Cognitive Behavioral Therapy: A Comprehensive Guide
For many people struggling with ADHD or other mental health challenges, therapy may be an effective tool. Cognitive behavioral therapy (CBT) is a widely recognized and effective form of psychotherapy that addresses unhelpful emotions, behaviors, and thoughts.
CBT can often produce quick results and help individuals cope with specific challenges in their lives. For example, CBT may be a useful therapy option if you struggle with challenges such as addiction, anxiety, and depression, among others. Although you may have a general idea about CBT, you might be curious about what it entails.
Continue reading to learn more about the key aspects, techniques, and advantages of CBT as a form of therapy.
Table of contents
What is Cognitive Behavioral Therapy (CBT)?
CBT is a structured short-term form of therapy that helps people identify how our thoughts, behaviors, and emotions are linked. A therapist trained in CBT can help people tackle various issues and achieve their treatment goals.
A Brief History of CBT
CBT first began as cognitive therapy. Cognitive Therapy is a type of psychological treatment that was developed in the 1960s by psychiatrist Aaron Beck. He noticed that his patients with depression often expressed thoughts that were not always valid and displayed a pattern of cognitive distortions in their thinking. This led him to hypothesize that depression could be better understood as a cognitive disorder rather than merely a mood disorder.
Other doctors and researchers became interested in this new treatment and started developing their own versions of CBT. As the various protocols and forms of cognitive therapy developed it was changed to Cognitive Behavioral Therapy and used to treat a variety of mental health challenges.
Various delivery methods for CBT are available
CBT has been adapted for use in group settings, self-help materials, and even online platforms, making it more accessible to a wider range of people. Today, CBT remains the most researched therapy type, offering evidence-based treatments for diverse mental health issues.
Key Principles and Concepts
CBT is based on the key principle that our thoughts, emotions, and behaviors are interconnected. In other words, changing one thought, emotion, or behavior can affect the others. Some core principles of CBT include:
We all have core beliefs, which are our deeply held beliefs about ourselves, the world, and other people
Certain negative thoughts about the world, also known as cognitive distortions, can distort our own reality. Some examples of cognitive distortions include all-or-nothing thinking, and “should” statements, like believing that you should never make mistakes
Exploring and becoming aware of the automatic thoughts that our minds generate based on our core beliefs can lead to major changes in our internal landscape.
A collaborative therapeutic relationship between the therapist and the client can be very important for change when sessions are conducted in-person
CBT should be structured with goal-oriented sessions with a limited number of meetings
CBT involves various steps and techniques that therapists and clients work through together in order to achieve their goals. From identifying problematic thoughts and behaviors to learning and practicing new, healthier ways of thinking, let’s go over what to expect when participating in CBT sessions.
The Process of CBT
The process of CBT typically begins with an initial visit, where the therapist and the client work together to identify the presenting problem, establish rapport and the therapist introduces the goals and theories associated with CBT. The goal is to help the client understand the therapeutic process and know what to expect in their sessions. Usually, you will provide some background before this session such as any medical records and intake forms. The therapist will then discuss your therapeutic plan, timeline, and together you will negotiate how sessions will be laid out. If you are attending CBT for specific issues, such as ADHD, your therapist will also go into detail about how CBT concepts apply to ADHD. After each CBT session you’ll be given a chance to give feedback to your therapist.
It can be helpful to bring a list of questions, concerns, and any relevant records to your first session to facilitate open communication and ensure your needs are met. Remember, building trust and a strong rapport with your therapist can help improve the success of CBT.
An important part of CBT is homework. Your therapist will give you homework assignments that help you gain awareness into your current habits and practice new ways of interacting with your world. Each session will include a review of the previous week’s homework.
As therapy goes on, the therapist helps the client develop new skills and an enhanced level of understanding and awareness into habits, core beliefs, and ways of thinking that are negatively impacting your wellbeing. Self-guided programs will use a similar structure but will not always include an opportunity for back and forth conversations. The skills developed through CBT can create long-lasting positive changes and enhanced coping abilities that improve quality of life.
What to Expect
CBT is a short-term treatment, with clients usually attending a limited number of sessions. Sessions are structured and involve setting goals, discussing thoughts and behaviors, and practicing coping strategies. As mentioned, you may be given homework assignments to help integrate the skills learned in therapy into everyday life.
CBT sessions usually last for around 30 to 60 minutes and typically include 12 to 20 sessions over several weeks. These sessions may vary depending on the individual’s needs, preferences, and treatment goals. A therapist will assess how CBT is working over time and make any adjustments as needed.
