective when it's combined with other treatments, such as antidepressants or other medications.
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In general, there's little risk in getting cognitive behavioral therapy. But you may feel emotionally uncomfortable at times. This is because CBT can cause you to explore painful feelings, emotions and experiences. You may cry, get upset or feel angry during a challenging session. You may also feel physically drained.
Some forms of CBT, such as exposure therapy, may require you to confront situations you'd rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety.
However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.
How you prepare
You might decide on your own that you want to try cognitive behavioral therapy. Or a doctor or someone else may suggest therapy to you. Here's how to get started:
- Find a therapist. You can get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). Or you can find a therapist on your own — for instance, through a local or state psychological association or by searching the internet.
- Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of therapy sessions a year. Also, talk to your therapist about fees and payment options.
- Review your concerns. Before your first appointment, think about what issues you'd like to work on. While you can also sort this out with your therapist, having some sense in advance may provide a starting point.
Psychotherapist is a general term, rather than a job title or indication of education, training or licensure. Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.
Before seeing a psychotherapist, check his or her:
- Background and education. Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master's or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.
- Certification and licensing. Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline.
- Area of expertise. Ask whether the therapist has expertise and experience treating your symptoms or your area of concern, such as eating disorders or PTSD.
The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.
What you can expect
Cognitive behavioral therapy may be done one-on-one or in groups with family members or with people who have similar issues. Online resources are available that may make participating in CBT possible, especially if you live in an area with few local mental health resources.
CBT often includes:
- Learning about your mental health condition
- Learning and practicing techniques such as relaxation, coping, resilience, stress management and assertiveness
Your first therapy session
At your first session, your therapist will typically gather information about you and ask what concerns you'd like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation. Your therapist may discuss whether you might benefit from other treatment as well, such as medications.
The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match for you. Make sure you understand:
- His or her approach
- What type of therapy is appropriate for you
- The goals of your treatment
- The length of each session
- How many therapy sessions you may need
It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best course of action. If you don't feel comfortable with the first therapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from CBT.
Your therapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.
CBT generally focuses on specific problems, using a goal-oriented approach. As you go through the therapy process, your therapist may ask you to do homework — activities, reading or practices that build on what you learn during your regular therapy sessions — and encourage you to apply what you're learning in your daily life.
Your therapist's approach will depend on your particular situation and preferences. Your therapist may combine CBT with another therapeutic approach — for example, interpersonal therapy, which focuses on your relationships with other people.
Steps in CBT
CBT typically includes these steps:
- Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental health disorder. You and your therapist may spend some time deciding what problems and goals you want to focus on.
- Become aware of your thoughts, emotions and beliefs about these problems. Once you've identified the problems to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.
- Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.
- Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what's going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won't take as much effort.
Length of therapy
CBT is generally considered short-term therapy — ranging from about five to 20 sessions. You and your therapist can discuss how many sessions may be right for you. Factors to consider include:
- Type of disorder or situation
- Severity of your symptoms
- How long you've had your symptoms or have been dealing with your situation
- How quickly you make progress
- How much stress you're experiencing
- How much support you receive from family members and other people
Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:
- Threatening to immediately or soon (imminently) harm yourself or take your own life
- Threatening to imminently harm or take the life of another person
- Abusing a child or a vulnerable adult ― someone over age 18 who is hospitalized or made vulnerable by a disability
- Being unable to safely care for yourself
Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life.
Getting the most out of CBT
CBT isn't effective for everyone. But you can take steps to get the most out of your therapy and help make it a success.
- Approach therapy as a partnership. Therapy is most effective when you're an active participant and share in decision-making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and assess progress over time.
- Be open and honest. Success with therapy depends on your willingness to share your thoughts, feelings and experiences, and on being open to new insights and ways of doing things. If you're reluctant to talk about certain things because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know about your reservations.
- Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to discuss.
- Don't expect instant results. Working on emotional issues can be painful and often requires hard work. It's not uncommon to feel worse during the initial part of therapy as you begin to confront past and current conflicts. You may need several sessions before you begin to see improvement.
