Do I Have to Be in Therapy Forever? CBT Thinks Not

Rooted in ancient wisdom and backed by decades of research, cognitive behavioral therapy is the gold standard for real change—often in just weeks.

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If you’ve ever been in therapy, you may have quietly wondered: Is this working—and should it really take this long?

For many, therapy becomes a years-long endeavor. Sometimes that’s necessary, but in other cases, it may mean the approach isn’t providing the tools needed for real change.

That was the experience of Greg Lukianoff, a lawyer and free speech advocate, who struggled with clinical depression for much of his life—culminating in a suicidal crisis in 2007. After searching for relief, he turned in 2008 to cognitive behavioral therapy (CBT)—a form of psychotherapy built not on open-ended conversation, but on practical tools for identifying and reshaping unhelpful thought patterns.

As Lukianoff learned to challenge the negative and distorted thoughts fueling his depression, such as treating his feelings as facts—through CBT, his symptoms began to lift. Within a few months, he had built a set of tools he could return to long after formal treatment ended.

What Is CBT?

A recent meta-analysis published in JAMA Psychiatry, which included 375 trials and nearly 33,000 patients, confirms what many clinicians have long observed: CBT is highly effective across a wide range of mental health conditions—and can even support more complex ones, like psychosis and bipolar disorder.

“Most people seek CBT for anxiety, depression, eating disorders, or ADHD [attention-deficit/hyperactivity disorder],” clinical psychologist Terri Bacow told The Epoch Times in an email. “But others are looking to improve relationships, build self-esteem, or navigate major life transitions.”

There are dozens of evidence-based versions of CBT designed for problems like insomnia and pain. And even without a diagnosis, many people turn to CBT during stressful periods—a breakup, divorce, or a career upheaval.

The first part of CBT is to identify patterns in our thinking that shape how we feel and act, said clinical psychologist Lauren O’Flaherty. One person sees a black cat and thinks, “Bad luck—I should stay inside.” Another sees the same cat and smiles: “It reminds me of my childhood pet.”

Their emotions follow the stories. “Each person will feel differently based on the story they are telling themselves,” she said.

CBT helps people spot and shift common thinking traps—like catastrophizing (imagining the worst-case scenario), mind reading (assuming others are thinking something negative about you), all-or-nothing thinking (seeing things in extremes), overgeneralization (drawing sweeping conclusions from a single event), and rigid internal rules that fuel guilt or frustration.

CBT therapists listen for these irrational patterns—the shoulds, the musts, the rigid demands, said clinical psychologist Mike Abrams. “They help the person see that it’s not just the situation causing distress—it’s the way they’re interpreting it.” 

Once you learn to spot these common thinking traps, the next step is to gently challenge them—and experiment with new, more balanced ways of thinking.

From Thought Patterns to Real-Life Changes

Take the father who came to therapy because his temper was creating tension at home. When his kids misbehaved, he didn’t just see spilled milk or toys on the floor—he saw failure. I’m a bad parent, he told himself. Guilt turned to frustration, frustration to outbursts—and afterward, more guilt.

In CBT, O’Flaherty taught him to slow down and examine those automatic thoughts. Were they accurate? Were they fair? Was he jumping to conclusions?

The father practiced challenging those reactions, and the cycle began to shift. He stopped seeing every tantrum as proof that he was failing as a father—and started responding with more patience.

That’s the core of cognitive restructuring, one of CBT’s most foundational tools: spotting distorted thoughts and learning to replace them with more balanced ones.

However, none of that happens without trust.

“Even in the most structured CBT sessions, everything rests on the therapeutic alliance,” Abrams said. “You have to show the person you’re listening. That you accept them—even if you don’t accept every behavior. That relationship is what allows the work to happen.”

Breaking Free From the Inner Critic

CBT can also help quiet the inner critic—that voice that says you’re not good enough.

O'Flaherty recalls a young professional who spiraled into self-loathing every time she made a mistake at work: I’m useless. I should just quit, she’d think.

“When we are depressed, we are wearing the opposite of rose colored glasses, causing us to see most things in a negative light,” O’Flaherty said. Together, they labeled her thinking traps—generalization and jumping to conclusions—and began to reframe them.

With practice, her thoughts shifted instead to: I made a mistake, but I care about doing a good job. I’m human—and I’m learning. Her depression eased, and her confidence returned.

CBT isn’t just about thinking differently—it’s also about acting differently. That’s where behavioral activation comes in—a technique for depression that encourages people to take small, meaningful actions even when motivation is low. Over time, these steps can help lift mood and reengage with life.

It might start with a 10-minute walk. That walk brings movement, daylight, and a sense of progress. One small action leads to another.

At its heart, CBT is about reclaiming agency, said Abrams. The overarching principle is: I am responsible for my feelings—not in the sense of blame, but in the sense of ability to respond. “Through hard enough work, I can change it,” he said.

Rewiring Fears: CBT for Anxiety and Panic

While behavioral activation helps people with depression reengage with life, exposure therapy is CBT’s go-to tool for anxiety. The principle is to face our fears rather than avoiding them.

Anxiety tends to follow a predictable loop, said Bacow, who wrote the guided journal “Goodbye, Anxiety” after working with hundreds of anxious patients.

