Trying to change bad habits or dark thoughts? You may benefit from CBT, the therapy 'gold standard'

• Experts consider CBT the "gold standard" treatment because it can treat many different concerns.
• CBT teaches you to identify and challenge negative thoughts that affect your mood and hold you back.

Cognitive behavioral therapy (CBT) is based on the idea that your thoughts can have a significant impact on your mood and emotions. In other words, if you can break unwanted or unhelpful thought patterns, you can change the way you feel and behave.

Psychiatrist Aaron Beck developed CBT in the 1960s as a treatment for depression. Beck noticed people with depression often presented with cognitive distortions, or negatively biased and often inaccurate thought patterns about themselves, others, and the world.

CBT is largely considered the gold standard of psychotherapy — not only because there's a wealth of research supporting its benefits, but also because it can treat a wide variety of concerns beyond depression, including:

• Eating disorders
• Anxiety disorders
• Personality disorders
• Substance use disorders

Here's what to know about the benefits of CBT, what to expect from sessions, and how to try it.

Who can benefit from CBT?

CBT may prove helpful:

• If you have depression: A 2021 review found CBT was more effective for treating depression symptoms than no treatment at all — and just as effective as taking antidepressants.
• If you have anxiety: CBT can help people challenge catastrophic thinking and other beliefs that drive or worsen anxiety, says Laurel Steinberg, a licensed psychologist in private practice. A 2019 review linked CBT to lower anxiety symptoms within 12 months after treatment in people with any anxiety disorder.
• If you live with chronic pain: CBT can help people with chronic pain reframe their mindset about pain, put it into perspective, and work toward acceptance, says Joshua Klapow, a clinical psychologist in private practice and creator of Mental Drive. A 2015 review found CBT helped reduce the intensity of pain in 43% of studies examined.
• If you have post-traumatic stress disorder (PTSD): CBT can help improve PTSD symptoms for veterans, refugees, and survivors of natural disasters and sexual assault. A 2018 review found CBT more effectively improved PTSD symptoms than supportive therapy, self-help booklets, or no treatment. After CBT treatment, 61%-82% of participants no longer met the criteria for PTSD.
• If you have an eating disorder: CBT can help unravel cognitive distortions that contribute to disordered eating behaviors. A 2018 review found CBT was an effective treatment for eating disorders — especially bulimia nervosa and binge eating disorder — and these benefits persisted at 3-6 month follow-ups.
• If you have a substance use disorder (SUD): A 2021 review found CBT effectively helped treat dependence on alcohol, marijuana, cocaine, and opioids. CBT didn't just help reduce cravings and substance use. It also helped lessen other symptoms like extreme mood swings and anxiety.
• If you experience relationship conflict: CBT may help you get along better with others, according to Steinberg, because it can challenge distorted thought patterns that contribute to relationship tension and disagreements. A 2018 study found that after women who felt unhappy in their marriages attended four 90-minute sessions of CBT, their reported marital quality significantly increased.

It's worth noting that CBT also translates well to virtual sessions, according to Meagan Turner, a licensed associate professional counselor at Emerge Counseling at Compassion Cove.

A 2017 review found Internet-based CBT effective in the treatment of:

• Depression
• Social anxiety disorder and general anxiety disorder
• Phobias
• Substance use disorders
• Bipolar disorder
• OCD
• Panic disorder

CBT basics

According to CBT theory, fixed patterns of thinking can negatively affect your mental health and well-being — but since these patterns are learned over time, you can take action to "unlearn" them for a better quality of life.

Here's how it works, according to Martin: You walk past a group of coworkers laughing and immediately assume they're talking about you. This belief triggers feelings of shame, self-consciousness, or even anger. So, you avoid the situation and isolate yourself.

Replacing that thought with the possibility someone told a funny joke unrelated to you, Martin says, might spark feelings of curiosity that lead you to engage with your coworkers and maybe make some new friends.

"Different thoughts lead to different feelings, which then lead to different behaviors," Martin says.

Note: CBT focuses solely on identifying and addressing those patterns and their impact on problems in your present mood, relationships, and life overall — not childhood traumas or other past experiences.

What to expect

Your therapist will work with you to explore various techniques that can help you address any thought and behavior patterns that disrupt your daily life. According to Martin and Turner, those techniques might include:

• Role playing: This involves acting out imaginary scenarios to prepare for anxiety-inducing or otherwise challenging interactions. It also helps you practice communication, conflict resolution, and social skills.
• Cognitive restructuring: This involves identifying and reframing negative thought patterns. For example, "I lost my job because I'm worthless" might become "Losing this job was hard, but I guess it wasn't a good fit — and now I'm making way for opportunities better suited to my skills."
• Socratic dialogue, or guided discovery: You'll answer questions posed by your therapist that help you unpack your thoughts, assess their accuracy and helpfulness, and test them against reality. For example, Turner says your therapist may ask, "What's the evidence that no one will hire you after college? What would you tell a friend in your place?"
• Behavioral activation: This involves monitoring your daily activities and then purposefully scheduling time for those activities you find enjoyable, meaningful, and empowering
• Relaxation and ground exercises: Your therapist will teach you deep breathing, muscle relaxation, and mindfulness exercises — which Turner says can reduce anxious thoughts by helping you feel more present and in control.
• Successive approximation: This technique teaches you to break down overwhelming tasks into smaller and more manageable steps to increase your confidence and get a handle on anxiety.
• Exposure therapy: You'll use this approach to slowly and gradually expose yourself to your phobias or fears while implementing guidance from your therapist to manage feelings of anxiety that surface.
• Behavioral experiments: You'll predict the outcome of a feared or overwhelming event and then follow up to compare your prediction with what really happened.

Another important part of CBT? Homework.

Martin says your therapist will likely ask you to keep a daily journal logging:

• Negative thoughts
• Their impact on your mood
• Positive alternative thoughts

They'll probably also recommend practicing the relaxation and grounding techniques you learned in therapy between sessions.

According to Klapow, this homework aims to help you continually reinforce and build on the skills you learn in therapy and apply them to daily life. The idea is that eventually, you'll learn to become your own therapist.

Klapow says CBT typically lasts for 8-16 sessions, though this can depend on symptom severity and why you're seeking therapy.

Limitations

While many experts consider CBT the "gold standard" treatment for many mental health conditions, it isn't right for everyone — and it isn't the only effective approach. Other popular modalities include:

• Dialectical behavior therapy
• Interpersonal therapy
• Psychodynamic therapy
• Eye movement desensitization and reprocessing therapy (EMDR)

According to Klapow, psychotic disorders, like schizophrenia, don't always respond well to CBT, because people who feel disconnected from reality may not be able to test the validity of their thoughts.

Also, since CBT is focused on your current life rather than past events, Martin says it's not ideal for working through childhood traumas.

However, Klapow says CBT may be combined with other modalities to help you unpack and test out the impact of your trauma on your beliefs about the world. For example, CBT may be used in conjunction with interpersonal therapy if you find it difficult to form or maintain healthy relationships.

Insider's takeaway

CBT can help many people with a range of concerns — from depression and anxiety to eating disorders and substance use issues.

This modality focuses on addressing current mental health symptoms by challenging and replacing cognitive distortions.

While it may not be the ideal approach if you want to work through childhood trauma or other experiences from your past, it can offer a great starting place for working through thought patterns that negatively affect your mood, emotions, or behavior.