- Do your homework between sessions. If your therapist asks you to read, keep a journal or do other activities outside of your regular therapy sessions, follow through. Doing these homework assignments will help you apply what you've learned in the therapy sessions.
- If therapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from CBT after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach.
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Whom and how will cognitive therapy help?
Knowing Yourself A Human Among Humans
Anxiety and depression, eating disorders and phobias, couple and communication problems—the list of questions CBT attempts to answer continues to grow year by year.
Does this mean that psychology has found a universal "key to all doors", a cure for all diseases? Or are the advantages of this type of therapy somewhat exaggerated? Let's try to figure it out. nine0003
Return the psyche to its place
In the beginning there was behaviorism. This is the name of the science of behavior (hence the second name of cognitive-behavioral therapy - cognitive-behavioral, or CBT for short). The American psychologist John Watson was the first to raise the banner of behaviorism at the beginning of the 20th century.
His theory was a response to the European fascination with Freudian psychoanalysis. The birth of psychoanalysis coincided with a period of pessimism, decadent moods and expectations of the end of the world. This was reflected in the teachings of Freud, who argued that the source of our main problems is outside the mind - in the unconscious, and therefore it is extremely difficult to cope with them. nine0003
Between the external stimulus and the reaction to it there is a very important instance - the person himself
The American approach, on the contrary, assumed some simplification, healthy practicality and optimism. John Watson believed that the focus should be on human behavior, on how we react to external stimuli. And - to work on improving these very reactions.
However, this approach was successful not only in America. One of the fathers of behaviorism is the Russian physiologist Ivan Petrovich Pavlov, who received the Nobel Prize for his research and studied reflexes up to 19 years of age. 36 years old.
It soon became clear that, in its quest for simplicity, behaviorism had thrown the baby out with the water — in fact, reducing man to a totality of reactions and bracketing the psyche as such. And scientific thought moved in the opposite direction.
Finding errors of consciousness is not easy, but much easier than penetrating into the dark depths of the unconscious
an important authority is, in fact, the person who reacts. Or rather, his mind. nine0003
If psychoanalysis places the origins of the main problems in the unconscious, inaccessible to us, then Beck and Ellis suggested that we are talking about incorrect "cognitions" - errors of consciousness. Finding which, although not easy, is much easier than penetrating into the dark depths of the unconscious.
The work of Aaron Beck and Albert Ellis is today considered the foundation of CBT.
Errors of consciousness
Errors of consciousness can be different. One simple example is the tendency to view any event as having something to do with you personally. Let's say the boss was gloomy today and greeted you through his teeth. “He hates me and is probably about to fire me” is a fairly typical reaction in this case. But not necessarily true. nine0003
We don't take into account circumstances we simply don't know about. What if the boss's child is sick? If he quarreled with his wife? Or has he just been criticized at a meeting with shareholders? However, it is impossible, of course, to exclude the possibility that the boss really has something against you.
But even in this case, repeating “What a horror, everything is gone” is also a mistake of consciousness. It’s much more productive to ask yourself if you can make a difference in the situation and what the benefits of leaving your current job might be. nine0003
Traditional psychotherapy takes a long time, while cognitive behavioral therapy can take 15-20 sessions
This example illustrates the "scope" of CBT, which does not seek to understand the mystery behind our parents' bedroom door, but helps to understand a specific situation.
And this approach turned out to be very effective: “No other type of psychotherapy has such a scientific evidence base,” emphasizes psychotherapist Yakov Kochetkov.
He is referring to the study by psychologist Stefan Hofmann confirming the effectiveness of CBT methods 1 : extensive analysis of 269 articles, each of which, in turn, contains a review of hundreds of publications.
The cost of effectiveness
“Cognitive behavioral psychotherapy and psychoanalysis have traditionally been considered the two main areas of modern psychotherapy. So, in Germany, in order to obtain a state certificate of a psychotherapist with the right to pay through insurance cash desks, it is necessary to have basic training in one of them.
Gestalt therapy, psychodrama, systemic family therapy, despite their popularity, are still recognized only as types of additional specialization,” psychologists Alla Kholmogorova and Natalya Garanyan note 2 . In almost all developed countries, for insurers, psychotherapeutic assistance and cognitive-behavioral psychotherapy are almost synonymous.
