What is Cognitive Behavioral Therapy?
Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the
relationships between thoughts, feelings and behaviors. By exploring patterns of thinking
that lead to self-destructive actions and the beliefs that direct these thoughts, people with
mental illness can modify their patterns of thinking to improve coping. CBT is a type of
psychotherapy that is different from traditional psychodynamic psychotherapy in that the
therapist and the patient will actively work together to help the patient recover from their
mental illness. People who seek CBT can expect their therapist to be problem-focused, and
goal-directed in addressing the challenging symptoms of mental illnesses. Because CBT is
an active intervention, one can also expect to do homework or practice outside of sessions.
A person who is depressed may have the belief, "I am worthless," and a person with panic
disorder may have the belief, "I am in danger." While the person in distress likely believes
these to be ultimate truths, with a therapist’s help, the individual is encouraged to challenge
these irrational beliefs. Part of this process involves viewing such negative beliefs as
hypotheses rather than facts and to test out such beliefs by “running experiments.”
Furthermore, people who are participating in CBT are encouraged to monitor and write down
the thoughts that pop into their minds (called "automatic thoughts"). This allows the patient
and their therapist to search for patterns in their thinking that can cause them to have
negative thoughts which can lead to negative feelings and self-destructive behaviors.
When is CBT used as a form of therapy?
Scientific studies of CBT have demonstrated its usefulness for a wide variety of mental
illnesses including mood disorders, anxiety disorders, personality disorders, eating
disorders, substance abuse disorders, sleep disorders and psychotic disorders. Studies have
shown that CBT actually changes brain activity in people with mental illnesses who receive
this treatment, suggesting that the brain is actually improving its functioning as a result of
engaging in this form of therapy.
CBT has been shown to be as useful as antidepressant medications for some individuals
with depression and may be superior in preventing relapse of symptoms. Patients receiving
CBT for depression are encouraged to schedule positive activities into their daily calendars
in order to increase the amount of pleasure they experience. In addition, depressed patients
learn how to change (“restructure”) negative thought patterns in order to interpret their
environment in a less negatively-biased way. As regular sleep has been found to be very
important in both depression and bipolar disorder, therapists will also target sleeping
patterns to improve and regulate sleep schedules with their patients. Studies indicate that
patients who receive CBT in addition to treatment with medication have better outcomes
than patients who do not receive CBT as an additional treatment.
CBT is also a useful treatment for anxiety disorders. Patients who experience persistent
panic attacks are encouraged to test out beliefs they have related to such attacks, which
can include specific fears related to bodily sensations, and to develop more realistic
responses to their experiences. This is beneficial in decreasing both the frequency and
intensity of panic attacks. Patients who experience obsessions and compulsions are guided
to expose themselves to what they fear in a safe and controlled therapeutic environment.
Beliefs surrounding their fears (of contamination, illness, inflicting harm, etc.) are identified
and changed to decrease the anxiety connected with such fears.
The same is true for people with phobias, including phobias of animals or phobias of
evaluation by others (termed Social Anxiety Disorder). Those in treatment are exposed to
what they fear and beliefs that have served to maintain such fears are targeted for
modification. CBT is often referred to as a “first line treatment” in many anxiety disorders
including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and
obsessive-compulsive disorder and specific phobias.
Over the past two decades, CBT for schizophrenia has received considerable attention in the
United Kingdom and elsewhere abroad. While this treatment continues to develop in the
United States, the results from studies in the United Kingdom and other countries have
encouraged therapists in the U.S. to incorporate this treatment into their own practices. In
this treatment, often referred to as Cognitive Behavioral Therapy for Psychosis (CBT-P),
patients are encouraged to identify their own delusional or paranoid beliefs and to explore
how these beliefs negatively impact their lives.
Therapists will then help patients to engage in experiments to test these beliefs. Treatment
focuses on thought patterns that cause distress and also on developing more realistic
interpretations of events. Delusions are treated by developing an understanding of the kind
of evidence that a person uses to support their beliefs and encouraging them to recognize
evidence that may have been overlooked, evidence that does not support the belief. For
example, a person who thinks that they are being videotaped by aliens may feel less worried
when their therapist helps them to discover that there are no hidden cameras in the waiting
room, or that a television remote does not contain any Alien technology within it.
CBT’s focus on thoughts and beliefs is applicable to a wide variety of symptoms. While the
above summary is certainly not comprehensive, it provides an overview of the principles of
CBT and how they apply to the treatment of various mental illnesses. Because CBT has
excellent scientific data supporting its use in the clinical treatment of mental illness, it has
achieved wide popularity both for therapists and patients alike. A growing number of
psychologists, psychiatrists, social workers, and psychiatric nurses have training in CBT.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., July 2012
NAMI • The National Alliance on Mental Illness • 1 (800) 950-NAMI •
www.nami.org 3803 N. Fairfax Drive, Suite 100, Arlington, Va. 22203
The Greek physician 
Concern about the treatment of mentally ill people grows to the point that occasional reforms are instituted. After the French Revolution, French physician Phillippe Pinel takes over the Bicêtre insane asylum and forbids the use of chains and shackles. He removes patients from dungeons, provides them with sunny rooms, and also allows them to exercise on the grounds. Yet in other places, mistreatment persists.
U.S. reformer Dorothea Dix observes that mentally ill people in Massachusetts, both men and women and all ages, are incarcerated with criminals and left unclothed and in darkness and without heat or bathrooms. Many are chained and beaten. Over the next 40 years, Dix will lobby to establish 32 state hospitals for the mentally ill. On a tour of Europe in 1854-56, she convinces Pope Pius IX to examine how cruelly the mentally ill are treated.
Mental illness is studied more scientifically as German psychiatrist Emil Kraepelin distinguishes mental disorders. Though subsequent research will disprove some of his findings, his fundamental distinction between manic-depressive psychosis and 
The primary treatments of neurotic mental disorders, and sometimes psychosis, are psychoanalytical therapies ("talking cures") developed by Sigmund Freud and others, such as Carl Jung. Society still treats those with psychosis, including schizophrenia, with custodial care.
A series of successful anti-psychotic drugs are introduced that do not cure psychosis but control its symptoms. The first of the anti-psychotics, the major class of drug used to treat psychosis, is discovered in France in 1952 and is named chlorpromazine (Thorazine). Studies show that 70 percent of patients with schizophrenia clearly improve on anti-psychotic drugs.
An estimated one-third of all homeless people are considered seriously mentally ill, the vast majority of them suffering from schizophrenia.
