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J. Connor Barnhart, MD

Cognitive Behavioral Therapy in San Francisco

Also known as: CBT, Cognitive Therapy, Cognitive Behavioural Therapy, Behavior Therapy, Cognitive-Behavioral Treatment

4 min readLast updated: 2026-02-20
Reviewed by J. Connor Barnhart, MD

Cognitive behavioral therapy (CBT) is a structured, evidence-based form of psychotherapy that focuses on identifying and modifying unhelpful patterns of thinking and behavior that contribute to psychological distress. Through collaborative work between therapist and patient, CBT teaches practical skills for managing symptoms, with extensive research supporting its effectiveness for depression, anxiety disorders, PTSD, insomnia, and a range of other mental health conditions.

At a Glance

  • A large review of over 400 clinical trials found that about 42% of people with depression improved with CBT, compared to 19% without treatment[1]
  • A review of 269 meta-analyses concluded that the evidence base for CBT is very strong, with the strongest support for anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress[2]
  • CBT is recommended as a first-line psychological treatment for depression and anxiety disorders in clinical practice guidelines from the APA, NICE, and other major professional organizations[3]
  • Research indicates that CBT produces outcomes comparable to pharmacotherapy in the short term, with evidence suggesting more durable effects at 6 to 12 month follow-up[1]

Overview

Cognitive behavioral therapy is based on the principle that psychological problems are partly maintained by unhelpful patterns of thinking and learned patterns of behavior. By identifying and challenging distorted thoughts and gradually changing maladaptive behaviors, individuals can develop more effective ways of coping with difficulties and reduce psychological distress.

CBT is typically a structured, time-limited treatment conducted over a defined number of sessions. Unlike more open-ended therapeutic approaches, CBT follows a collaborative agenda-setting model where therapist and patient work together on specific, measurable goals. Sessions involve both in-session exercises and between-session practice to reinforce new skills.

The cognitive component of CBT involves identifying automatic negative thoughts and cognitive distortions, evaluating the evidence for and against these thoughts, and developing more balanced, realistic alternatives. Common cognitive distortions addressed include catastrophizing, black-and-white thinking, overgeneralization, and mental filtering.

The behavioral component includes techniques such as behavioral activation, exposure to feared situations, behavioral experiments to test predictions, and skills training. CBT has one of the largest evidence bases of any psychotherapy, supported by hundreds of randomized controlled trials across a wide range of conditions.

What to Expect During Treatment

  1. 1Initial assessment involves a comprehensive evaluation of symptoms, their history and triggers, current functioning, and treatment goals to develop a shared understanding of the problem and create a treatment plan.
  2. 2Psychoeducation introduces the cognitive model, explaining the connections between thoughts, feelings, and behaviors and how therapy will target these connections.
  3. 3The therapist and patient collaboratively set an agenda at the beginning of each session, prioritizing the most important issues to address.
  4. 4Cognitive restructuring exercises help the patient identify, evaluate, and modify unhelpful thought patterns using tools such as thought records, Socratic questioning, and evidence-based reasoning.
  5. 5Behavioral interventions are introduced based on the patient's specific needs, which may include behavioral activation, exposure exercises, behavioral experiments, or skills practice.
  6. 6Between-session homework assignments are collaboratively designed to practice skills learned in session, gather data about thought and behavior patterns, and test new strategies in daily life.
  7. 7Regular progress monitoring occurs through clinical assessment and standardized measures to evaluate whether the treatment approach is effective and adjust the plan as needed.
  8. 8Relapse prevention planning occurs toward the end of treatment, helping the patient consolidate gains, anticipate future challenges, and develop a plan for maintaining progress independently.

How does Cognitive Behavioral Therapy work?

  • CBT is based on the cognitive model, which proposes that distorted or unhelpful thinking patterns influence emotions and behaviors, and that modifying these thoughts can lead to changes in how a person feels and acts
  • Cognitive restructuring teaches patients to identify automatic negative thoughts, evaluate the evidence supporting and contradicting these thoughts, and develop more balanced, realistic alternative interpretations
  • Behavioral activation increases engagement in valued activities to counter the withdrawal and avoidance patterns common in depression, directly improving mood through increased positive reinforcement
  • Exposure-based techniques involve gradual, systematic confrontation with feared stimuli or situations, allowing new learning to occur and reducing anxiety responses through habituation and inhibitory learning
  • Behavioral experiments provide a structured way to test predictions and beliefs in real-world situations, generating direct evidence that can shift deeply held assumptions
  • Skills training components may include relaxation techniques, problem-solving strategies, assertiveness training, and stress management, providing practical tools that patients can apply independently

When It's Recommended

  • Major depressive disorder and persistent depressive disorder
  • Generalized anxiety disorder, social anxiety disorder, and panic disorder
  • Post-traumatic stress disorder (PTSD) and acute stress disorder
  • Obsessive-compulsive disorder (OCD)
  • Specific phobias and agoraphobia
  • Insomnia and sleep-wake disorders
  • Eating disorders including bulimia nervosa and binge eating disorder
  • Substance use disorders
  • Bipolar disorder (adjunctive to medication)
  • Attention-deficit/hyperactivity disorder (ADHD) in adults
  • Chronic pain management (psychological component)

Conditions I Treat

Anxiety

Anxiety is a mental health condition that can involve persistent worry, nervousness, or unease about events with uncertain outcomes. Anxiety disorders...

