Cognitive Behavioral Therapy (CBT) for Teens

Cognitive behavioral therapy (CBT) is a type of therapy that can help teens identify unhealthy and unhelpful thought and behavior patterns so they can change them. CBT is based on the idea that our thoughts and emotions are intrinsically linked to our behavior. That is, how we behave is more related to our thought process than it is to external factors or environments. 

Cognitive behavioral therapy for teens helps replace a negative thought pattern with a healthier, more productive one. Because it’s so individually driven, CBT can be an excellent type of therapy for teens — the process can be tailored to the unique developmental needs and concerns of every teen.

Keep reading to learn more about CBT for teens.

How Does CBT Work?

CBT helps teens break down large issues into smaller, more manageable issues that can be dealt with individually. It differs from other forms of therapy in that the process doesn’t tackle things in the past. Instead, cognitive behavioral therapy focuses on issues currently being experienced so teens can identify where they’re struggling and develop new approaches that allow them to handle things more effectively. 

At its core, CBT works in 3 simple steps:

1. Identify negative thought patterns.
2. Challenge unhealthy thoughts — ask, “Is this true?” or “Who told me this?” 
3. Replace unhealthy or unhelpful thoughts with positive, more productive ones. 

CBT for teens can be effective in treating conditions like:

• Depression
• Anxiety
• Disordered eating or body image issues
• Post-traumatic stress disorder (PTSD)
• Substance use disorder
• Obsessive compulsive disorder (OCD)

Why CBT for Teens?

CBT is an effective form of therapy for teens because it helps them navigate difficult times in the healthiest way possible. Learning to identify and change unhealthy patterns is a powerful, lifelong skill that’s useful during times of stress, anxiety, depression, or other challenging periods. 

Understanding teen mental health challenges

According to the Centers for Disease Control (CDC), nearly half (42%) of students feel “persistently sad or hopeless,” and almost a third (29%) have poor mental health. Even more alarming, 10% of students have attempted to take their own life, and 22% — that’s more than 1 out of every 5 — seriously thought about it. The World Health Organization (WHO) notes that dying by suicide is the 4th leading cause of death for 15-29 year olds.

WHO also states that the leading mental health conditions for adolescents are anxiety, depression, and behavioral disorders — all of which can be treated by CBT. 

The unique needs of teenagers

Teens have an entirely different and unique set of challenges when we look at mental health. Not only are they trying to figure out their place in the world, but they also have increased hormones and often encounter social pressures they don’t fully know how to manage yet — and this is all before we even consider that their brains are still developing. 

The effectiveness of CBT in adolescent populations

In studies, CBT was effective in treating anxiety disorders, depression, PTSD, and OCD in children and adolescents. More than 77% of research participants saw significant symptom improvement post-treatment, and early 82% still saw improvement at follow-ups ranging from 1 to 89 months post-treatment. 

Common improvements in teen mental health include:

• Mood improvement: CBT helps stabilize mood by teaching coping techniques to redirect negative thought processes.
• Better decision-making skills: Negative thinking patterns can cloud judgment, but CBT helps teens identify when they’re about to make a poor decision so they can course-correct before it’s too late.
• Increased self-esteem: Tailored sessions can specifically address and improve the self-image issues that are common for teenagers.

Ways That Negative Thinking Affects Teens

Negative thinking patterns can affect every teen’s life experiences. They can alter everything from how teens think they’ll do in class or on a test to what they fear others might think about them in social settings.

Learning to identify — and then to change — a negative thought pattern is step 1 in creating and developing patterns, and healthy thought processes promote mental well-being. 

Impact on self-esteem and self-image

Teenagers are already sensitive, not to mention vulnerable, when it comes to their self-image. CBT can help them identify and challenge the negative self-talk they engage in. Then, they can work on replacing it with positive affirmations that boost self-esteem and self-image while building confidence.

Low self-esteem and self-image issues are more common in teen girls than boys. The National Organization of Women (NOW) conducted a study that offered shocking results. More than half of girls in this country (53%) are unhappy with their bodies, and by the age of 17, that percentage skyrockets to 78%. 

Think about a teen girl constantly scrolling and comparing herself (and her body) with images and posts she sees on social media. The effects of social media on teens can be significant. It’s easy to start looking at others — both people she knows and those she’s never met — and begin to feel less than worthy. 

“A little perspective goes a long way. Professional therapeutic support is always good, but sometimes even a trusted friend, parent or adult can support you in moving out of a negative headspace. Sometimes negative self-talk feels like it just won’t let up, and getting some help to pause, reflect and counter or respond can truly help us feel so much better.”

– Talkspace therapist Elizabeth Keohan, LCSW-C 

How CBT can help

Cognitive behavioral therapy can help her discover what triggers these unhealthy thoughts — in this case, using social media — so she can stop herself before she engages in negative self-talk. She’ll learn to replace old behaviors that harm her psyche with new, healthier, more rewarding ones. For example, the next time she grabs her phone to scroll Instagram, she might instead decide to pick up a journal and list 3 things she’s grateful for.

Consequences for academic and social performance

Unfortunately, unhealthy thinking typically doesn’t stay in just one area of life. More often than not, it trickles over into other aspects — it can negatively impact everything from schoolwork to friendships to relationships with teachers and parents. One bad thought can lead to another and another, and another, until teens feel so beaten down by the vicious cycle that they struggle or fail in multiple parts of their lives. 

