What is cognitive behavioral psychotherapy

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:

  • Depression
  • Anxiety disorders
  • Phobias
  • PTSD
  • Sleep disorders
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Substance use disorders
  • Bipolar disorders
  • Schizophrenia
  • 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.

Check qualifications

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.

During 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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Cognitive behavioral therapy - InformedHealth.org

Created: August 7, 2013; Last Update: September 8, 2016; Next update: 2022.

Cognitive behavioral therapy (CBT) is one of the most common and best studied forms of psychotherapy. It is a combination of two therapeutic approaches, known as cognitive therapy and behavioral therapy.

Which methods of treatment are applied depends on the illness or problem to be treated. The basic principle behind therapy is however always the same: What we think, how we feel and how we behave are all closely connected – and all of these factors have a decisive influence on our well-being.


What is cognitive therapy?

The term cognitive comes from the Latin "cognoscere", meaning "to recognize. " The point of cognitive therapy is to form a clear idea of your own thoughts, attitudes and expectations. The goal is to reveal and change false and distressing beliefs, because it is often not only the things and situations themselves that cause problems, but the importance that we attach to them too.

For example, a dangerous thought pattern might be when somebody immediately draws negative conclusions from an occurrence, generalizes them and applies them to similar situations. In psychology, this generalized way of thinking is called “over-generalizing.” Another distressing error in reasoning is “catastrophizing”: If something disturbing happens, people immediately draw exaggerated conclusions about the scope of the supposed disaster ahead.

Such thought patterns can sometimes develop into self-fulfilling prophecies and make life difficult for the people affected. Cognitive therapy helps people learn to replace these thought patterns with more realistic and less harmful thoughts. It also helps people to think more clearly and to control their own thoughts better.

How does behavioral therapy work?

Behavioral therapy has its origins in American “behaviorism.” This theory assumes that human behavior is learned and can therefore be unlearned or learned anew. Behavioral therapy aims to find out whether certain behavioral patterns make your life difficult or intensify your problems. In the second step you work on changing these behavioral habits.

For example, people who have developed depressive thoughts often tend to withdraw and give up their hobbies. As a result, they feel even more unhappy and isolated. Cognitive therapy helps to identify this mechanism and find ways to become more active again.

In anxiety disorders, behavioral therapy often includes learning methods to help you calm down. For example, you can learn to reduce anxiety by consciously breathing in and out deeply so that your body and breathing can relax. When doing this you concentrate on your breathing instead of what is bringing on your anxiety. These kinds of techniques can help you to calm down instead of getting all worked up with anxiety.

By the way, in Germany, most psychotherapists who are trained in cognitive behavioral therapy call themselves behavioral therapists.

Which thought and behavioral patterns are harmful, which are not?

Harmful thoughts or behavioral habits can make people feel bad about themselves. For example: You see somebody you know on the street and say hello, but they do not say hello back. Your own reaction to that very much depends on how you assess the situation:

Thoughts“He ignored me – he doesn’t like me anymore.”“He didn't notice me – maybe he doesn’t feel well. I should give him a call and find out how he is doing.”
FeelingsSomeone who thinks like this feels down, sad and rejected.These thought patterns do not cause any negative feelings.
BehaviorThe consequence of this thought is to avoid this person in the future, although the assumption could be completely false.This thought is a prompt to get back in touch with the person to find out if everything is all right.

How is cognitive behavioral therapy different from other psychotherapies?

Cognitive behavioral therapy is a problem-oriented strategy. It focuses on current problems and finding solutions for them. Unlike psychoanalysis, for example, it does not deal primarily with the past. Cognitive behavioral therapy is much more concerned with dealing with current problems. The most important thing is helping people to help themselves: They should be able to cope with their lives again without therapy as soon as possible. This does not mean that cognitive behavioral therapy completely ignores the influence of past events. But it mainly deals with identifying and changing current distressing thought and behavioral patterns.

Analytic psychotherapy, which has its origin in classic Freudian psychoanalysis, uses different methods. Here the therapist tries to help the patient discover and understand problems and their deeper causes.

When is cognitive behavioral therapy an option?

Cognitive behavioral therapy is used to treat conditions such as depression, anxiety and obsessive-compulsive disorders, and addictions. But it is also an option for treating physical conditions such as chronic pain, tinnitus and rheumatism. It can help to relieve the symptoms.

Cognitive behavioral therapy requires the patient's commitment and own initiative. Therapy can only be successful if the patient actively takes part in the treatment and also works on their problems between sessions. This can be a considerable challenge, especially with severe conditions such as depression or anxiety disorders. That is why medication is sometimes used at first to quickly relieve the worst symptoms so that psychotherapy can be started.