Personalized CBT for different needs
CBT is not a one-size-fits-all solution. Everyone's experiences, thoughts, and feelings are different. Therapists work closely with clients to make the therapy fit their specific needs, making sure it tackles the problems they face in a way that works for them. There are also different types of CBT that have been adapted specifically for different needs. For instance, Acceptance and Commitment Therapy (ACT) is a type of CBT that focuses more on embracing and accepting difficult thoughts and feelings rather than trying to modify them. ACT often works better for people who have differences in how their brains process emotions, such as in ADHD. Your therapist may even take an eclectic approach where they integrate techniques from different types of therapy in order to help you get the best results.
Who Can Benefit from CBT?
Cognitive behavioral therapy is a versatile treatment method that can help a range of different people facing various challenges. CBT may be useful for the following groups of people:
For neurodivergent individuals, such as those with attention deficit hyperactivity disorder (ADHD), CBT can assist in addressing challenges related to social skills, emotional regulation, and organizational abilities. In addition, CBT can help people develop healthy coping mechanisms and strategies to manage stress more effectively, leading to an overall improvement in their quality of life. Research shows that CBT can help create positive and long-lasting changes in adults with ADHD. Many therapists prefer to use a form of CBT known as Acceptance and Commitment Therapy with ADHD since it helps with issues such as emotional dysregulation.
People with anxiety disorders
People with anxiety disorders, such as general anxiety, social anxiety, and panic disorder, may also benefit from CBT. Through CBT, individuals can learn the tools to challenge and alter the thoughts and behaviors that may trigger or worsen their anxiety. For example, someone with social anxiety might practice facing feared situations and reevaluating their beliefs about others' judgments.
Individuals with depression
Another group of people that can benefit from CBT is individuals experiencing depression. CBT may help individuals identify and address negative thought patterns, which may improve mood and mental health. They may also learn behavioral activation techniques to increase engagement in enjoyable activities, boosting their mood. The benefits of CBT are most well established in people with depression and anxiety disorders.
People with PTSD
People living with post-traumatic stress disorder (PTSD) are another group that can benefit from CBT. The therapeutic process can help these individuals develop coping skills to effectively handle triggers and distressing emotions, such as grounding techniques during flashback episodes. CBT can also help weaken unhelpful associations between the trauma and activities of daily life that often causes a great deal of distress in PTSD. A form of CBT known as exposure therapy is considered the gold standard therapy for PTSD.
People struggling with substance use disorder
Similarly, people struggling with substance use disorder may also find CBT useful in breaking the cycle of addiction. They can learn to tackle the thoughts and behaviors that drive their substance use, such as identifying high-risk situations and developing alternative coping strategies.
Individuals with OCD
Individuals with obsessive-compulsive disorder (OCD) can also benefit from CBT by learning strategies to confront and manage their intrusive thoughts and compulsive behaviors. Since challenging difficult thoughts may not be overly helpful for OCD, a form of CBT known as exposure and response prevention (ERP) therapy is usually used for people with OCD.
Individuals and couples with relationship difficulties
CBT can also help those facing relationship difficulties by providing practical techniques to improve communication and resolve conflicts. For instance, couples might learn how to actively listen, express their needs, and develop problem-solving skills together.
The Effectiveness of CBT
Many studies have showcased CBT's success in treating diverse emotional and psychological issues. A meta-analysis published in the Journal of Psychology & Psychotherapy found that CBT was effective for treating the core and emotional symptoms of ADHD. Participants with ADHD who underwent CBT experienced an increase in self-esteem and quality of life, which shows benefits for people with ADHD who may also have depression and anxiety.
CBT can be effective through in-person and online therapy sessions. Online CBT, also known as iCBT has been found to be effective for an array of problems such as anxiety disorders, PTSD, as well as anxiety and depression. Interventions with iCBT in adhd can be more challenging due to adherence issues, so it is generally recommended that people with ADHD seek an in-person therapist or an iCBT program that includes accountability checks.
Although CBT has shown promising outcomes for numerous mental health concerns, it may not be effective for everyone. Factors such as personal motivation, therapeutic rapport, challenges with emotional dysregulation, and treatment adherence can impact the success of CBT. Nonetheless, the extensive research backing CBT's effectiveness makes it a highly recommended option for individuals seeking psychological help.
CBT with other forms of treatment
CBT is often used along with pharmacotherapy or medication. The combination of treatments can be useful for addressing different aspects of mental health problems, including cognitive, behavioral, and emotional symptoms. It’s important to consult a healthcare provider for guidance on combining therapies. Sometimes medication can be essential in reducing symptoms enough to get the most out of therapy.
