Cognitive Therapy

Have you ever thought, “I’m going to scream if he says that to me again” or “I’m going to screw up that big presentation at work, get fired and lose my house”? The scenario may not be exactly the same, but we all have had similar thoughts at one point or another. If thoughts like this happen frequently and cause feelings of stress, anxiety, anger or depression they can also affect your behavior and well as cause physiological reactions in your body, such as increased heart rate, sweating, chronic pain and even insomnia. When help in this area is needed, cognitive therapy might be the answer. Here, we delve into what cognitive therapy is and how it can help.

What is Cognitive Therapy?

Cognitive therapy, pioneered in the 1960s by psychiatrist Aaron T. Beck, M.D., who specialized in depression psychoanalysis, is a type of psychotherapy that focuses on replacing maladaptive or faulty patterns of thinking with desirable ones.[1] This type of therapy is based on the notion that what we think affects our emotions, what we choose to do or not do, and our physiological reactions.[2]

What is the Basis of Cognitive Therapy?

Cognitive therapy is based on the notion that how we perceive situations influences how we feel emotionally, not that situations in themselves directly affect a person’s emotions.

For example, two office workers might be given a marketing assignment that is not typical of their daily job duties. One might think, “This is extra work that I’m not qualified for, I probably won’t do a good job and I won’t be paid overtime for.” This person will feel angered and discouraged. The other person might think, “This is an excellent opportunity to learn a new skillset, branch out of my regular routine, and show that I have more ability than my current job enables.” This person will feel happy and optimistic.

Since people who are in distress often have negative thoughts, cognitive therapy can help people identify these thoughts and determine how realistic the thoughts are. By doing this, people can then learn to change their negative thinking and in turn feel better.

What Happens During Cognitive Therapy?

Cognitive therapy is usually short-term, lasting 8 to 16 weeks. Unlike other therapies that take a traditional doctor-patient approach, cognitive therapy allows for the patient to have a more active and collaborative role in hopes to empower the patient to solve future issues without being dependent on a therapist. It’s important to note that cognitive therapy is not merely positive thinking, as many unqualified self-help experts espouse, but is the pursuit of accurate thinking.

At the beginning of therapy, the therapist assesses the person’s maladaptive emotions, beliefs, and behaviors. After completing this initial assessment, the therapist and patient together create short-term goals, which are measured and adjusted accordingly throughout treatment. In some cases a person might need longer-term treatment, but even in these circumstances short-term goals are still set.[2.4]

During cognitive therapy, people are taught to identify the connection between their negative and distorted thoughts with their upsetting feelings, behaviors and physiological reactions. This skill is called “thought record” and is central to cognitive therapy. Once these connections are established, thought records are then used to look at the accuracy of the thoughts that are causing distress or maladaptive behavior. If it turns out that the thoughts are inaccurate, then the goal is to replace them with more accurate thoughts. If the thoughts are deemed accurate, then problem solving is in order.[2]

The main goals during cognitive therapy include the following:[2,4]

  • Learn self-awareness and emotional understanding in order to distinguish healthy from unhealthy feelings
  • Understand how distorted perceptions and thoughts contribute to painful feelings
  • Find solutions for current problems causing distress
  • Learn specific techniques to identify and challenge distorted thinking
  • Work to prevent future emotional distress by changing core beliefs that cause suffering

What Types of Issues Can Cognitive Therapy Help?

Cognitive therapy has been found to be helpful with the following:[2]

In general, compared to other therapy treatments, cognitive therapy has shown to have the best results when treating anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress.[5] Further, cognitive therapy is short-term and less expensive than psychodynamic or interpersonal type therapies. For this reason, many insurance companies and managed care companies prefer cognitive therapy.

Is Medication Used in Combination with Cognitive Therapy?

Many people are treated without medication while they undergo cognitive therapy, however, some disorders respond better to a combination of medication and cognitive therapy. After four to six weeks of therapy, a cognitive therapist might assess how well therapy is helping and discuss if medication is needed.[3]


  1. Webster. Cognitive therapy. Retrieved October 3, 2013, from
  2. Center for Cognitive Therapy. What is cognitive therapy? Retrieved October 3, 2013, from
  3. Academy of Cognitive Therapy. Frequently Asked Questions. Retrieved October 7, 2013, from
  4. The Washington Center for Cognitive Therapy. What is Cognitive Therapy? Retrieved October 7, 2013, from
  5. NCBI. The Efficacy of Cognitive Behavioral Therapy: A review of Meta-analyses. Retrieved February 10, 2014, from Center for Cognitive Therapy. What is cognitive therapy? Retrieved October 3, 2013, from

By C. J. Newton, MA, Editor

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