Choosing a certain kind of psychotherapy also depends on the goals. If you feel the need for deep insight into the causes of your problems, cognitive behavioral therapy is probably not the right choice. It is particularly useful if you are mainly interested in tackling specific problems and are only secondarily concerned with the “why.”

How does cognitive behavioral therapy work and how long does it take?

It is important that you and your psychotherapist have a close and trusting working relationship. It can sometimes take a while to find the right therapist.

In the first session, you will briefly explain your current problems and outline your expectations. That forms the basis for discussing the goals of therapy and the therapy plan. The plan can be adjusted if your personal goals change over the course of therapy.

Therapy often includes recording your own thoughts in a journal over a certain period of time. The therapist will then check the following things with you: Do I perceive things appropriately and realistically? What happens if I behave differently than I normally do in a certain situation? You will regularly discuss any problems you may have and progress that you have made.

Cognitive behavioral therapy also uses relaxation exercises, stress and pain relief methods, and certain problem-solving strategies.

Compared to analytical psychotherapy approaches, cognitive behavioral therapy is a short-term treatment. But there is also no standard length of cognitive behavioral therapy. Some people already feel much better after a few sessions, while others need treatment for several months. This depends on the kind and severity of the problems, among other things. An individual session lasts about an hour. Sessions usually take place once a week. Cognitive behavioral therapy is offered in psychotherapy practices, hospitals and rehabilitation clinics. It is sometimes also offered as group therapy.

Can cognitive behavioral therapy also have side effects?

Side effects resulting from psychotherapy cannot be ruled out. Being directly confronted with your problems or anxieties may be very stressful at first, and relationships might also suffer as a result. It is crucial to speak openly with your psychotherapist if any difficulties come up during therapy.

Hardly any research has been done on possible side effects of psychotherapy.

Who covers the costs?

In Germany, statutory health insurance pays for cognitive behavioral therapy to treat mental illnesses such as depression, anxiety or obsessive-compulsive disorders as well as addictions. The costs of cognitive behavioral therapy can also be covered for the treatment of severe symptoms that result from a chronic illness. It can however sometimes take several weeks or months until you can see a therapist or until the insurance company approves therapy.

In Germany, a psychotherapy practice can bill the statutory health insurance company directly for up to five trial sessions. This way you can get to know the psychotherapist, find out what the problems are and whether therapy is worthwhile. After the trial sessions, you and your psychotherapist have to prepare an application explaining why therapy is needed. You have to submit this application to your health insurance company before therapy can begin. Besides this application, your health insurance company also requires a medical report from your doctor stating that the symptoms are not caused by a physical problem, and that there are no medical reasons against psychotherapy. The statutory health insurance company decides whether to approve therapy based on an evaluation.


  • Robert Koch Institute (RKI). Psychotherapeutic healthcare. Berlin: RKI; 2008. (Federal Health Reporting, Booklet 41).

  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Cognitive behavioral therapy (CBT) what is it?

Psychotherapist Seregin Dmitry Alekseevich told about what cognitive-behavioral therapy is, how one can prepare for it and what can be done to achieve good results in therapy.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) helps people identify and change ineffective habits related to thinking, behavior, relationships with others and replace them with more beneficial ones. CBT works well in the treatment of anxiety and depression, for example, by helping you recognize and address negative thoughts and behaviors that make depression worse and stop them.
Benefits of CBT:

  • Cognitive therapy is one of the few forms of psychotherapy that has been found effective in hundreds of clinical trials for a wide variety of disorders.
  • CBT, unlike other forms of psychotherapy, is more specific, focused not on past traumas, but on current problems and ways to solve them. The patient is practicing new skills in real situations that he is facing right now.
  • The skills that the patient learns during the sessions, he can subsequently use on his own so that the condition does not recur.
  • CBT is a faster method than others. Sometimes 6-8 meetings are enough for the state to change for the better.

What is CBT based on?

It is based on a cognitive model that our emotions are influenced not only by the situation itself, but also to a large extent by how we perceive it. Often a negative way of perceiving reality becomes habitual, stereotyped. A person, experiencing another trouble, automatically thinks something like: “I never succeed,” and this, like a vicious circle, intensifies negative emotions, makes the mood even worse and reduces the ability to approach the situation constructively.

In fact, “it never works out” is not a reality, but a harmful cognitive distortion, a generalization.
Cognitive therapy helps to assess how realistic we think, identify distortions and learn how to correct them. When thinking becomes more realistic, the patient feels better, and it becomes easier for him to change his behavior and actively solve problems.

How to prepare for the first session of psychotherapy?

