Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy, or CBT, is a structured, goal-focused kind of talk therapy. It looks at how your thoughts, feelings and actions affect one another, and teaches practical skills you practice between sessions. It is commonly used for anxiety and depression, and several clinicians at Balanced Life Counseling Services use it.
Who it helps
Thoughts that jump to the worst outcome before you can stop them
Wanting practical tools, not only a place to talk
Putting off or avoiding things because of how they make you feel
Harsh self-talk that shapes how you act
Liking a clear plan and a way to see progress
What CBT is, in plain terms
CBT explores the relationships among a person's thoughts, feelings and behaviors. The idea is simple to say and takes practice to use: the way you read a situation affects how you feel, and how you feel affects what you do next.
In CBT, a therapist works actively with you to become aware of automatic ways of thinking that are inaccurate or harmful, question them, and try out different responses. For example, a thought like "I can't do anything right" can be tested against what has actually happened in your life and replaced with a more realistic one.
CBT is described as goal-oriented, structured and practical. Sessions focus on specific goals you want to reach, and on strategies and exercises you can use in daily life.
Conditions and concerns CBT is used for
CBT is supported by a large body of research and is a recommended treatment for a range of mental health conditions. It is commonly used for:
Generalized anxiety, where it helps people identify and question unhelpful thought patterns and change behaviors that feed worry. See anxiety therapy.
Panic, often with exposure work that helps people gradually face the sensations and activities they have been avoiding.
Depression, where people learn to challenge and change unhelpful thoughts and behaviors. See depression counseling.
Stress and low self-esteem, where the same skills may be applied to everyday pressures and self-critical thinking.
What a CBT session involves
Sessions are a working conversation. Your therapist will ask questions, explain ideas and practice skills with you, so you are doing more than describing your week.
Set goals together. Early on, you and your therapist agree on what you want to change, such as fewer panic symptoms or getting back to activities you have dropped.
Map the pattern. You look at a recent situation and separate out what happened, what you thought, what you felt and what you did. Tracking these shows how they affect each other.
Test and practice. You examine a thought for accuracy, try a coping or problem-solving skill, or plan a small step toward something you have been avoiding.
Plan the week. Before you leave, you agree on something to practice. At the next session, you can look at how it went.
What CBT homework looks like
People in CBT are asked to practice the skills they learn between sessions. Homework is meant to be specific and doable, and you choose it with your therapist. Common examples:
Writing down negative thoughts in a journal as they come up
Practicing replacing a negative thought with a more realistic one based on your own past experience
Tracking moods and activities to see what lifts or lowers your day
Using a relaxation or breathing exercise at set times
Scheduling an activity that is pleasant or productive, even when motivation is low
Taking one planned, gradual step toward a situation you fear
If the homework does not get done
Tell your therapist. You will not be graded or scolded.
What got in the way is useful information, and the task can be made smaller or changed.
If CBT as a whole does not suit you, say that too. People respond differently to different kinds of therapy.
CBT next to other approaches at our practice
CBT is one of several methods our clinicians use. Some are also trained or certified in EMDR therapy, which is used for trauma. If you are weighing the two, our article on EMDR versus CBT lays out the differences.
Psychotherapy can be used alongside medication. Our team includes a psychiatric nurse practitioner, and medication questions are handled by the prescriber.
If you are in crisis, including thoughts of suicide during depression, call or text 988 or call 911. Our office does not provide emergency services and cannot respond to urgent situations.
How to begin CBT in Salisbury or Bethesda
You do not need to know in advance that CBT is the right method. Tell us what you are dealing with, and your therapist will explain the approach they recommend. The new patients page explains scheduling and first-visit paperwork.
Appointments are available in person and by telehealth. Accepted plans and self-pay rates are listed under insurance and fees. Please verify your benefits with your plan.
Frequently asked questions
How long does CBT take?
CBT is generally described as a brief, structured treatment, but the length depends on your needs and goals, and we cannot give a fixed number of sessions here. Weekly meetings are typically recommended at the beginning. You and your therapist review progress and decide together when to meet less often or wrap up.
Is CBT just positive thinking?
No. CBT is about accurate thinking, not cheerful thinking. Its core is identifying negative or false beliefs and testing them against evidence from your own life. Sometimes the realistic thought is still uncomfortable. In that case the work shifts to coping skills, problem solving and what you can do next.
Do I have to do homework in CBT?
Practice between sessions is a regular part of CBT, because skills are learned by using them in daily life. You and your therapist choose tasks together, and they should feel doable. If an assignment is too much or does not make sense to you, say so and it can be adjusted.
Is CBT right for everyone?
No single therapy fits everyone. Some people respond better to one type of therapy than another, and a therapist considers the problem being treated and the person when recommending an approach. If CBT is not a good match, your therapist can talk with you about other methods used at our practice.
Can CBT be done by telehealth?
Yes. We offer telehealth appointments, and psychotherapy can be provided in person or virtually. Written exercises can be kept in a notebook and talked through during the video session. Video sessions depend on where you are located during the appointment, so ask about your situation when you call.
Does insurance cover CBT?
CBT is a form of psychotherapy. Whether it is covered, and what you pay, depends on your plan's mental health benefits, copay and deductible. Call your insurer to verify. Our self-pay rate for a 45 to 50 minute individual session is $130, and a 30 minute session is $65.
Do your therapists use CBT with teens?
Our practice works with children, teens and adults, and several clinicians use CBT. Which approach a therapist uses with a young person depends on age and what is going on. Ask when you call which clinicians work with your child's age group and what methods they use.
Ready to talk with someone?
Call 443-978-8688 or request an appointment. We see clients in person in Salisbury and Bethesda and by telehealth across Maryland.
Sources
U.S. Department of Veterans Affairs: Evidence-Based Treatment
National Institute of Mental Health: Generalized Anxiety Disorder: What You Need to Know
National Institute of Mental Health: Panic Disorder: What You Need to Know
If you are in crisis or thinking about suicide, call or text 988. In an emergency, call 911.
