Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy, or CBT, is a type of talk therapy. It teaches you to notice the thoughts that run through your mind, check whether they are accurate, and change habits that keep you stuck.¹ It is one of the most studied therapies in the world.^2,3

CBT is practical. It focuses on problems you are facing now, and you practice new skills between sessions.^4,5 This page explains how CBT works, what it can help, and how to use our free 6-week self-guided course.

What CBT is

The psychiatrist Aaron Beck developed the ideas behind CBT. His main idea was simple. How you see a situation often shapes your reaction more than the situation itself.⁵

In CBT, you and a therapist work as a team. You learn to catch automatic thoughts (quick thoughts that pop up on their own). Then you test whether they are true and helpful. You also try new actions, solve problems and build skills.^1,5

CBT has a few features that set it apart:

• Present-focused. It works mostly on what is happening in your life now, not on your whole past.⁵
• Structured. Sessions usually have a plan and clear goals.⁵
• Skills you keep. The aim is for you to learn to check your own thoughts, so you can keep going after therapy ends.⁵
• Practice between sessions. You usually get "homework," such as a short diary or a small task to try. This practice is a key part of why CBT works.^4,5

The CBT model: thoughts, feelings and actions

CBT sees thoughts, feelings, body sensations and actions as linked in a circle. A change in one part affects the others.^1,5

Here is a simple example. Say a friend does not call back.

The situation is the same. The thought is different, so the feeling and action change too. CBT does not ask you to "think positive." It asks you to think accurately, looking at all the facts.

You can try this right now with our thought check tool.

What CBT can help

CBT has been tested for many problems. The evidence is strongest for some of them.³

Many other therapies on this site grew out of CBT or share its tools. These include behavioral activation, exposure therapy, MBCT and ACT.

What the research shows

The largest review of CBT for depression pooled 409 trials with more than 52,000 people. It was published in 2023.² Here is what it found, in plain words:

• CBT vs. no treatment or usual care: CBT helped a lot more. The effect was large, and it lasted 6 to 12 months later.²
• CBT vs. other talk therapies: About the same. CBT was only slightly ahead, and the gap was so small it may not matter.²
• CBT vs. antidepressant medicine: About the same in the short run. After 6 to 12 months, CBT may hold up a bit better, but only a few trials checked this.²
• CBT plus medicine: Better than medicine alone. Not clearly better than CBT alone.²
• Self-help CBT with no therapist: Still helped, but less than CBT with a therapist.²

What this means for you. CBT works well for many people, but not for everyone. It is a good choice, not the only choice. If you prefer medicine, another therapy or both, that is also a valid path. Talk with your doctor about what fits you. Never stop or change a medicine on your own.

CBT in later life

CBT works for older adults too. A U.S. psychology guideline recommends group CBT for depression in older adults, often in 7 to 15 weekly sessions. It is one of three recommended talk therapies, along with interpersonal therapy and group life review.⁷

For anxiety in older adults, a review of 12 trials found CBT clearly helped compared with usual care or a waitlist. The benefit was smaller when compared with other active help, and seemed smaller than in younger adults.⁹

Therapists often adjust CBT for later life. They may go more slowly, write things down, use large print, repeat key points, or invite a family member. These changes can also help people with hearing, vision or memory problems.

Medicare covers it. Medicare Part B pays for individual and group talk therapy. Covered providers now include marriage and family therapists and mental health counselors, along with psychologists, clinical social workers and others. You usually pay 20% after the Part B deductible.¹⁰ See what Medicare covers for mental health.

What CBT with a therapist is like

At the first visit, the therapist asks about your problems and goals. Together you decide whether CBT is a good fit.⁴

After that, a typical session might go like this:

1. Check in on your mood and the past week.
2. Review your practice task from last time.
3. Pick one problem to work on today.
4. Learn or practice a skill, such as testing a thought.
5. Plan a small task to try before the next visit.

Most people have about 5 to 15 sessions.⁴ A British guideline suggests about 8 sessions of individual or group CBT for milder depression, and more when problems are complex.⁸ You can get CBT in person, by video, by phone, in a group, or as guided self-help.⁴

To find a therapist trained in CBT, NIMH suggests the directories of the Association for Behavioral and Cognitive Therapies and the Academy of Cognitive and Behavioral Therapies, as well as your insurance plan's list.¹ Our guide on how to find a therapist walks you through it. If you want an app or online program, read online therapy and apps first.

Our free 6-week CBT course

This self-guided course teaches the core CBT skills, one week at a time. Each lesson has clear steps and a practice task. Plan on 15 to 20 minutes a day.

If your main trouble is low energy and pulling away from life, the behavioral activation lessons may be a better first step. If it is sleep, try the CBT-I lessons.

In this section

When to get help from a professional

Self-help works best for mild to moderate problems. Self-guided CBT helps less on average than CBT with a therapist.² See a doctor or therapist if:

• Your mood or worry makes it hard to work, sleep, eat or care for yourself.
• You have had symptoms for more than two weeks and they are not getting better.
• You have had a big loss, trauma or a sudden change in memory or thinking.
• You use alcohol or drugs to cope.
• You have tried the course for several weeks and feel no better, or worse.

Is CBT just "positive thinking"?

No. CBT asks you to look at all the facts, good and bad. Sometimes a negative thought turns out to be true. Then CBT helps you solve the problem or cope with it.

Do I have to talk about my childhood?

Not much. CBT focuses mostly on the present. Past events may come up when they help explain a belief you hold today.⁵

Can CBT help if I am also taking an antidepressant?

Yes. In research, CBT plus medicine worked better than medicine alone for depression.² Keep taking your medicine as prescribed, and tell your doctor you are starting therapy.

Can a person with memory problems use CBT?

Sometimes, with changes. Shorter sessions, written notes and help from a family member can make it easier. For people living with dementia, see our dementia section and cognitive stimulation therapy.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.