It is always easier to start if the patient has previously defined the goals of therapy. Think:

  • What is your goal, what would you like to change at work, in your personal life, relationships?
  • What symptoms, bad habits do you want to eliminate?
  • What useful habits, skills would you like to acquire?

At the first session, the psychotherapist will help you evaluate and clarify these goals, set priorities.
Before the session, the therapist may ask you to take experimental psychological tests to assess your mood. Test results will help you and your therapist objectively evaluate your progress.
Collaboration will then begin, which combines discussing and solving the issues you have on the agenda together and assessing the accuracy of your thoughts and beliefs about them. In the future, in the course of psychotherapy, the patient learns new skills. At each session, we check together how you feel compared to the previous weeks.

How long does a psychotherapy course last?

As a rule, it becomes clear in 1-2 sessions. The decision is made jointly depending on the patient's condition and the tasks set. Some patients stay in psychotherapy for only a short time, six to eight sessions. Others may wish to continue therapy for several months.

How often do you need to come?

Patients in acute crisis come twice a week, the usual frequency is once a week. Toward the end of the course, when the patient feels better, we arrange more rare meetings - there is a "narrowing" of sessions, when the patient comes every two, and then every three weeks. This "narrowing" allows you to practice the acquired skills, occasionally checking them with a psychotherapist.

How can I prepare for therapy sessions?

You can supplement psychotherapy by reading books on cognitive therapy that I can recommend, doing tasks in workbooks, brochures.
You can also reflect on what you learned in the previous session, write down everything you would like to discuss in the next session.
It is better to use the acquired skills in practice and analyze the difficulties encountered, and then discuss this with the therapist.

"When will I get better?"

This usually happens by 3-4 sessions if you visit them and follow the recommended appointments. You will notice an improvement both subjectively and in the tests we will run.

Cognitive Behavioral Therapy (CBT) or Cognitive Behavioral Psychotherapy (CBT)


We tell you how one of the most popular psychotherapy methods works, which allows you to correct thinking and emotional reactions.




Behaviorism and cognitivism

Basic concepts

Techniques and exercises

When will CBT help?

Course duration

Evidence-based medicine and CBT

Medical therapy and CBT

Case studies

What to read

What is CBT?

Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions.

From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.

Behaviorism and cognitivism

The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee. As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved.

Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect.

“Cognitions are, in principle, all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs. Dysfunctional and maladaptive views make it difficult to adequately assess life situations. Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems.

Anastasia Afanasyeva, Psychotherapist KPT:

Historically, the development of KPT is divided into 4 waves:

The first wave

Behavioral therapy

Second wave

Classical approach of CBT and rational-emotional psychotherapy

Third wave

Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)

The fourth wave

The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications

In 1913, the American psychologist John Watson publishes the first articles on behaviorism. He urges colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process.

In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.

Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.

Historical reference

Basic concepts: automatic thoughts, cognitive distortions

Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment. Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel.

“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear. Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career.

Anastasia Afanasyeva, psychotherapist CBT:

Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:


“I never have relationships”, “I always spoil everything”, “I always have bad luck”. A person carries over the characteristics of a single incident for the rest of his life.


“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.


“I owe”, “They owe me”, “Everything should have turned out this way, and not otherwise. Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account.


“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.

The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.

Techniques and exercises

One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.

An example of what columns a CBT diary can contain. Each therapist offers his own diary system.

“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.”

Anastasia Afanasyeva, CBT psychotherapist:

Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.

For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it.

When will CBT help?

The effectiveness of the CPT was proved for the following states:

All types of phobia


Panic disorder and panic attacks


Sleep disorders

Obsession-compulsive disorders (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals

Psychosomatic disorders

irritable intestine, headaches and other

post -traumatic stress disorder

Eating disorders

Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations

Dependencies 9000

Physical and physical mental

Aggressive behavior

CBT in panic attacks

Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.

A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.

“Panic attacks can happen in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist.

Anastasia Afanasyeva, psychotherapist CBT:

The exposure technique mentioned above is very well the main tool for working with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.

“First, there is a stage of psychoeducation: we tell what happens in the patient's body at the time of the attack. We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears.

Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.

The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition. "

Anastasia Afanasyeva, psychotherapist CBT:

Duration of the course

CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work.

Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.

« Terms are always individual and depend on the severity of the condition. For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder.

As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.

Anastasia Afanasyeva, CBT psychotherapist:

Evidence-based medicine and CBT

Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy. In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here.

1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).

Medication and CBT

There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression. However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression.

« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.

If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.”

Anastasia Afanasyeva, psychotherapist CBT:

Case studies

“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite . In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be".

During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.

Anastasia Afanasyeva, psychotherapist CBT:

What to read?

Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning

This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT.

Learn more