Psychotherapy

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a psychotherapeutic approach that focuses on the connection between thoughts, emotions, and behaviors. Its goal is to help individuals identify and change negative thought patterns and behaviors that contribute to a mental health issue or an unwanted behavior—such as teeth clenching.

For example, imagine the following situation: a friend rides past us on a bicycle and doesn’t say hello. We might think they didn’t notice us—but we might also assume they didn’t greet us because they are upset with us.

This negative thought can trigger not only unpleasant emotions but also physical reactions, such as teeth clenching. CBT helps us recognize and consciously change these negative thinking and behavioral patterns, essentially offering a way out of our own mental “hamster wheel.”

CBT is typically structured and time-limited, meaning the therapy lasts for a specific number of sessions—usually 10–20—and sets clear goals, such as reducing involuntary teeth clenching. During the therapeutic process, patients work together with the therapist to learn strategies for managing their problems and achieving positive, lasting change.

What types of CBT exist?

As standard CBT evolved, several new approaches emerged. The two main methods of the second wave of cognitive therapies are schema therapy and dialectical behavior therapy (DBT). These approaches aim to treat more complex issues, including personality disorders.

The third wave includes two prominent approaches: metacognitive therapy and mindfulness-based therapy. These provide additional tools and broader frameworks for coping with difficulties.

What techniques does CBT use?

Cognitive behavioral therapy (CBT) applies various techniques designed to change negative thinking patterns and behaviors—such as harmful oral habits like teeth clenching, cheek biting, or pressing the tongue against the palate. Below are examples of some commonly used techniques:

• Identifying automatic thoughts: Clients learn to notice the quickly arising negative thoughts that influence their emotions and behaviors.
  Example: Anna has an important presentation at work. When she imagines the situation, she immediately thinks she will mess it up because she cannot speak clearly. This negative automatic thought fills her with anxiety and causes her to clench her teeth.
• Reevaluating cognitive distortions: Clients learn to identify and challenge distortions in their thinking, such as black-and-white thinking or catastrophizing. Example: Anna realizes her fear is unfounded—she usually performs well when presenting. Her automatic thought (“I will mess up the presentation”) was an example of catastrophizing. Seeing the situation realistically, she understands she has no reason to worry.
• Behavioral experiments: Clients test new behaviors in real-life situations to see how these changes affect their core problems.
  Example: Anna has often been asked to present at work, but she has avoided it for years out of fear. Avoidance kept her fear alive. Following her therapist’s advice, she does not avoid the situation this time and gives the presentation. It goes well, showing her that her fear was not supported by reality.
• Relaxation techniques:Relaxation plays an important role in CBT, especially for managing anxiety and stress. Clients learn techniques to calm their bodies, which improves their thoughts, emotions, and behaviors. Example: While practicing her presentation at home, Anna becomes anxious and loses focus. Her therapist teaches her a simple breathing technique to calm herself. Using it, she can concentrate better during practice and during the actual presentation.

How does CBT work?

Cognitive behavioral therapy (CBT) operates through several structured steps that help clients understand and change their thinking patterns and behaviors.

• Establishing the therapeutic relationship: The therapist builds trust and cooperation, creating a supportive environment where the client can freely share thoughts and feelings.
• Setting goals: Therapist and client define clear therapy goals together (e.g., reducing teeth clenching), based on the client’s needs and difficulties.
• Identifying problems: The therapist helps the client recognize the specific issues behind their anxiety, depression, or other difficulties.
• Mapping thinking patterns: The client learns to identify negative automatic thoughts and cognitive distortions that influence emotions and behaviors. Example: Anna has an important presentation. The thought “I will mess it up” appears instantly, causing anxiety and teeth clenching.
• Exploring background experiences: Together they explore earlier experiences that shaped current thinking
  

and understand what created and maintains the problem.
Example: As a child, Anna froze during a school performance and felt strong shame, influencing her confidence to this day.