If a person is afraid of heights, then during the course of therapy he will have to climb the balcony of a high-rise building more than once.
For insurance companies, the main arguments are scientifically proven effectiveness, a wide range of applications and a relatively short duration of therapy.
An amusing story is connected with the last circumstance. Aaron Beck said that when he started practicing CBT, he almost went bankrupt. Traditionally, psychotherapy lasted for a long time, but after a few sessions, many clients told Aaron Beck that their problems were successfully solved, and therefore they see no point in further work. The salaries of a psychotherapist have drastically decreased. nine0003
Questions for David Clark, Cognitive Therapist
You are considered one of the pioneers of CBT. What path did she take?
I think we could improve a lot. We have improved the system for measuring the effectiveness of therapy, we were able to understand which components are important in the first place. It was possible to expand the scope of CBT - after all, it was initially considered only as a method of working with depression.
Authorities and insurance companies are attracted by this therapy economically - a relatively short course brings a tangible effect. What are the benefits for clients? nine0068
Exactly the same! It quickly gives a positive result, allowing you not to spend money on trips to a therapist for many years. Imagine, 5-6 sessions in many cases is enough for a tangible effect. Moreover, often the most significant changes occur at the beginning of therapeutic work. This applies, for example, to depression, and in some cases to anxiety disorders.
This does not mean that the work has already been done, but the patient begins to experience relief in a very short time, and this is extremely important. In general, CBT is a very focused therapy. She does not set the task of improving the condition in general, she works with the specific problems of a particular client, whether it be stress, depression or something else. nine0003
How to choose a CBT therapist?
Find someone who has completed a certified, internationally recognized training program. And one where supervision is provided: the work of a therapist with an experienced colleague. You cannot become a psychotherapist by simply reading a book and deciding that you are ready.
Our research shows that supervised therapists are much more successful. Russian colleagues who started practicing CBT had to regularly travel to the West, because they could not undergo supervision in Russia. But now the best of them are themselves ready to become supervisors and help spread our method. nine0003
How to use
The duration of the CBT course may vary. “It is used both in the short term (15–20 sessions in the treatment of anxiety disorders) and in the long term (1–2 years in the case of personality disorders),” Alla Kholmogorova and Natalya Garanyan point out.
But on average, this is much less than, for example, a course in classical psychoanalysis. That can be perceived not only as a plus, but also as a minus.
CBT is often accused of superficial work, likening a painkiller pill that relieves symptoms without affecting the causes of the disease. “Modern cognitive therapy starts with symptoms,” explains Yakov Kochetkov. “But working with deep convictions also plays a big role. nine0003
It's just that we don't think they should be worked with for many years. The usual course is 15-20 meetings, not two weeks. And about half of the course is working with symptoms, and half is working with causes. In addition, working with symptoms also affects deep-seated beliefs.
If you need quick relief in a particular situation, then 9 out of 10 experts in Western countries will recommend CBT
This work, by the way, includes not only conversations with a therapist, but also a method of exposure. It lies in the controlled impact on the client of the very factors that serve as a source of problems. nine0003
For example, if a person is afraid of heights, then during the course of therapy he will have to climb the balcony of a high-rise building more than once. First, together with a therapist, and then independently, and each time to a higher floor.
Another myth apparently stems from the very name of therapy: as long as it works with consciousness, the therapist is a rational coach who does not show empathy and is not able to understand what concerns personal relationships.
This is incorrect. Cognitive therapy for couples, for example, in Germany is recognized as so effective that it has the status of a state program. nine0003
Many methods in one
“CBT is not universal, it does not displace or replace other methods of psychotherapy,” says Yakov Kochetkov. “Rather, she successfully uses the findings of other methods, each time verifying their effectiveness through scientific research. ”
CBT is not one but many therapies. And almost every disorder today has its own CBT methods. For example, schema therapy was invented for personality disorders. “Now CBT is successfully used in cases of psychoses and bipolar disorders,” continues Yakov Kochetkov. nine0003
- There are ideas borrowed from psychodynamic therapy. And recently, The Lancet published an article on the use of CBT for patients with schizophrenia who have refused to take medication. And even in this case, this method gives good results.
