What is Cognitive Therapy?

Cognitive therapy is most often paired with behavioral therapy, typically as part of cognitive behavioral therapy. However, cognitive therapy is an independent treatment and area of study.

Cognitive therapy is a scientifically validated treatment shown to be highly effective in treating numerous psychological problems and disorders through in-person and online therapy. Surprisingly, most other forms of therapy have not been clinically validated by experimental research. Even more surprisingly, many of those that have been tested, have not proven to be very effective. 

Cognitive therapy has been the subject of more than 300 scientific studies, and is considered to be among the most effective treatments for depression, anxiety, and many other mental health problems. Because it is so effective, a course of cognitive therapy is typically briefer than traditional talk therapy. Some people need as few as six sessions to achieve their goals, while other people with deeper issues may need several months or more to adequately address their treatment needs.

Cognitive therapy focuses on changing negative thought patterns (also known as cognitive distortions), by examining the rationality and validity of the assumptions behind them. This process is termed cognitive restructuring.

Who is cognitive therapy for?

Cognitive therapy is a treatment option for a number of mental disorders, including agoraphobia, Alzheimer's disease, anxiety or panic disorder, attention deficit-hyperactivity disorder (ADHD), eating disorders, mood disorders, obsessive-compulsive disorder (OCD), personality disorders, post-traumatic stress disorder (PTSD), psychotic disorders, schizophrenia, social phobia, and substance abuse disorders. It can be useful in helping individuals with anger management problems, treating ptsd and has been reported to be effective in treating insomnia. It is also frequently prescribed as an adjunct, or complementary, therapy for patients suffering from back pain, cancer, rheumatoid arthritis, and other chronic pain conditions.

How successful is cognitive therapy?

Because cognitive therapy is employed for such a broad spectrum of illnesses, and is often used in conjunction with medications and other treatment interventions, it is difficult to measure overall success rates for the therapy. Cognitive and cognitive behavioral treatments have been among those therapies not likely to be evaluated,; however, and efficacy is well-documented for some symptoms and problems.

Some studies have shown that cognitive therapy can reduce relapse rates in depression, panic disorder, bipolar disorder, social anxiety, intrusive thoughts, and in schizophrenia, particularly in those patients who respond only marginally to antidepressant medication. It has been suggested that this is because cognitive therapy focuses on changing the thoughts and associated behavior underlying these disorders rather than just relieving the distressing symptoms associated with them.

How does cognitive therapy work?

Cognitive therapy is based on the idea that although our problems may have started in the past, they are maintained by the present. Unlike other forms of psychotherapy, the approach with cognitive therapy is to focus on treating problems by targeting the present. More traditional talk-therapy tends to focus on the past, but with cognitive therapy, patients learn to identify the current thought patterns that result in negative moods and counterproductive or self-sabotaging behavior. 

Cognitive therapy work is founded on what is known as the cognitive model of emotions and behavior, which explains the relationship between thoughts, feelings, and behavior. People usually attribute their distress to difficult external factors, but, in reality, it is the reactions to situations that are more to blame than the situations themselves. Certain situations may trigger overly negative or distorted thinking that can lead to distressing thoughts or unwanted behaviors. In other words, cognitive therapy proposes that perceptions often dictate how we feel and what we do, and that’s what needs to change in order to see different behavior –– not addressing the behavior itself.   

What are the different techniques used in cognitive therapy?

Cognitive therapy is usually administered in an outpatient setting (clinic or doctor's office) by a therapist trained or certified in cognitive therapy techniques. Therapy may be in either individual or group sessions, and the total length of treatment is shorter than traditional psychotherapy. It can often be completed in 12 sessions or less. The professionals who give treatment are generally therapists who are psychologists (Ph.D., Psy.D., Ed.D., or M.A. degree), clinical social workers (M.S.W., D.S.W., or L.S.W. degree), counselors (M.A. or M.S. degree), or psychiatrists (M.D. trained in psychiatry).

Therapists use several different techniques in their approach to cognitive therapy to help patients examine thoughts and behaviors. Depending on the person and the issue they’re looking to resolve, the therapist may employ a mix of the following techniques:

  • Validity testing. The therapist asks the patient to defend his or her thoughts and beliefs. If the patient cannot produce objective evidence supporting his or her assumptions, the invalidity, or faulty nature, is exposed.