Reframing thinking patterns: Unrealistic, distorted interpretations are identified and replaced with more realistic thoughts.
Example: Anna realizes her fear is unfounded—she usually performs well, and her past experience distorted her perception.

Her negative automatic thought (“I will mess up the presentation”) was a form of catastrophizing (a type of cognitive distortion), because when she considers the situation realistically, she has no real reason to worry.

• Developing behavioral strategies: The therapist suggests various behavioral techniques and strategies that the client can try to approach their problems in new ways. Example: Anna has often been asked to give presentations at work, but in recent years she declined because she feared she would fail. By consistently avoiding the situation, her fear persisted. Following her therapist’s suggestion, she does not avoid it this time and gives the presentation. It goes well, allowing Anna to experience that her fear was unfounded, so next time she is more willing to accept similar tasks.

• Ongoing feedback and evaluations: Throughout therapy, the client and therapist continuously assess progress and adjust the approach as needed.

• Encouraging independence: CBT aims to help clients apply the learned techniques and strategies independently (not only during sessions) even after therapy ends. Because CBT is structured and time-limited, requiring active client participation, clients learn how to manage their own difficulties in the future.

In what cases is CBT effective?

Cognitive behavioral therapy (CBT) is highly versatile and can be applied in a wide range of situations. Due to its flexibility and structured approach, it is effective for many mental health concerns, including:

• stress management
• anxiety
• depression
• phobias
• post-traumatic stress disorder (PTSD)
• addictions
• sleep disorders

Who is CBT recommended for?

CBT can be especially beneficial for individuals who are motivated to change and willing to actively engage in the therapeutic process. When the problems and goals are clearly defined, they fit well into the structured framework of cognitive therapy. CBT is ideal for people who prefer logical, practical, and evidence-based techniques, and who appreciate understanding what happens during the process, why it happens, and how it will help them.

 

How is CBT structured and what does the process look like?

CBT is typically short-term, lasting 10–20 sessions, depending on the client’s needs. Sessions usually take place weekly, each focusing on targeted skill-building and problem-solving. The therapist actively guides the process, while the client also has an active role, including completing homework between sessions.

1. Exploring the problem and setting goals: At the beginning of therapy, the therapist and client identify the issues the client struggles with (e.g., jaw pain caused by teeth clenching). Together they set clear, specific therapy goals, such as improving anxiety management.
2. Case conceptualization and psychoeducation:During the initial sessions, the therapist uses questions and assessments to understand the client’s mental state, thinking patterns, emotional responses, and behaviors. This stage includes identifying cognitive distortions and negative thought patterns. The therapist explains how thoughts, emotions, and behaviors interact and introduces the client to the CBT model and its mechanisms.
3. Cognitive restructuring:A core CBT technique in which the therapist helps the client recognize and change dysfunctional thoughts, deep-rooted beliefs, and attitudes. Example: Anna frequently worries about performing poorly due to a childhood experience (freezing on stage during a Mother’s Day performance) and her perfectionism. Her negative automatic thought: “I will mess up the presentation.”
   More realistic interpretation: “I usually perform well—at university I often got good grades on presentations. Even if I make a small mistake, my colleagues will still like me.” The goal is for the client to evaluate situations rationally and respond in less negative, harmful ways.
4. Using behavioral therapy techniques:Behavioral components help clients learn new, healthier behaviors. Techniques may include:
   • Exposure:The client gradually faces avoided situations to reduce anxiety. Example: Anna had been avoiding presentations for years. Following her therapist’s suggestion, she gives the presentation instead of avoiding it. It goes well, helping her realize her fear was unfounded.
   • Behavioral activation:Used especially for depression, helping clients re-engage in enjoyable or meaningful activities.
     Example: Outside of work, Anna spent most days lying in bed on her phone. With her therapist’s help, she realized this worsened her mood. Getting up to walk the dog immediately improved her motivation for other tasks.
   • Self-monitoring:The client keeps a journal of thoughts, emotions, and behaviors to better understand personal patterns.
5. Skills development and prevention:In later stages, the therapist teaches skills that allow the client to handle challenges independently after therapy ends. Prevention strategies focus on avoiding relapse and maintaining progress.
6. Final phase and follow-up:At the end of therapy, the therapist and client evaluate the process and the results. If needed, the therapist may schedule additional follow-up sessions to support long-term success.
   