How to Get Started with CBT
To get started with CBT, you’ll want to find a qualified therapist who specializes in this approach. You might look for recommendations from your primary care physician, friends, or family members who have experienced success with CBT.
Once you've found a therapist, it's important to prepare for your first session. During this initial meeting, your therapist will gather essential information about your mental health history and concerns. They will also discuss your goals and expectations for therapy.
Although CBT is traditionally conducted in an in-person setting, online therapy platforms are also available to help connect people with mental health professionals. Before starting CBT, you may want to get a formal diagnosis. Frida is an ADHD virtual clinic that offers diagnostic assessments and treatment options delivered by qualified specialists. If you’re suspected of having ADHD after a self-assessment, you can be matched with an expert who can recommend treatments, such as medication and therapy.
If you’re looking for support with CBT
As a client, you are expected to actively participate in the process, work as a team with your therapist, and be committed to practicing the strategies learned during your sessions. You may also consider supplementing your therapy with self-help techniques and resources. Numerous CBT worksheets, books, and mobile apps can be helpful tools for reinforcing the skills you learn during therapy.
What Are the 5 Stages of CBT?
CBT has a five stage model that consists of five interlinking parts.
Situation: The who, what, when, where and why element which looks at the environment and conditions that gave rise to your thought
Thought: The automatic thought that arose from the situation
Emotions: The feelings associated with the thought or interpretation
Physical state: The response in your body from the emotions such as hanging your head low if sad or clenching your jaw if upset.
Behavior: How you act due to the situation.
Intervening on any one of these areas can lead to positive benefits for the other areas.
How Does CBT Differ from Other Forms of Therapy?
CBT stands out because it focuses on finding and changing negative thought patterns and beliefs. Unlike other therapies, CBT is structured and goal-oriented, often leading to faster results and fewer sessions and involves a much more interactive experience with the therapist. While some therapies, like psychodynamic therapy, rely on the therapist gently guiding a person into self-exploration and insights, CBT is a collaborative problem-solving relationship between therapist and client that focuses on developing concrete skills for present-day challenges.
Is CBT for ADHD?
Yes, CBT can be a helpful treatment for people with ADHD. It works by using special techniques to help individuals overcome challenges like acting without thinking, staying organized, and managing time. CBT teaches ways to cope, problem-solve, and keep track of personal progress, which leads to improved focus and self-control. This helps those with ADHD to function better in their daily lives, be more productive, and feel better about themselves.
Who is CBT Not Recommended For?
CBT can be useful for many, but it might not work well for those who find it hard to think about their thoughts or don't want to change. If someone has trouble with self-reflection or isn't open to making changes, other types of therapy, like person-centered therapy or art therapy, could be a better match. These methods offer a supportive space to explore feelings and personal growth without putting as much emphasis on changing thought patterns as CBT does. Traditional CBT may also not be the best option for people with schizophrenia and certain personality disorders. Some experts also state that certain aspects of CBT such as challenging unhelpful thoughts in disorders like OCD and social anxiety may be ineffective. Finally, individuals who have a great deal of struggle with regulating their emotions may find that starting with a form of therapy that’s more focused on managing these emotions is essential before proceeding with CBT.
Can CBT Be Helpful for Individuals Without a Mental Health Diagnosis?
CBT can be helpful even for those without a mental health diagnosis who are dealing with issues like stress, relationship problems, big life changes, or even just general everyday life. CBT offers practical skills, like better communication, problem-solving, and managing stress. CBT also helps you identify maladaptive ways of interacting with your world that were developed in childhood, before you even had conscious thought. Learning to handle everyday challenges and tackle tough situations may help lead to a more balanced and enjoyable life.
How Long Does CBT Treatment Typically Last?
The length of CBT treatment can be different for everyone, but many people start feeling better within 12 to 20 sessions. How long it takes depends on things like how serious the problem is, how dedicated the person is to the therapy, and the therapist's particular methods. Sometimes, shorter or longer treatment might be needed to make sure the person gets the most out of therapy and experiences lasting improvements in their life. After your initial set of sessions, your therapist may schedule you for intermittent spaced out sessions for check-ins and any needed maintenance.
Can CBT Be Combined with Other Therapies or Medications?
Yes, CBT can work together with other therapies, such as group therapy, family therapy, and medications, to help treat many mental health issues. It's important to talk with a healthcare professional to figure out the best treatment plan for you. By combining different therapies and medication, treatment can be more effective, offering a well-rounded approach to mental health care and increasing the chances of improvement.