Cognitive behavioral therapy

Cognitive behavioral therapy is not one fixed procedure but a group of related, evidence-based psychological treatments. A central idea is that thoughts, beliefs, emotions, bodily responses and behavior can influence one another. For example, interpreting a difficult situation in a particular way may affect how a person feels and what they do next; changing an unhelpful response can, in turn, alter how that situation is experienced.

CBT usually focuses on specific problems in a person's current life, while personal history can help explain how patterns developed. The therapist and client work collaboratively to define goals and choose methods suited to the problem. CBT does not assume that every distressing thought is inaccurate or that all difficulties can be solved by changing thought alone; social circumstances, physical health and other treatments may also matter.

A course often uses a structured sequence of sessions, but its length and content vary with the condition, goals and delivery format. Common methods include noticing and re-examining unhelpful interpretations, solving practical problems, learning coping or relaxation skills, and approaching situations that have been avoided. Some approaches include keeping records or practising skills between sessions. These exercises are intended to help people use strategies outside therapy as well as during appointments; not every course uses every method.

CBT can be provided one-to-one, in a group, or through guided self-help and digital programmes. National Institute for Health and Care Excellence (NICE) guidance for adult depression, for example, describes individual CBT, group CBT and structured guided self-help among treatment options. The specific format and number of sessions depend on clinical needs and the service providing care.

CBT is used in treatment for several conditions, including depression, anxiety disorders and post-traumatic stress disorder; specific CBT-based approaches are also used for problems such as obsessive-compulsive disorder, eating disorders and substance use. Some health services use CBT-based methods for sleep difficulties, chronic pain or other problems. These uses are not interchangeable: techniques, treatment aims and the evidence supporting them differ by diagnosis and protocol.

Guidelines generally situate CBT within a wider assessment of care rather than treating it as the only possible intervention. Depending on a person's circumstances and the condition being treated, care may involve another psychological approach, medication, or a combination. Decisions are made in the context of professional assessment, preferences and available services.

CBT has been tested extensively, but evidence should be read in relation to the condition and the comparison being studied. A 2023 comprehensive meta-analysis examined 409 trials of CBT for depression involving 52,702 participants. It reported a moderate-to-large average benefit compared with control conditions. The researchers also found substantial variation among studies; the small apparent advantage over other psychotherapies was not robust in most sensitivity analyses. Results from depression trials do not by themselves establish how CBT performs for every diagnosis or individual.

Like other forms of treatment, CBT may not help everyone, and its effects can depend on the therapeutic approach, access to a trained provider, the person's needs and the quality of the evidence. Its practical, collaborative style and emphasis on skills are central features, but they should not be confused with a promise of quick or certain improvement.