What happens during a CBT session?

A typical cognitive behavioral therapy (CBT) session usually includes the following steps:

• Review of the previous session (5–10 minutes): The therapist and client go over the last session and discuss what happened during the week.
• Discussion of current issues (10–20 minutes): The client shares current problems; the therapist helps identify thoughts, emotions and behaviors behind them.
• Cognitive restructuring and behavioral techniques (15–20 minutes): The therapist helps identify and change negative thoughts and teaches behavioral tools such as anxiety reduction or gradual exposure.
• Practicing new skills (5–10 minutes): The therapist teaches and practices new coping strategies (e.g., stress management, problem-solving).
• Assigning homework (5 minutes): The therapist gives tasks to complete before the next session (e.g., journaling, trying new behaviors).
• Closing the session (2–5 minutes): The therapist summarizes the session and clarifies next steps.

What results can be expected from CBT?

Cognitive behavioral therapy is a highly effective and evidence-based method for treating many mental health issues. Most clients experience positive results, although the degree and timeline of improvement vary from person to person. CBT helps clients recognize and rework dysfunctional thoughts and beliefs.
Example: Negative, overly generalizing, or irrational thoughts are replaced by more realistic and balanced thinking.

CBT also helps change problematic behaviors (e.g., avoidance, overeating, self-harm). Clients learn healthier behavioral patterns and become better equipped to respond to stressful situations. By the end of therapy, clients are typically able to apply the learned techniques independently in everyday life. This empowers them to manage stress, anxiety, and other challenges long-term without constant therapeutic support.

While CBT is highly effective, not everyone progresses at the same pace. Some clients may need more time, and success strongly depends on the client’s active participation and commitment.

Challenges that may occur during CBT

During cognitive-behavioral therapy (CBT), several common challenges may arise:

• automatic negative thoughts: It can be difficult to recognize and change deeply rooted negative thoughts, as they are often automatic and hidden. For example: One of Anna’s negative automatic thoughts is that she imagines herself freezing in performance situations (e.g., giving a presentation or attending a job interview). These thoughts come to her mind often and unnoticed, and she no longer even pays attention to them. Nevertheless, they still affect her emotional state (she feels anxious) and her body (she starts clenching her jaw).
• resistance to change: The client may feel more comfortable with old patterns, making it difficult to accept changes.
  For example: It is easier for Anna to avoid situations that trigger anxiety (e.g., giving presentations) than to face them. As a result, her fear cannot decrease.
• excessive expectations: If the client expects rapid improvement, they might feel disappointed if changes happen more slowly.
  lack of homework completion: Homework assignments are important for the success of CBT, but due to motivational difficulties, the client may not complete them.
• strong emotional reactions: Processing negative thoughts and feelings can trigger intense emotional responses that must be managed.
• relapse: Despite practicing new, healthier behavioral patterns, old ways of thinking may occasionally return, especially in stressful situations.
• limited time: CBT is a short-term therapy, and if the issue is complex, it may not be possible to fully address every problem within the available time.

What types of homework are used in CBT?

