Cognitive Behavioral Therapy

What to Expect in Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, or CBT, is offered at NSIGHT PsychologyCognitive Behavioral Therapy and Addiction. CBT is a goal-oriented talk therapy. It is an evidence-based treatment that is popular for its effectiveness and relatively short-term duration.  CBT was first introduced in the 1950s and has been slowly replacing more traditional psychotherapies as the most popular modality of therapy.  It is also popular among insurance agencies for its short-term duration.

Cognitive Behavioral Therapy is very effective for treating anxiety, depression, trauma, substance abuse, and eating disorders but is also applied to other problems.  It is designed to equip individuals with life skills and coping strategies that they can use beyond the time they spend in therapy.

The Premise of Cognitive Behavioral Therapy

The premise of CBT is that emotions and behaviors are a direct result of thoughts. It is the way one interprets or perceives events, rather than events themselves, that affect the way one feels and behaves.  This can be illustrated by a simple example.  Say you’re watching a tennis match and supporting Roger Federer.  If he gets a point, you’ll cheer and be happy.  His opponent’s supporters however will be disappointed.  The same thing happened – Federer scored a point – but different people had different reactions because it meant different things to them.  All of Cognitive Behavioral Therapy is based on this concept.

CBT aims to replace negative thinking with rational thinking in order to make you feel and behave the way you want to.  Research has identified certain negative thinking styles that contribute to anxiety and/or depression.  These are often termed ‘cognitive distortions’.  You can think of these as ‘unhelpful thinking habits’ or ‘mental mistakes’. Cognitive Behavioral Therapy will help you identify your cognitive distortions and challenge them.  Challenging your negative thinking styles will allow you to come up with more rational thinking styles and equip you with better coping skills.

Some examples of cognitive distortions are:

All-or-Nothing or Black & White Thinking – This is when you see things in extremes or absolutes e.g. ‘I always mess up the dinner!’

Shoulds and Musts – This is when you set unrealistic expectations for yourself, by thinking ‘I should’ or ‘I must’ do something e.g. ‘I must get the ball in the basket every time I shoot.’

Mental Filter – This is when you magnify the negative aspects of an experience and ignore any positives.  For example, if someone said something sarcastic to you at a party and you spend all night thinking about that one comment and thinking about how the entire evening was awful, you’re filtering positive memories of the party out.

Catastrophizing – This is when you believe things to be the absolute worse they can be e.g. ‘This essay is totally awful!’

Predicting the Future – This is when you believe you know exactly how things will turn out and that there is no other possible way for things to occur e.g. ‘He’s going to be so mad at me!’

Mind-reading – This is when you believe you know what others are thinking e.g. ‘I failed my last assessment.  The teacher must think I’m so stupid.’

Blaming – Specifically, this is when you believe others are responsible for making you feel bad e.g. ‘You make me feel so dumb!’

Cognitive Behavioral Therapy in Action

Preparing for Therapy

When you first come in for CBT, your therapist will ask you what brought you into therapy.  Though exploring your past is not the main focus of Cognitive Behavioral Therapy, you will be asked for a detailed history of your social development, educational background, and mental health.  Your therapist will also ask for full contact details and about your current mental health.  These details will help inform therapy as the therapist will gain a deeper understanding of you and your situation.

Before you begin therapy, you will to set your goals for therapy.  These can’t be wishy washy goals like, ‘I want to feel better’.  Your goals must be well-defined and measurable.  What does ‘feeling better’ look like? Your therapist will help you come up with such a goal.

Your therapist will also spend some time discussing the premise of CBT with you.

Identifying Cognitive Distortions

Once your goals for therapy have been defined and you understand the concept of Cognitive Behavioral Therapy, your therapist will educate you on different types of cognitive distortions. You might find that you can immediately come up with examples of these in your life. You may not be able to identify with all of them and you may be able to identify with some more than others. Everyone’s cognitive distortions are different.


Identifying your cognitive distortions will require self-monitoring. Your therapist might have you note over the week any events that make you unduly upset. You will be asked to note (A) what happened, (B) what you thought as it was happening and (C) what you felt or how you behaved as a result of this. This is the ABC model of emotion and is commonly used in CBT. You might find it easier to identify (A) and (C) before you can identify (B). Sometimes people believe that there is no thinking that happens between an event taking place and the way you feel because your emotional reaction seems immediate. This thinking happens so quickly that you don’t notice it. Becoming aware of your cognitive distortions (B) takes practice.

Challenging Negative Thinking

Identifying your negative thinking means you’re now ready to challenge those thoughts and replace them with rational ones. Rational thinking is different from positive thinking. Positive thinking focuses only on the bright side of things. Rational thinking is thinking that is based on fact and enables you to achieve your goals.

Challenging negative thinking means looking for evidence for your thoughts and beliefs. You might question what led to these beliefs forming and how much truth is in them. Replacing negative thoughts with positive thoughts takes time and practice. After all, you’re used to thinking negatively – habits don’t develop overnight.


Your therapist will utilize the time between therapy sessions to get the most out of your treatment by giving you assignments to complete until the next time you meet. This isn’t like a school assignment and you won’t lose marks for not doing it. These are small tasks that are personal to you and are tailored to help you achieve your goals. You will help define these tasks and will be at complete liberty to finish however much of the task you wish to.

Things You Should Know

Your therapist will treat any single piece of information you provide with the utmost confidentiality. Your confidentiality can only be breached in exceptional circumstances: if the therapist believes you are in imminent danger of being harmed or harming others. In such an event, your therapist is required by state or federal law to notify appropriate authorities.

Some people leave Cognitive Behavioral Therapy in the middle of treatment because they start to feel better. Starting to feel better does not mean that you have ingrained in you the habit of thinking rationally. People who leave therapy after a few weeks often find themselves back to where they started or blaming therapy for failing them and not working. Sticking through with the treatment plan all the way to the end is more likely to ensure a lasting result.

Many people also report that sometimes they feel worse before they start to feel better, as they face their feelings. It will take some effort and courage on your part to complete your CBT treatment. Your NSIGHT team will be there to encourage and support you all the way.

If you or a loved one are struggling with depression, trauma, anxiety, addiction, alcoholism, or an eating disorder, reach out…get help.  Call us now at (888) 557-8091 or send us a confidential email to  We will be happy to discuss treatment options for you or your loved one and what you should look for when calling ANY treatment provider.

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