Definition
Cognitive-behavioral therapy (CBT) is a form of talk therapy. This means that you discuss your thoughts, feelings, and behaviors with a mental health professional. CBT focuses on how the way you think affects the way you feel and act.

A situation may be perceived in a positive way by one person, enhancing his/her well-being. Another person may perceive it in a negative way, contributing to feelings of sadness or anxiety. Your therapist helps you identify negative thoughts and evaluates how realistic these thoughts are. Then, he or she teaches you to unlearn negative thought patterns and learn new, helpful ones.

CBT is a problem-solving approach. While you cannot control other people or situations, you can control the way you perceive and react to a particular situation. CBT teaches you the skills to change your thinking and manage your reactions to stressful people and situations.

Reasons for Procedure
CBT is used to treat many health concerns. These include:

• Major depressive disorder and mood swings
• Anxiety disorders, including social anxiety disorder and generalized anxiety disorder, which includes feelings of extreme shyness and/or excessive worry
• Managing stress
• Panic disorders
• Phobias
• Posttraumatic stress disorder (PTSD)
• Childhood depressive and anxiety disorders
• Obsessive-compulsive disorder (OCD)
• Eating disorders, including anorexia nervosa, bulimia nervosa, and obesity
• Insomnia and other sleep disorders
• Substance abuse or substance dependence
• Maladaptive styles of relating to others including enabling, passive aggression, or codependency
• Chronic pain
• Difficulty with relationships
• Low self-esteem
• Poor coping skills
• Uncontrolled anger

Managing Mental Health Concerns
Many mental health concerns are caused by a combination of physiological and emotional triggers. CBT can help patients cope by decreasing the effects of emotional triggers.

What to Expect

Prior to Procedure
There is no specific preparation for CBT. You may be asked to fill out a questionnaire about your feelings.

Description of the Procedure
You may receive CBT in one-on-one therapy sessions or in a group format. CBT can be divided into two parts: functional analysis and skills training.

Functional Analysis
In functional analysis, you and your therapist identify stressful situations. You also determine the thoughts that lead to or worsen these situations. These thoughts are then analyzed to see if they are realistic and appropriate. For example, your therapist may point out negative thought patterns, such as, “I can’t handle this” or "People are laughing at me.”

Skills Training
Next, through skills training, your therapist guides you to reduce unhealthy ways of thinking, and to learn healthier ways. Instead of thinking “I can’t handle this,” you will learn to draw on your strengths: “I’ve handled difficult situations before, so I can handle this one.”

You’ll also learn to ask more questions about yourself before making a conclusion. For example, “Could those people be laughing at something other than me?” The goal is to replace irrational thought patterns with more appropriate and rational ones.

Skills training takes a lot of practice, which is often given as homework. You might practice deep-breathing exercises or role-play how to act in certain social situations. A person dealing with substance abuse might practice ways to decline an alcoholic drink.

Homework is vital to the success of CBT. You must practice new, rational responses until they replace your previous, unhealthy responses. Homework also allows you to try new skills and give feedback to your therapist on which works best for you.

How Long Will It Take?
The length of an individual session is usually 50-100 minutes. Group sessions may last longer. Treatment sessions may occur 1-2 times per week for 12-16 weeks.

This is a general guideline and depending on your situation, treatment may be longer or shorter. Keep in mind it may take several tries to unlearn poor habits and to learn healthier ones.

Possible Complications
There are no known complications of CBT for patients.

Post-therapy Care
You may be given homework between sessions. You’ll need to practice the strategies you and your therapist have discussed.

Some therapists advise that you return for a check-up about 3, 6, and 12 months after therapy has ended. In addition, you may call your therapist whenever the need arises.

Outcome
The goal of CBT is to change your thought process and unhealthy thought patterns. This will allow healthy and realistic responses to difficult situations. Many patients notice an improvement in their symptoms within 3-4 weeks of beginning CBT and doing their homework.

Call Your Doctor
If the thoughts, feelings, or other difficulties that led you to seek therapy are returning or worsening, call your doctor. If you have thoughts of hurting yourself or others, call your doctor or 911 immediately.