Say a teenage boy is suddenly struggling in a class or feeling increased pressure to fit in with his social group — it can be a painful experience. Most teens today desperately want to do well in school and be liked by their peers. When the cycle of negative thought patterns stems from school or social pressures, teens may worry they’ll never be successful in life — they might convince themselves they won’t ever have a healthy adult relationship, won’t do well in college (academically or socially), or won’t get a good job as an adult. 

How CBT can help

CBT helps teens spot the exact moment they start to use negative self-talk about their academic achievements or social interactions. It allows them to realize the path they’re taking themselves down so they can stop. Over time, CBT equips teenagers with the tools to change directions long before their negativity impacts them in a harmful way. 

Relationship with anxiety and depression

Mental Health America (MHA) conducted research that found more than 15% of youth aged 12 – 17 experienced 1 or more major depressive episodes in the last 12 months. The National Institute of Mental Health estimates that nearly 32% of adolescents have a form of anxiety disorder. For 8.3% of them, it causes severe impairment. Having persistent negative thoughts can exacerbate the severity and occurrence of depression or anxiety symptoms.

Both anxiety and depression can convince a teen they’re unable to do the simplest of tasks. Maybe they can’t make it out the door to school in the morning or find the energy to shower and meet up with friends for a movie or to hang out at the mall. These seemingly small things that shouldn’t be overwhelming can suddenly become too daunting to even attempt for a teen with anxiety or depression.

How CBT can help

Whether it’s teen depression or anxiety, CBT can offer hope by breaking down overwhelming thoughts and emotions. It gives teens a playbook with tools and directions on how to deal with anxiety or overcome depression. 

Effects on behavior and decision-making

Teens are known for making the occasional what-in-the-world-were-you-thinking?! decision — but it’s not entirely their fault. Beyond the hormonal imbalance they’re battling that can alter their thought process and ability to make sound decisions, there’s actually neuroscience behind adolescent decision-making. Risky choices can’t always be chalked up to them “not thinking things through.” Scientific evidence suggests teen brain function is unique and hasn’t yet reached adult levels. 

“When our automatic negative thoughts are on autopilot, we create anxiety that can stand in the way of our goals. For example, catastrophizing a situation can lead us to make impulsive decisions based on what we anxiously might anticipate and conclude rather than a well thought out rational perspective.”

– Talkspace therapist Elizabeth Keohan, LCSW-C 

A teenager might experience mood swings that feel like an emotional rollercoaster. The effects can impact how they behave and the decisions they make. They might lash out, have little patience, or be overly emotional about things that might not have bothered them in the past. High-risk behavior or distancing themselves from a social circle can lead to hanging out with a new crowd or experimenting with drugs or alcohol. 

How CBT can help

Cognitive behavioral therapy for teens can be instrumental in teaching teens to cope, giving them a roadmap for how they can act and make decisions.

Benefits of CBT for Teens

Being a teenager today is anything but simple. It’s not the same as it was in the past. Social media, high-stakes testing, intense college admittance pressures, and more create the perfect storm for mental health struggles. CBT can help teens battle negative thoughts and empower them, allowing them to make healthier decisions and understand their potential, worth, and strength.  

Enhancing emotional regulation & resilience

Emotion regulation and resilience aren’t skills that always come naturally — but they are something that can be learned. CBT offers coping mechanisms that help teens recognize their emotions so they can better manage stressful situations instead of being consumed by them.  

For example, CBT can teach teens who react with impulsive, uncontrolled rage when angry to identify the triggers that set them off. Then, they can either avoid stimuli or practice using coping tools to navigate their anger in a healthy and productive way — like by discussing what upset them in a calm manner rather than screaming or becoming violent.   

Improving relationships & social skills

Social situations can be overwhelming during adolescence, especially for those struggling with social anxiety. Some teenagers are painfully shy, and interacting with peers or putting themselves out there feels incredibly scary. Teens who get CBT can learn to communicate and follow social cues so they feel safe and empowered in social settings. 

For example, CBT can help a teen with social anxiety or difficulty establishing and maintaining deep, meaningful friendships start to reframe negative thoughts and associations about being social. Over time, the teen might feel stronger, more confident, and more willing to take risks and participate in social events.  

Building self-esteem & positive self-image

Building self-esteem and creating a positive self-image are crucial to the teenage experience. CBT helps teens argue with their internal negative self-talk so they can find their inner beauty and cultivate positive self-esteem and self-image. 

Some teens have a negative body image. What they see isn’t reality. For example, a teen girl might be a healthy weight for her height and body type but believe she’s extremely overweight — and no amount of positive feedback from others will change that. Teen CBT helps break unhealthy thought patterns that alter her self-view so she can let go of what her inner critic is telling her and begin to set new, healthy expectations about how she should look.   

Find a Teen Therapist Specialized in CBT

If you’re exploring options for therapy, cognitive behavioral therapy for teens might be exactly what you’re looking for if you know a struggling teenager. Talkspace is an online therapy platform with CBT therapists who understand the challenges teens today face. See how Talkspace makes getting help easy, affordable, and convenient — even for busy teens. Get started with online therapy for teens. Plus, teens living in New York City may qualify for free online therapy from Talkspace.