The Science Behind CBT: Why it Works
Cognitive Behavioral Therapy (CBT) is an effective talk therapy modality used to manage a wide range of mental health conditions. Evidence shows CBT has successfully benefited individuals with anxiety disorders, depression, post-traumatic stress disorder (PTSD), insomnia, eating disorders, and more. Its versatility makes it one of the most valuable treatment options used by mental health professionals.
But patients may wonder what exactly makes CBT so beneficial. They may even ask how it’s possible for one modality to work for so many mental health concerns. In this article, we break down the mechanisms behind CBT and explain why it’s such a central part of the psychotherapy field.
1. CBT boosts awareness
Some people may view seeking services from a mental health professional as the first step in their treatment process. However, recovery isn’t quite that clear cut. There is truth to the saying that admitting you need help is the point when your treatment journey really starts. This goes for any mental health condition. But many individuals struggle to get from “I know I need help” to “This specific technique/mindset will get me where I want to be.”
The secret, essential ingredient that people need to go between these two statements is perspective, and this is exactly what CBT offers. Mental health professionals use CBT to help individuals understand the ways their thinking contributes to unhealthy habits, behaviors, and choices. By becoming more aware of how such thinking can be hurtful, individuals can learn to modify or create new ways of thinking that support a healthier lifestyle. Someone will not be able to explore new possibilities if they don’t admit their current mindset could use some tweaking.
Awareness (clinically known as insight) is proven beneficial for someone’s well-being and cognitive function. Someone who has awareness is more likely to manage their emotions and self-regulate as needed. A big reason for this is because people who are aware of their needs can use resources around them to their advantage. Therefore, awareness also helps people play an active role in their treatment because they know which of their feelings, beliefs, and behaviors are strengths and what may need improvement. Awareness building is one of several ways CBT shines.
2. CBT rewires the brain’s patterns
Our brain constantly works hard. It communicates with every part of our body, processes what is going on around us, and makes things run smoothly. Since our brain has a lot of jobs, it tends to form shortcuts pretty quickly to allow some tasks to run on autopilot.
These shortcuts let our brain dedicate time to more complicated things. Once a behavior becomes a shortcut, it can be hard to break. This is great for staying consistent with healthy habits such as exercising and eating healthy. But the brain’s hardwiring makes it a bit more difficult to replace troublesome habits with more positive ones.
However, it isn’t impossible to make these changes. This is yet another way that Cognitive Behavioral Therapy is advantageous. CBT uses a concept called cognitive restructuring to form new mental shortcuts for these healthier habits and mindsets. To do this, cognitive restructuring (in combination with awareness building) taps into the logical part of the brain. This is where someone holds negative beliefs, which may be about themselves, other people in general, or the world around them. Cognitive Behavioral Therapy uses various techniques to identify, discuss, and adjust these thoughts. Ultimately, the outcome is more positive, realistic, and healthier beliefs that support habits of the same nature. A concept called neuroplasticity is the precise reason CBT works so well. Neuroplasticity is the brain’s constant ability and openness for change. This trait does everything from enabling our recovery after injuries to developing, growing, and learning across our life.
3. CBT offers practice for new habits
Most forms of therapy come along with some type of homework. CBT is no different, because practicing the new techniques and ways of thinking you are learning is an essential part of making them a habit. There are several scientific concepts that contribute to this, including skill acquisition and automaticity. Each of these emphasizes how important repetition and continual practice are to adopting better habits and turning those into new skills.
Let’s use a common CBT technique as an example. Many therapists who use CBT ask their patients to keep a thought diary, which is a journal where they log negative thoughts any time they enter their mind. As part of this exercise, therapists instruct their patients to write down the negative thought(s), what is happening around them when they have the thought(s), and what their feelings are at the time. If the patient experiences negative thoughts three times each day on a regular basis, for example, they will need to write three times each day for the diary to be effective.
There are several reasons for this. The act of journal writing every time these thoughts arise will help the patient respond to those thoughts in the right way. The alternative involves having the same negative thought or mindset, which will undoubtedly impact their behavior as they may act in an attempt to make themselves feel better. In addition, the more often the patient writes in their journal, the more they will associate journal writing with new, positive thoughts, which will help them consistently change the negative thoughts into healthier ones. By adjusting these thoughts each time they happen, the patient will also see changes in their behaviors. This may be natural over time, but is often the direct result of new coping mechanisms or lifestyle changes recommended by their therapist. Either way, this process will help someone’s brain associate behavior change with the act of journaling, which will further encourage their consistency.
After around 2 months (sometimes more) of regular journaling, the thought diary should become a habit. It will take several more months – possibly even up to a year – for this habit to become automatic enough to be a skill. Some experts note a person needs to thoughtfully engage in an activity for 10,000 hours in order for it to become a skill. This amounts to quite a bit of dedication and practice, but there is a great deal of research stating how well this works.
Takeaway
As you can see, there is strong scientific reasoning and evidence to support CBT. This treatment approach has proven beneficial for many mental health concerns, so it can be useful for many forms of emotional distress that stem from negative thought patterns. CBT allows people to build lifelong skills that help them develop better mental health and is valuable for many individuals.
References
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InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. In brief: Cognitive behavioral therapy (CBT) [Updated 2022 Jun 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279297/
Scientific American. (2024). How Long Does It Really Take to Form a Habit? Retrieved from https://www.scientificamerican.com/article/how-long-does-it-really-take-to-form-a-habit/
American Psychological Association. (2017). What is Cognitive Behavioral Therapy? Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
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