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What CBT is

4 minute read

Cognitive behavioral therapy, usually shortened to CBT, is a practical, present-focused approach to psychological difficulties. Its central idea is simple: the way we interpret a situation shapes how we feel and what we do, and what we do then feeds back into what we believe. Change any part of that loop and the rest tends to move with it.

Thoughts, feelings, and actions

Imagine two people who both see a friend walk past without saying hello. One thinks "she must not have seen me" and carries on with the day. The other thinks "she is avoiding me, I must have upset her" and feels a wave of anxiety, replays the last conversation, and avoids texting for a week. The event was identical. The interpretation, the emotion, and the behavior were not.

CBT grew out of Aaron Beck's work in the 1960s and 1970s, first on depression and then on anxiety. Beck noticed that his patients had streams of rapid, believable "automatic thoughts" that they rarely examined, and that these thoughts followed predictable patterns for each problem. Anxiety, for example, comes with an overestimate of danger and an underestimate of one's ability to cope.

The CBT triangle

Most introductions to CBT draw the same picture: a triangle with thoughts at one corner, feelings at another, and behaviors at the third, with arrows running both ways along every side. It is simple, and it is the most useful thing to hold in mind while using the app.

Thoughts are the interpretations and predictions that run through your head, often so quickly you barely notice them. Feelings are emotions and the body sensations that come with them: the tight chest, the racing heart, the heat in your face. Behaviors are what you do, including the quiet things, like looking at the floor or leaving early.

The arrows matter more than the corners. A thought like "they will laugh at me" produces the feeling of dread. Dread makes you avoid the meeting. Avoiding means you never find out whether they would have laughed, so the thought stays. Round and round.

You cannot decide to feel differently, and arguing with a thought only goes so far. What you can change directly is the behavior corner. Do something different, watch what happens, and the thought has to answer to the evidence. That is the whole logic of a behavioral experiment.

Why "behavioral" matters

The cognitive side of CBT is about noticing and examining those interpretations. The behavioral side is about testing them in real life. Talking about a fear in the abstract rarely shifts it very far. Doing the feared thing, while paying close attention to what actually happens, often does. This app is built around that second half.

Behavioral experiments are one of the main ways CBT turns insight into experience. The other well-known tool, the thought record, works on paper. An experiment works in the world.

Does it work?

CBT is one of the most thoroughly researched psychological treatments. Reviews of many trials find it effective for anxiety disorders, depression, and a range of other problems, with effects that hold up over time. It is recommended as a first-line treatment for most anxiety disorders by clinical guidelines in the United States, the United Kingdom, and elsewhere.

That does not mean it works for everyone, or that self-guided work is the same as therapy. See the article on working with a therapist for what the research says about doing this on your own.

What CBT is not

CBT is not positive thinking. The goal is accuracy, not optimism. If a fear turns out to be justified, that counts as learning too, and the next step is coping with it rather than pretending it away.

CBT is also not a quick fix. Beliefs that have been rehearsed for years rarely change after one experiment. They change through repetition, variety, and paying attention to results.

References

• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
• Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
• Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. doi.org/10.1016/j.cpr.2005.07.003
• Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. doi.org/10.1007/s10608-012-9476-1
• Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3), 245–258. doi.org/10.1002/wps.20346

Helpful links

• Beck Institute: Understanding CBT
• NHS: Cognitive behavioural therapy (CBT)
• Psychology Tools: What is CBT?
• APA: What is cognitive behavioral therapy?

Educational content, not medical advice or a substitute for professional care. Ready to try it? Open the online worksheet or get the app.