  • Cognitive rehearsal. The patient is asked to imagine a difficult situation he or she has encountered in the past, and then works with the therapist to practice how to successfully cope with the problem. When the patient is confronted with a similar situation again, the rehearsed behavior will be drawn upon.

  • Guided discovery. The therapist asks the patient a series of questions designed to guide the patient towards the discovery of his or her cognitive distortions, with the idea that identifying and recognizing them will make them manageable.

  • Journaling. Patients keep a detailed written diary of situations that arise in everyday life. This will include not just the events of the day, but also the thoughts, emotions, and behavior that accompany them. The therapist and patient then review the journal together to discover maladaptive thought patterns and how these thoughts impact behavior.

  • Homework. In order to encourage self-discovery and reinforce insights made in therapy, the therapist may ask the patient to do homework assignments outside of sessions. These may include note-taking during the session, journaling (see above), review of an audiotape of the patient session, or reading books or articles appropriate to the therapy. They may also be more behaviorally focused, applying a newly learned strategy or coping mechanism to a situation, and then recording the results for the next therapy session.

  • Modeling. Role-playing exercises allow the therapist to act out appropriate reactions to different situations. The patient can then model this behavior.

What happens during a cognitive therapy session?

During the first session, the cognitive therapist and patient will collaborate to set goals for treatment for each different types of therapy. Once there are clearly defined goals, therapy will focus on examining the cognitive and behavioral barriers to goals, and then work towards targeting these barriers in a very focused way during each session. 

For example, if the goal is to be more successful at work or get a promotion, some behavioral barriers maybe not speaking up during meetings and avoiding interactions with supervisors. If this is due to social anxiety, the cognitive therapist will help identify thoughts that contribute to the anxiety, and then help develop cognitive and behavioral skills to reduce the anxiety and be more visible around promotion time. 

What is cognitive-behavioral therapy?

One may ask what is therapy? One of the most common ways therapists use cognitive therapy is through cognitive-behavioral therapy (CBT), which integrates features of behavioral modification into the traditional cognitive restructuring approach. In cognitive-behavioral therapy, the therapist works with the patient to identify the thoughts that are causing distress, and employs behavioral therapy techniques to alter the resulting behavior. 

Patients may have certain fundamental core beliefs, known as schemas, which are considered flawed because they have a negative impact on the patient's behavior and functioning. For example, a patient suffering from depression may develop a social phobia because he/she is convinced he/she is uninteresting and impossible to love. A cognitive-behavioral therapist would test this assumption by asking the patient to name family and friends that care for him/her and enjoy his/her company. By showing the patient that others value him/her, the therapist exposes the irrationality of the patient's assumption and also provides a new model of thought for the patient to change his/her previous behavior pattern (i.e., I am an interesting and likeable person, ;therefore I should not have any problem making new social acquaintances). 

Additional behavioral techniques such as conditioning (the use of positive and/or negative reinforcements to encourage desired behavior) and systematic desensitization (gradual exposure to anxiety-producing situations in order to extinguish the fear response) may then be used to gradually reintroduce the patient to social situations.

How to find a cognitive therapist?

Firstly, it’s important to note that cognitive therapy may not be appropriate for all patients. People with significant cognitive impairments like a traumatic brain injury or organic brain disease, and individuals who are not willing to take an active role in the treatment process are not usually good candidates.

Because cognitive therapy is a collaborative effort between therapist and patient, a comfortable working relationship is critical to successful treatment. Individuals interested in cognitive therapy should schedule a consultation session with their prospective therapist before starting treatment. The consultation session is similar to an interview session, and it allows both patient and therapist to get to know one another. During the consultation, the therapist gathers information to make an initial assessment of the patient and to recommend both direction and goals for treatment. The patient has the opportunity to learn about the therapist's professional credentials, his/her approach to treatment, and other relevant issues.

A good place to start for finding a therapist is your network of friends and family, in addition to your primary care provider, who will have referrals. Otherwise, Advekit is a great place to take a mental health quiz or quickly get matched with a few different cognitive therapists to interview.

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