Cognitive Behavioral Therapy (CBT)


Our therapists apply Cognitive Behavioral Therapy CBT and related behavioral therapies to achieve optimal results for the patients that respond best. Others respond well to more recent iterations of CBT: “third wave approaches.”

What is Cognitive Behavioral Therapy (CBT)?

CBT is a solution focused therapy, and is best suited for those who have specific goals for their life and who are open to learning better coping skills. It’s a type of talk therapy that is best done one-on-one with a CBT trained clinician. It’s based on the idea that we think in processes, so we can break down how we think in order to change how we act. Because it is goal focused, it tends to require fewer sessions than other therapy modalities.

While we offer traditional cognitive behavioral therapy (CBT), we also are one of the few therapy providers in the Seattle area that practice “third wave” cognitive behavioral therapies. These include the use of acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT) in our practice.

Why are these our preferred treatment options? Simply because they work.

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In What Conditions is CBT Treatment Used?

Some mental health disorders that improve with CBT include:

  • Depression
  • Anxiety disorders
  • Phobias
  • PTSD
  • Sleep disorders (insomnia)
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Substance use disorders
  • Bipolar disorders
  • Schizophrenia
  • Sexual disorders

    How Cognitive Behavioral Therapy Works

    The 4 Steps of Cognitive Behavioral Therapy

    Step One:

    Set goals. Then identify the relationship between your thoughts, feelings and behaviors.

    You can think of your life as a cycle between thoughts, feelings and behavior. For example, those with social anxiety may think that in order to be accepted at a social gathering they have to entertain everyone there, and so must act and drive the conversation. This can be burdensome and make them dread attending, possibly to the point where they are too anxious to show-up and instead act out and call in sick.

    If our expectations of ourselves feel too high, we can feel overwhelmed and behave anxious or avoidant. This in turn may put more pressure on ourselves to be even more entertaining at the next event, only increasing our stress.

    Cognitive behavioral therapy examines such a cycle in order to help break it. For this reason at Acuity we start by asking “what is the specific goal you want to achieve after coming to therapy?” Only then do we examine the thoughts, feelings and behaviors that you currently experience in relation to that goal.

    Notably, at times we have deeper core beliefs that change how we act. Beliefs such as: “I am worthless”, “I am incompetent”, “No one could love me”, “I must excel in my work”, “ It’s too dangerous to express my feelings” or “I must do whatever it takes to get others approval.” Discovering your core beliefs and considering if they are preventing your personal growth is an important step in our process at Acuity.


    Step Two:

    Challenge the thoughts that form obstacles in your life.

    After you have undergone some initial introspection, you can start challenging how you think. You may have realized that in certain situations we take mental shortcuts to the wrong conclusion (what we therapists call cognitive distortions).

    For example: If your spouse comes home and doesn’t say “hello,” as they usually do, what do you think?

     Thought #1: You could think, “they are too busy to say hello because they don’t care.”

     Or could an alternate explanation be:

     Thought #2: “They didn’t say hello because they didn’t see me or they were preoccupied.”

    It’s easy to jump to that first conclusion, but catching that you are doing that is an important step to improvement. At Acuity we can take such distortions one at a time and examine what has led us to believe or feel that way, and then consider some alternatives.

    Overall, being able to challenge your thoughts and conclusions at a deeper level allows you to think more clearly and move forward. Your CBT therapist will help you identify your specific “mental shortcuts” and help you challenge these beliefs so that you can react more clearly in the future.


    Step Three:

    Develop new coping strategies and skills

    Keep in mind that retraining your brain doesn’t always come easily. Sometimes we have to learn new coping strategies and skills. These can be anything from stress reduction techniques to communication skills.

    For example, if you are avoiding social situations because you don’t know what to say, your therapist may role-play a typical interaction. You can learn some ways to share more about yourself, and to open a conversation on your terms. Then later you can apply this to more challenging situations in which you have less control.


    Step 4:

    Homework. What you learn in session should be applied to your daily life.

    Depending on your preferences, some cognitive behavioral therapists may assign homework. This can range from journaling, to exposing yourself to difficult situations or listening with a different intention during an argument with your spouse. The specifics depend on each person, but overall we know that applying the new skills that you learn in therapy helps you to get back into the swing of things.

    CBT Takes Advantage of Our Neuroplasticity 

    CBT is based on the idea that our brain is always changing.

    The idea that can be most damaging to patient success is the idea that our brains are “stuck” one way or the other, or are static. Many people believe that once we reach a certain age, we are done developing, and that we won’t change. Though this may make us feel secure in who we are, this isn’t the whole truth.   

    The truth is that our brains are able to constantly rewire themselves. We can change what we know about something, how we react and in turn how we behave. That means that if you are behaving in an unproductive or dangerous way now, it doesn’t mean that you always will. In fact, humans have a significant opportunity for rebirth unlike any other animal in the world. 

    The idea that our brain can rewire itself is called “neuroplasticity” and has been thoroughly researched. For example, the brains of patients who have undergone CBT have been shown to change throughout the course of therapy, as shown through brain scans. [1

    More basic talk therapies that ask you to examine your past tend to get too backwards looking. CBT works because it asks you to change your behavior today and tomorrow. By going one step further, CBT has been shown to be successful in treating many mental conditions involving non-ideal behaviors.

    Acuity Uses the Latest Variation of CBT: Third Wave CBT

    Traditional CBT can get a little too mechanical, and can devolve into treating patients like machines. “Fix A then B and C with resolve.” But people are much more complicated than that. That’s why at Acuity we draw from a few “third wave” cognitive behavioral therapies. For example, ACT and MBCT both ask us to come to terms with our emotions, challenge them at times, but not let that challenge turn into a lifelong and tiring fight against our emotions.