Homework assignments help clients apply therapeutic techniques in real-life situations. The most common types include:

• thought records:The client documents negative thoughts, situations, and emotions to recognize and transform them.
  Example: Situation: Anna’s boss asks whether she would be willing to give a presentation. Emotions: fear (80%), worry (60%). Negative automatic thought: I will mess up the presentation.
• cognitive restructuring:Dysfunctional thoughts are replaced with more realistic, balanced alternatives.
  Example: Due to Anna’s negative childhood experiences (freezing on stage during a Mother’s Day performance) and her perfectionism, she often devalues her own performance and worries about future failure. By transforming her negatively biased thoughts into more realistic ones, her anxiety becomes easier to manage. Her previous negative automatic thought: I will mess up the presentation. More realistic interpretation: I usually perform well—during university I often received good grades for my presentations. And even if I make a small mistake, my colleagues will still like me.
• behavioral experiments:The client tries out new behaviors in everyday life (e.g., practicing social interactions).
• exposure: The client gradually confronts their fears (e.g., in the treatment of phobias).
• behavioral activation:A client struggling with depression engages in enjoyable or meaningful activities to improve mood.
  Example: Outside of work, Anna spent most of her day lying in bed and scrolling on her phone. With her therapist’s help, she realized this worsened her mood. However, when she got up and took the dog for a walk, she immediately felt more motivated to do other things as well.
• emotion regulation: Practicing relaxation or mindfulness techniques to reduce stress and anxiety.
  Example: While practicing her presentation at home, Anna repeatedly becomes anxious and loses focus. Her therapist teaches her a simple breathing technique that helps her calm herself in stressful moments. By using it, she can better concentrate during practice and the actual presentation.
• problem-solving and goal setting: The client works on concrete problems and sets achievable goals.
  Example: Anna’s task is to formulate her overall goal (e.g., being able to give a presentation at work) and break it down into smaller steps (e.g., being able to rehearse the presentation at home alone, then later for her husband).
• self-reflection: The client keeps a journal to track their progress and uses self-reward to strengthen motivation.

How do homework assignments help?

In CBT, homework assignments help clients practice the techniques they learn in therapy and give them the opportunity to work on their difficulties outside the sessions. The tasks vary depending on the client’s current problems, but all share the same aim: to ensure that the client actively participates in the therapeutic process and gains the necessary tools to manage their problems in real-life situations.

What Are the Benefits of CBT?

Cognitive-behavioral therapy has several advantages compared to other therapeutic approaches:

• brief and goal-oriented: typically brings results within 12–20 sessions.
• long-lasting changes: clients can apply the acquired skills in the long term.
• self-directed use: helps clients manage their difficulties even after therapy has ended.
• wide applicability: effective in treating anxiety, depression, phobias, eating disorders, etc.
• measurable outcomes: progress can be easily monitored.
• flexible: can be delivered individually, in groups, or online.

What are the advantages of individual CBT?

Both group and individual cognitive-behavioral therapy (CBT) are effective, but each has its own advantages depending on the client’s needs and preferences. Individual therapy provides full attention and a personalized approach, which can be especially helpful when addressing deeper, more complex issues.

What are the advantages of group CBT?

Both group and individual cognitive-behavioral therapy (CBT) are effective, but each has its own strengths depending on how well they match the client’s needs and preferences. Group therapy offers participants the opportunity to share experiences and support one another, which strengthens the sense of community.

Participating in a group can help clients understand that they are not alone with their problems and that others struggle with similar difficulties. The group setting also provides opportunities to develop social skills, communication, and interaction—particularly for those who feel anxious or tend to avoid social situations. Seeing the progress of other group members can motivate participants and strengthen their commitment to positive change.

Individual or group CBT—what is recommended?

Individual therapy is recommended for more complex, deeper, or more specific issues, or when the client prefers a more confidential environment. Group therapy is ideal for developing social support and social skills. The choice depends on the client’s specific difficulties and the format in which they feel most comfortable.

Both approaches are effective and can lead to successful outcomes with proper guidance. They may also be combined if appropriate.

Book an appointment for a CBT consultation!

Feeling stressed and overwhelmed—and even experiencing jaw pain? If you feel it’s time to seek professional support and would like to relieve your discomfort using a practical and effective method, book a CBT consultation. Our psychologist has extensive expertise and experience in reducing anxiety.

We look forward to hearing from you and helping you move forward! Click the Appoinment button to schedule an appointment online, or call us at +36 70 555 75 33, and we will assist you in finding the most suitable time.