Cognitive and Behavioral Therapies: Learn It 2—Cognitive-Behavioral Therapy

Psychotherapy: Cognitive and Cognitive-Behavioral Therapy

cognitive therapy

Cognitive therapy is a form of psychotherapy that focuses on how a person’s thoughts lead to feelings of distress. The central idea is that how you think determines how you feel and act—it’s not situations themselves that cause distress, but rather our interpretation of those situations.

Cognitive therapists help clients identify and change cognitive distortions—systematic errors in thinking that maintain psychological problems. For example:

  • A student who fails one test might overgeneralize, thinking “I’m stupid and worthless”
  • Someone who makes one mistake at work might catastrophize, concluding “I’m going to get fired”

Cognitive therapy was developed by psychiatrist Aaron Beck in the 1960s, initially focusing on depression. Beck observed that depressed patients often had self-defeating thought patterns that maintained their depression despite positive events in their lives.

Two three-stage flowcharts showing two reactions to failing a test. The first flowchart flows from “Failed test” to “Internal beliefs: I’m worthless and stupid” to “Depression.” The second flowchart flows from “Failed test” to “Internal beliefs: I’m smart, but I didn’t study for this test. I can do better.” to “No depression.”
Figure 1. Your emotional reactions are the result of your thoughts about the situation rather than the situation itself. For instance, if you consistently interpret events and emotions around the themes of loss and defeat, then you are likely to be depressed. Through therapy, you can learn more logical ways to interpret situations.

Cognitive-Behavioral Therapy (CBT)

During the 1980s and 1990s, cognitive and behavioral techniques merged into cognitive-behavioral therapy (CBT). CBT has become one of the most widely researched and practiced forms of psychotherapy, with hundreds of studies demonstrating its effectiveness across numerous conditions.

cognitive-behavioral therapy

CBT helps clients examine how their thoughts affect their behavior and aims to change both cognitive distortions and self-defeating behaviors. A fundamental technique is cognitive restructuring (or reappraisal)—learning to identify maladaptive thoughts and replace them with more balanced, adaptive ones.

For example, if it’s your first time meeting new people, you may have the automatic thought, “These people won’t like me because I have nothing interesting to share.” That thought itself is not what’s troublesome; the appraisal (or evaluation) that it might have merit is what’s troublesome. The goal of CBT is to help people make adaptive, instead of maladaptive, appraisals (e.g., “I do know interesting things!”). With cognitive restructuring, it is the therapist’s job to help point out when a person has an inaccurate or maladaptive thought, so that the patient can either eliminate it or modify it to be more adaptive. In essence, this approach is designed to change the way people think as well as how they act.

The ABC Model

CBT often uses the ABC model to understand the relationship between events, thoughts, and emotions:

  • Action (or Activating event): Something happens
  • Belief about the event: How you interpret what happened
  • Consequences: The emotional and behavioral results of your belief

Let’s say that Jon and Rodrigo both attend a party where they are hopeful about meeting a significant other. They both get rejected, even after having a nice conversation with people they are interested in.

Let’s say Jon tells himself he is a loser, or is ugly, or “has no game.” Jon then gets depressed and decides not to go to another party, which starts a cycle that keeps him depressed. Rodrigo tells himself that he had bad breath, goes out and buys some gum, goes to another party, and meets someone new.

Jon’s belief about what happened results in a consequence of further depression, whereas Rodrigo’s belief does not. Jon is internalizing the attribution or reason for the rebuffs, which triggers his depression. On the other hand, Rodrigo is externalizing the cause, so his thinking does not contribute to feelings of depression.

Cognitive Distortions

Cognitive-behavioral therapy examines specific maladaptive and automatic thoughts and cognitive distortions. Some examples include:

overgeneralization

In overgeneralization, someone takes a small situation and makes it huge—for example, instead of saying, “This particular woman was not interested in me,” the man says, “I am ugly, a loser, and no one is ever going to be interested in me.” Or “I failed one test, so I’m going to fail everything.”

all-or-nothing thinking

All-or-nothing thinking, which is a common type of cognitive distortion for people suffering from depression, reflects extremes. In other words, everything is on or off, black or white, yes or no. After being turned down for a date, Jon begins to think, “No woman will ever go out with me. I’m going to be alone forever.” He begins to feel anxious and sad as he contemplates his future. In other words, “”If I’m not perfect, I’m a total failure.”

jumping to conclusions

The third kind of distortion involves jumping to conclusions—assuming that people are thinking negatively about you or reacting negatively to you, even though there is no evidence.

Consider the example of Savannah and Hillaire, who recently met at a party. They have a lot in common, and Savannah thinks they could become friends. She calls Hillaire to invite her for coffee. Since Hillaire doesn’t answer, Savannah leaves her a message. Several days go by and Savannah never hears back from her potential new friend. Maybe Hillaire never received the message because she lost her phone or she is too busy to return the phone call. But if Savannah believes that Hillaire didn’t like Savannah or didn’t want to be her friend, she is demonstrating the cognitive distortion of jumping to conclusions.

catastrophizing

Catastrophizing is expecting the worst possible outcome. For example, it’s thinking that “If I make a mistake in this presentation, my career is over.”

 

How effective is CBT?

CBT has one of the strongest evidence bases of any psychotherapy. Hundreds of randomized controlled trials have demonstrated its effectiveness for depression, anxiety disorders, PTSD, eating disorders, substance use disorders, and many other conditions (Hofmann et al., 2012).

One client said this about his cognitive-behavioral therapy:

I have had many painful episodes of depression in my life, and this has had a negative effect on my career and has put considerable strain on my friends and family. The treatments I have received, such as taking antidepressants and psychodynamic counseling, have helped [me] to cope with the symptoms and to get some insights into the roots of my problems. CBT has been by far the most useful approach I have found in tackling these mood problems. It has raised my awareness of how my thoughts impact on my moods. How the way I think about myself, about others and about the world can lead me into depression. It is a practical approach, which does not dwell so much on childhood experiences, whilst acknowledging that it was then that these patterns were learned. It looks at what is happening now, and gives tools to manage these moods on a daily basis. (Martin, 2007)

A large 2025 study across 29 university outpatient clinics in Germany found that CBT was effective across diverse clinical diagnoses, supporting its use in real-world clinical practice. Research also shows that CBT can be delivered effectively through telehealth and digital platforms, making it more accessible.

Recent developments include “third-wave” CBT approaches such as:

  • Dialectical Behavior Therapy (DBT): Emphasizes emotion regulation and interpersonal skills
  • Acceptance and Commitment Therapy (ACT): Focuses on accepting difficult thoughts rather than fighting them
  • Mindfulness-Based Cognitive Therapy (MBCT): Combines CBT with mindfulness practices