It often starts with a triggering thought: What if I embarrass myself? That sparks a surge of emotion—panic, dread, tension. To cope, people avoid the situation altogether—or rely on “safety behaviors” like seeking constant reassurance or planning exit strategies.

The problem? Avoidance brings short-term relief, but it reinforces the anxiety long-term. “Because you don’t get a chance to disprove your concern,” Bacow said.

To confront anxiety, Bacow uses a gradual approach known as a fear ladder—starting with low-stakes exposure and building up.

Consider a woman struggling with social anxiety—skipping parties, dodging phone calls, and dreading work events. Rather than diving into high-stakes situations, Bacow would ask her to start small.

First, say hello to a coworker. Next, call a friend instead of texting. And eventually, give a presentation at work.

At each step, the CBT approach targets the beliefs behind the fear: No one likes me. I’ll say something dumb. Over time, she replaces them with more realistic thoughts: Some people like me. Everyone says awkward things sometimes.

With practice, the grip of her anxiety loosens—not just in social settings, but in her sense of self.

From Panic to Peace: When Fear Feels Physical

Not all anxiety is social. Sometimes, it comes in the form of panic attacks—sudden waves of unexplainable fear.

This may occur with someone who starts experiencing panic after exercise—or seemingly at random. Their heart races, their chest tightens, and dizziness sets in, triggering catastrophic thoughts: What if I’m dying? What if I pass out?

Treatment begins with education about how panic works—how the brain misreads normal physical sensations as danger.

Once the person sees the link between bodily sensations, catastrophic thoughts, and escalating anxiety, they can start to shift their response. Rather than thinking that something is terribly wrong, they learn to reassure themselves: This is anxiety—and it can’t hurt me.

Then comes exposure—reintroducing the very activities that triggered fear. If the fear was related to exercise, that might start with a light jog, followed by a steeper hike. Gradually, each success builds evidence: I’m safe. I can handle this.

Over eight to 12 sessions, the panic attacks may fade. But more importantly, the fear of the fear begins to lift. Because the goal isn’t to eliminate anxiety altogether—it’s to change your relationship with it.

When CBT Isn’t Enough

CBT isn’t designed to make you dependent on a therapist. At its core, it’s about building autonomy—giving people tools they can use whenever needed after therapy ends.

“I typically see impactful results in as little as three sessions,” O’Flaherty said.

This short-term, skills-based approach is backed by data.

“There are standards and measures in every other health profession. Psychology and psychotherapy are the only ones where that’s still up for debate,” Abrams said. “But it doesn’t need to be. We have evidence for what works. And if someone isn’t getting better, we should adapt the approach.”

Still, not every case fits neatly into that structure. “There are people who need longer-term care,” Abrams said, pointing to conditions like schizophrenia, more severe autism spectrum disorders, or deep-rooted personality disorders. In these cases, ongoing support may be necessary alongside specific therapeutic techniques or life coaching.

The Balanced View

Some people benefit from a blended approach. For those navigating complex conditions—like bipolar disorder or long-standing personality patterns—CBT may be just one part of a broader toolkit, alongside medication, lifestyle changes, or longer-term relational therapy.

“I frequently incorporate CBT principles into therapy regardless of what the client’s issue is,” Bacow said.

Even with more common issues like anxiety or depression, context matters. Someone facing chronic trauma, grief, or burnout may need a slower pace, more flexibility, or extra emotional space than CBT’s standard structure typically allows.

Today, there are dozens of recognized variations and offshoots, from trauma-focused and mindfulness-based CBT to CBT for psychosis. Each reflects the same core principles, applied in different ways.

‌CBT is grounded in more than just technique. It also draws on a philosophy that’s been around for centuries. As Abrams noted, those core principles echo a much older philosophy: stoicism. Ancient thinkers like Epictetus and Marcus Aurelius believed that suffering stems not from events themselves, but from how we interpret them—a concept that continues to shape CBT’s approach to emotional resilience today.

Try It Yourself

You don’t have to be in a therapist’s office to benefit from CBT. One of its core tools, cognitive restructuring, can be practiced anytime—with a journal, a few minutes, and a willingness to look inward. There are also plenty of digital tools and apps that walk you through the basics—helping to track your moods, spot unhelpful thoughts, and shift your perspective in real time.

Here’s a simple way to start:

• Name the feeling: Write down what you’re experiencing
• Rate the intensity: On a scale from 1 to 100, how strong is it?
• Identify the thought: What triggered the feeling? What story did your mind tell?
• Spot the distortion: Are you catastrophizing? Mind reading? Seeing things in black and white?
• Check the facts: What’s the evidence for and against that thought?
• Reframe: What’s a more balanced or compassionate way to look at the situation?
• Re-rate the emotion: Has the intensity shifted?

With practice, this becomes a habit—a way to pause, reflect, and respond with more clarity.

For those seeking approaches that align with CBT, Abrams recommends reviewing the American Psychological Association’s regularly updated listing of evidence-based psychological therapies—a resource that matches best practices to specific conditions based on the latest research.

“With life’s inevitable suffering comes the opportunity to have meaning, to contribute, to make a difference to yourself and others,” Abrams said, adding that this sense of purpose reflects the deeper value behind CBT—one that goes beyond symptom relief.