All this does not mean that CBT has finally established itself as "psychotherapy No. 1". She has many critics. However, if you need quick relief in a particular situation, then 9 out of 10 experts in Western countries will recommend contacting a cognitive-behavioral psychotherapist. nine0003
1 S. Hofmann et al. "The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses". Online publication in the journal Cognitive Therapy and Research dated 07/31/2012.
2 A. Kholmogorova, N. Garanyan "Cognitive-behavioral psychotherapy" (in the collection "The main directions of modern psychotherapy", Kogito-center, 2000).
Text: Yuri Zubtsov Photo credit: Getty Images
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Cognitive Behavioral Therapy | PSYCHOLOGIES
On November 1, 2021, Aaron Temkin Beck, an American psychotherapist, professor of psychiatry, who went down in history as the creator of the cognitive-behavioral direction in psychotherapy, died.
"The key to understanding and solving psychological problems lies in the patient's mind," said the psychotherapist. His groundbreaking approach to working with depression, phobias and anxiety disorders has shown good results in therapy with clients and has become popular with professionals around the world. nine0003
What is it?
This method of psychotherapy appeals to consciousness and helps to get rid of stereotypes and preconceived ideas that deprive us of freedom of choice and push us to act according to a pattern.
The method allows, if necessary, to correct the patient's unconscious, "automatic" conclusions. He perceives them as truth, but in reality they can greatly distort real events. These thoughts often become the source of painful emotions, inappropriate behavior, depression, anxiety disorders, and other illnesses. nine0003
How it works
Therapy is based on the joint work of the therapist and the patient. The therapist does not teach the patient how to think correctly, but together with him understands whether the habitual type of thinking helps him or hinders him. The key to success is the active participation of the patient, who will not only work in sessions, but also do homework.
If in the beginning the therapy focuses only on the symptoms and complaints of the patient, then gradually it begins to affect the unconscious areas of thinking - core beliefs, as well as childhood events that influenced their formation. The principle of feedback is important - the therapist constantly checks how the patient understands what is happening in therapy, and discusses possible errors with him. nine0003
Progress of work
The patient and the psychotherapist find out under what circumstances the problem manifests itself: how “automatic thoughts” arise and how they affect his ideas, experiences and behavior. In the first session, the therapist only listens carefully to the patient, and in the next they discuss in detail the patient's thoughts and behavior in numerous everyday situations: what does he think about when he wakes up? What about breakfast? The goal is to make a list of moments and situations that cause anxiety. nine0003
The therapist and patient then plan a program of work. It includes tasks to complete in places or circumstances that cause anxiety - take the elevator, eat dinner in a public place ... These exercises allow you to consolidate new skills and gradually change behavior. A person learns to be less rigid and categorical, to see different facets of a problem situation.
The therapist constantly asks questions and explains points that will help the patient understand the problem. Each session is different from the previous one, because each time the patient moves forward a little and gets used to living without the support of the therapist in accordance with new, more flexible views. nine0003
Instead of "reading" other people's thoughts, a person learns to distinguish his own, begins to behave differently, and as a result, his emotional state also changes. He calms down, feels more alive and free. He begins to be friends with himself and stops judging himself and other people.
When is it needed?
Cognitive therapy is effective for depression, panic attacks, social anxiety, obsessive-compulsive disorder and eating disorders. This method is also used to treat alcoholism, drug addiction and even schizophrenia (as a supportive method). At the same time, cognitive therapy is also suitable for dealing with low self-esteem, relationship difficulties, perfectionism, and procrastination. nine0003
It can be used both in individual work and in work with families. But it is not suitable for those patients who are not ready to take an active part in the work and expect the therapist to give advice or simply interpret what is happening.
How long should I have therapy? How much is it?
The number of meetings depends on the willingness of the client to work, the complexity of the problem and the conditions of his life. Each session lasts 50 minutes. The course of therapy is from 5-10 sessions 1-2 times a week. In some cases, therapy can last longer than six months.