Cognitive Behavioral Therapy (CBT) is a type of talk therapy that supports peoples’ mental health recovery. In CBT, a person talks to a trained therapist about worries and problems to try to understand them better, learn new, more helpful ways of making sense of them, and take action to change their life for the better. CBT works by breaking a person’s problems down to their feelings, thoughts, and actions. For example, when somebody is feeling low, it may be because they are thinking badly about themselves. As a result, they might have a hard time doing things in their life, like their interests, goals, and relationships. CBT can help the person break out of this negative cycle and feel better by thinking and acting in new, more helpful ways.

Many people find it helpful to talk with somebody when they have troubling experiences that make them feel depressed, anxious, scared, or confused. CBT can help by giving them a safe space to talk about these experiences and to learn ways to reduce them, cope with them better, and live the life they want. Many Veterans have completed CBT and have told us that it was a helpful tool for their recovery. CBT has been shown by research to be effective for a variety of problems including depression, anxiety, PTSD, bipolar disorder, psychosis/schizophrenia, substance use, and chronic pain.

CBT usually starts with an assessment so that the therapist can better understand you, including your vision about what you want your life to be about, as well as the problems and obstacles that are getting in the way of achieving that. You will then work together as a team to help solve these problems and remove the obstacles. The therapy usually involves:

• Breaking down your life goals into smaller steps
• Doing activities to help you feel better, more productive, and connected to other people
• Talking about how your difficult experiences began and how they’re affecting your life now
• Discussing how you are making sense of these experiences and trying out new perspectives
• Practicing new methods for reducing and coping with the difficult experiences

CBT has been used effectively for a variety of problems, including the following:

Voices

Sometimes people can hear someone, or a number of people, speaking or shouting, but nobody else seems to hear them. “Voices” like these can be very upsetting: they may say abusive things about the person or tell them to do unpleasant things. CBT can help them better understand why these voices are happening and what to do about them. Understanding them is important in reducing the fear and anxiety they cause. CBT also teaches people a variety of techniques which can help them to better cope with the voices and maybe even to reduce them. This can give people a better sense of control over the voices, so that they can do what they want with their life and not let the voices keep them down anymore.

Other difficult experiences

CBT can also help with experiences that cause stress and get in the way of life; for example, when people believe they are being followed or plotted against or that someone or something is interfering with their brain or body. On the surface these thoughts may seem reasonable, but it could be that the fears have gotten out of proportion or things have been taken too personally. It might be possible with CBT to look at the situation differently and get a new perspective. It may be that there is a different explanation that is less upsetting and less stressful. For example, anxiety can cause all sorts of strange feelings like numbness or tingling, pain or breathing problems, but these can sometimes be misinterpreted as electric shocks or physical attacks by an outside force.

Posttraumatic stress

People who have experienced traumatic life events like life-threatening accidents, combat, and abuse often struggle with depression, anxiety, insomnia, voices, and other difficult experiences. CBT can help a person recover from their trauma in a few ways. It can help the person to make sense of what happened to them and better understand how the experience has affected their life. It can help them to let go of unhelpful ways of thinking, like blaming themselves for something that wasn’t really their fault. And it can support them to feel the emotions they need to feel in order to heal from the trauma.

Depression and anxiety

CBT works on depression and anxiety by helping the person discover unhelpful and unbalanced ways of thinking, like thinking they are a bad person (in depression) or that terrible things are going to happen and they won’t be able to handle it (in anxiety). The therapy helps them correct their thinking so that they feel better, but also encourages them to try doing things to help their mood. For example, a person with depression might schedule daily activities that give them joy and a sense of accomplishment, and someone with anxiety might practice breathing techniques to reduce their anxiety and break large, scary tasks into small steps so they’re easier to accomplish.

To get the most out of CBT, you are expected to:

• Attend weekly sessions with a therapist that last about 45-50 minutes for up to approximately 4-6 months.
• Complete an assessment at the beginning of therapy and complete questionnaires periodically during therapy and at the end, to see how you are doing and if the therapy is working.
• Complete between-session practice (also called “action plans” or homework) each week. This is very important, because people who practice between CBT sessions get more out of the therapy and improve faster.
• Be on time to your sessions and notify your therapist beforehand if you have to cancel or reschedule.
• Give your therapist honest feedback about how the therapy is going.

You and your therapist will be working together as a team in CBT. Your therapist will:

• Customize the therapy so that it meets your specific needs.
• Provide the best quality CBT possible.
• Make every effort to be on time to your sessions and let you know beforehand if they have to cancel or reschedule.
• Have their work overseen by a clinical supervisor (if your therapist is a trainee).
• Give you honest feedback about how the therapy is going.

CBT is a very safe treatment. Like with any therapy, since you will be talking about difficult personal experiences, some difficult feelings may come up. Your therapist will support you through this process. Although CBT has been shown to be effective for many people, it does not work for everyone, so there is a chance that you may not benefit from it. If this happens, your therapist will suggest other treatment options with you and will offer to help connect you to them.

Most studies which have shown CBT to be effective for things like voices and the “other difficult experiences” described above have used it in combination with mental health medications. Sometimes people will accept medication but not CBT, and sometimes CBT but not medications—but it seems that the combination is best. There is however some new research showing that CBT can still be effective in people who refuse medications.