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Cognitive Behavior Therapy


Updated November 21, 2012

Cognitive behavior therapy is often used to help people with their PTSD, as well as a number of other psychological problems. So what exactly is cognitive-behavioral therapy?

The Basis for CBT

A cognitive-behavioral treatment is one that is based on the idea that psychological problems arise as a result of the way in which we interpret or evaluate situations, thoughts, and feelings, as well as our behaviors.

A Cognitive-Behavioral View of How Problems Develop

Let's say a spider bit you when you were a kid, and because of this, you think that all spiders are dangerous. By viewing all spiders this way, you likely would experience anxiety and fear whenever you came into contact with a spider, no matter how big or small it was.

Because of this fear, you may then take steps to avoid spiders. Now, you might be able to lead a very happy life by avoiding all contact with spiders. However, sometimes there are things that we cannot avoid so easily.

For example, say you are invited to a picnic by some friends you have not seen for some time. Unfortunately though, the picnic is being held in a wooded area where there may be spiders. You are worried that a spider may bite you so you decide not to go to the picnic. This makes you feel sad and down. This is an example of how fear and avoidance can interfere with living a fulfilling and positive life.

Sometimes even the thought of something we fear can bring about anxiety. Using the spider example again, let's say that someone who fears spiders hears a story about another person who was bitten by a spider while sleeping.

The person who fears spiders may then begin to worry about going to sleep at night. The person may imagine what it would be like to have a spider bite them and all the negative things that could happen as a result.

Worries like these can be quite taxing, and unfortunately, we really cannot avoid our thoughts. Yet, people still try hard to do so. Some people may simply try to distract themselves from their thoughts, such as by reading a book. This is not such a bad coping strategy and may be successful if the thoughts are not that distressing.

However, this may not work so well for thoughts or memories that are upsetting like those that occur in PTSD. People with PTSD may try more extreme strategies such as drinking or using drugs. Using substances may help someone forget about something briefly. But in the end, the thoughts just return and usually more intensely. In addition, the substance use will just cause a whole host of other problems.

The Goal of CBT

The goal of CBT, then, is to help people learn healthier ways of coping with distressing thoughts, as well as reducing avoidance or other problematic behaviors (like substance use).

The idea is that if someone can change how they evaluate their environment or thoughts and feelings, anxiety and avoidance may be reduced, improving a person's mood and overall quality of life.

How Is This Done in CBT?

A number of techniques may be used by a cognitive-behavioral therapist. Some common techniques are:

  • self-monitoring

  • cognitive restructuring

  • behavioral experiments

These techniques are all briefly reviewed below.


The therapist may first have the patient track (or monitor) their thoughts. The therapist may have the patient write down the thoughts they have in response to certain situations, especially those that bring about anxiety or another upsetting feeling. This helps the patient become more aware of how they evaluate their experience and the consequences of these evaluations, such as anxiety.

Cognitive Restructuring

Once these evaluations are identified, the therapist may then help the patient gather evidence for and against these evaluations. This process is called cognitive restructuring.

Through cognitive restructuring, the person may realize that their evaluations or interpretations of situations are not entirely accurate. They may also realize that, although thoughts often feel true, they are rarely based in fact.

For example, the person who fears spiders may realize that it is actually quite rare for spiders to bite you and, in fact, many spiders are not dangerous. This realization will lead to lower levels of anxiety. In addition, by realizing that spiders are not really as dangerous as once thought, the person may be less likely to avoid situations, such as the picnic.

Behavioral Experiments

Finally, the therapist will often ask the patient to take part in behavioral experiments. This involves having the patient "test out" these new ways of looking at the world by going into situations where he or she may contact something that was once feared.

By encountering something that was once feared (such as a spider) and not experiencing any negative outcomes (such as being bitten), the person will have even more evidence that their previous thoughts were not so accurate.

Who Can Cognitive-Behavioral Therapy Help?

CBT has been found to be successful in treating a range of problems, such as anxiety disorders, depression, eating disorders, and alcohol and drug use problems (Barlow, 2001). However, CBT may not be for everyone.

The sessions in CBT are generally quite structured. There are usually specific goals for each session, and the therapist will structure the session so as to meet those goals. Some people may like this structure. Other people who are looking to do more self-exploration in therapy may not like the structured sessions of CBT.

Many cognitive-behavioral treatments are also time-limited. The treatment may only last a certain number of weeks, after which the patient is expected to have gained enough skills to continue the work on their own. This works well for people who have one specific issue they would like to address. However, the short-term focus of some cognitive-behavioral treatments may not meet the needs of people looking for longer-term support.

It is important to shop around and learn as much as you can about the different types of treatments that are available. In doing so, you can find the one that best suits your needs. You can also learn more about cognitive behavioral treatments for PTSD that have support in reducing the symptoms of PTSD (such as Prolonged Exposure, Cognitive Processing Therapy, and Seeking Safety) at the American Psychological Association.


Barlow, D.H. (2001). Clinical handbook of psychological disorders. New York, NY: Guilford Press.

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