    In fact, in the last decade these new variations to CBT have been applied more and more to patient populations around the world to great success. We have seen this success in our own practice, which is why we have made “Third Wave” CBT integral to our practice and our treatment approaches. 

    What is “Third Wave” CBT?

    In short “Third Wave” CBT takes the essence of traditional CBT and infuses traditional techniques that have changed our brains and cognition for thousands of years. Three subfields of therapy can be used alone or in combination for treatment. These subfields are: mindfulness, acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT). 

    These new “mindful” additions to CBT can make it much more powerful, as these concepts have been proven to enhance our neuroplasticity (a fact that has been widely studied) [2]. In this way, the marriage of traditional CBT with these mindfulness based approaches was inevitable, as they have enhanced each other in very powerful ways.

    For example, instead of asking “Why am I sad?” and responding by trying to think happy thoughts and move on, we can come to terms with that sadness, accept it as a part of ourselves in some way, and not let it control us. We understand that you can accept (but not submit to) difficult feelings or thoughts and, in turn, not let them control you.

    Frequently Asked Questions for EMDR Therapy

    Which therapist is right for me?

    Let us help you find the right therapist. Many of our therapists specialize in anxiety, so view our profiles online to learn more about specific counselors specializing in anxiety treatment or speak with our Client Care Coordinator, who can help you with a personalized match to the right therapist for your needs. 

    Finding the RIGHT therapist is the most important piece of reaching your goals.

    How long does Therapy take?

    Counseling works best within the framework of a safe and trusted therapeutic alliance. Since it takes time to build this relationship with your therapist, we recommend committing to weekly sessions for at least 8 weeks. Research shows that consistency adds to the positive outcomes of therapy. Once you reach your 8-week goal, you and your therapist can discuss a frequency of sessions that will support your continued success.

    I’ve never done therapy before...What can I expect in my sessions?

    The unknown of anything new can make it scary. Especially if you’ve never been to counseling before. Let us show you the “roadmap” so you know what to expect:

    1st Session:
    This first meeting is an introduction for both you and your counselor. Your therapist will explain the therapy process and go over the specifics of informed consent. From there, your therapist will gather additional information about your history, current circumstances, as well as struggles and personal strengths, which will help them to define a treatment plan that aligns with your goals. 

    This is also the chance for you to learn more about your therapist. We encourage you to ask questions and get to know them; the relationship you build with your therapist will be the most important part of your work together. 

    2nd Session and Future sessions:
    In your weekly sessions, you and your therapist will use evidenced based therapies such as CBT, Mindfulness or ACT, to help you address your symptoms of worry, stress and anxiety. For anxiety rooted in trauma, or related to obsessive compulsive disorder (OCD), your therapist may recommend treatment with EMDR.

    Closing Sessions:
    Our goal is for you to find relief from your anxiety and be ready to “graduate” from therapy. In the last few sessions with your therapist, you will review your initial goals, the progress you have made, and solidify your new skills for managing anxiety in your life. At your last meeting together, you’ll have the time for the meaningful goodbye with your therapist.

    How much does Counseling cost?

    We strive to create access to high quality mental healthcare for everyone. Our therapists’ rates vary by experience and specialized training. We will make every effort to find the right therapist for you. 

    Acuity Counseling also accepts health insurance and offers both in-network and out-of-network coverage. 

    We are in-network partners with: 



    First Choice

    Premera Blue Cross

    * We do not participate in EAP plans

    Why don’t you only use Cognitive Behavioral Therapy (CBT)?

    While we use CBT as an aspect of our therapeutic approaches, we know that every individual is different. No one responds to any method perfectly, so by employing many techniques we are able to provide the most personalized support. Cognitive Behavioral Therapy is talked about in relation to mental health so often because it has a large body of research behind it and is easy to replicate across all cases. This is why you may hear it called “evidence based,” which it certainly is. However, we use other evidence based therapies in conjunction with CBT in our therapies.

    How can I evaluate whether therapy is working?

    Acuity is unique because we use research backed questionnaires to assess your mood, goals and progress. From time to time we may share with you your progress on these reports, “you report being angry 30% less days than when you started therapy,” and then ask what your goals for the future may be. We have found that by having clients set their own goals and following up regularly we can achieve better results.

    Is medication used in conjunction with your therapy?

    Some conditions for some people are best treated with the help of medication. If we find it necessary after our initial assessments, we will discuss types of medication, your comfort with it, and the pros and cons of medication with you. If you so choose, we can refer you to the appropriate psychopharmacologist in the area. If you are already on medication, we will coordinate treatment with your primary provider.

    Break-free and begin your journey to

    Your best

    There is a future life where trauma does not control your day. Imagine yourself feeling calm, confident and ready to handle new situations with ease. The tools to living the life you have always envisioned are here, at your fingertips.

    LifeStance Health can help.


    Reach out directly to our Client Care Coordinator for questions, matching, and scheduling:

    Online Counseling

    Our services are also available online through Zoom. Telehealth/Online counseling gives you the opportunity to explore your challenges in life without complicating your daily schedule.


    First Session Within 72 Hours of Calling

    We book you an appointment within 24 hours of contacting us (usually less) and make sure your first appointment is soon after.


    Call our office to schedule your appointment, or for any changes regarding scheduling.

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    Counseling services are often covered in full or in part by your health insurance company. LifeStance proudly accepts most major health insurance plans.
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