Depression

Depression is a common and serious mental health condition involving persistent feelings of sadness, hopelessness, and loss of interest in activities....

Bipolar Disorder

Bipolar disorder is a mental health condition that causes significant shifts in mood, energy, activity levels, and thinking. People with bipolar disor...

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after exposure to a traumatic event involving actual or threatened...

ADHD (Attention-Deficit/Hyperactivity Disorder)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition marked by persistent patterns of inattention, hyperactivity, and imp...

OCD (Obsessive-Compulsive Disorder)

Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences intrusive and recurring thoughts known as obsessions, e...

Recovery & Aftercare

  • CBT does not involve physical procedures, so there is no physical recovery period between sessions
  • Some emotional processing may continue between sessions as patients apply new cognitive and behavioral strategies in daily life
  • Skills learned in CBT, such as cognitive restructuring and behavioral activation, are designed to become self-sustaining tools that patients use independently
  • Treatment duration typically ranges from 8 to 20 sessions for many conditions, though more complex presentations may require longer treatment
  • Research suggests that CBT produces lasting gains, with effects often maintained or continuing to improve at follow-up assessments months after treatment ends

Alternative Treatments

  • Psychodynamic therapy for deeper exploration of unconscious patterns and relational dynamics
  • Acceptance and commitment therapy (ACT) for psychological flexibility and values-based living
  • Dialectical behavior therapy (DBT) for emotion regulation and distress tolerance
  • Psychiatric medication management for pharmacological support
  • Mindfulness-based stress reduction (MBSR) for stress and anxiety management
  • Interpersonal therapy (IPT) for depression related to relational difficulties

Related Treatments

Psychodynamic TherapyPsychotherapyMedication Management

Frequently Asked Questions

Cognitive behavioral therapy is a more structured form of talk therapy that helps you identify and change unhelpful patterns of thinking and behavior contributing to emotional distress. It is one of the most extensively researched psychotherapies, in part due to its structured design, with evidence in the treatment of depression, anxiety, PTSD, and many other conditions. While the standardization of CBT makes it easier for research to be conducted, it is not necessarily the "best" form of therapy or the right approach for everyone. Individual differences and the therapeutic relationship with your therapist likely matter more than the specific modality of therapy.
Some aspects of CBT, particularly exposure exercises for anxiety or trauma, can bring up difficult emotions temporarily. This is a normal and expected part of the process that typically leads to meaningful improvement. Your therapist will guide the pace of treatment to keep it manageable.
CBT is generally considered safe when conducted by a trained mental health professional. Commonly, temporary emotional discomfort when working through challenging material can occur. See the safety section above for specific considerations.
The number of sessions depends on the condition and its severity. Many people see meaningful improvement within a time-limited format of weekly sessions for 3 to 6 months. Conditions such as specific phobias may require fewer sessions, while more complex presentations may benefit from longer treatment.
During a typical session, you and your therapist set an agenda, review homework from the previous week, work through cognitive or behavioral exercises, and plan between-session practice. Sessions are typically 45 to 60 minutes and are more structured than some other forms of therapy.
Individuals in acute psychotic episodes without medication stabilization, those in immediate suicidal crisis requiring a higher level of care, or those unable to engage in between-session practice may not benefit from standard CBT initially. Alternative approaches may be more appropriate as a starting point.
For current session rates and payment options, please visit my Services page or contact my office directly. Fees are prorated based on time spent on patient care.
Dr. Barnhart is out-of-network with all commercial insurance and Medicare Advantage plans. He is enrolled as a non-participating physician with Original Medicare Part B (limited slots). Superbills are provided for out-of-network reimbursement. HSA and FSA payments are accepted.
Dr. Barnhart's office is at 35 Vicente Street, in the West Portal neighborhood of San Francisco. In-person sessions are available on select days of the week (contact the office to learn more). Telehealth sessions are available throughout California, when appropriate, following an initial in-person session.

Your Practitioner

J. Connor Barnhart

J. Connor Barnhart, MD

Dr. J. Connor Barnhart is a board-certified psychiatrist and psychotherapist practicing in San Francisco. He completed his psychiatry residency at UCSF, where he trained in the Bipolar, LGBT, and Women's Mental Health specialty clinics and developed focused expertise in integrative psychiatry through a year-long rotation at the UCSF Osher Center. He attended medical school at the University of Pennsylvania's Perelman School of Medicine and graduated from Brown University with honors in Human Biology. His practice combines insight-oriented therapy, medication management, supplements, and lifestyle optimization to holistically address the root causes of mental health challenges including depression, anxiety, and difficulties with focus.

Medically reviewed by J. Connor Barnhart, MD · Last reviewed: 2026-06-03