Cognitive behavioral therapy (CBT) is a framework of psychotherapy used for a variety of mental health conditions, including personality disorders. It focuses on helping you identify and restructure unhelpful patterns of thinking and behaving.

Personality disorders are identified by long-term patterns of thinking and behaving that fall outside of what’s typical and cause impairment in everyday life.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), a clinical guidebook used in the diagnosis of mental health conditions, lists 10 types of personality disorders:

These conditions all feature different unhelpful patterns of thinking and behaving. They’re often grouped together by similar characteristics into “clusters”:

  • Cluster A: odd, eccentric behaviors
  • Cluster B: dramatic, erratic behaviors
  • Cluster C: anxious, inhibited behaviors

Treating personality disorders can be challenging and nuanced, but cognitive behavioral therapy (CBT) is considered effective across multiple conditions because it focuses on identifying and restructuring unhelpful patterns of all types.

Experts consider CBT an effective treatment for personality disorders. It’s one of the primary psychotherapy approaches used during treatment and is evidence-based, meaning it’s been proven through research as effective across a variety of mental health conditions.

As a broad framework that comprises many techniques, CBT addresses the core challenges in personality disorders, such as:

  • unhelpful beliefs about self and others
  • emotional identification and regulation
  • environmental factors that reinforce unhelpful behaviors
  • ineffective or underdeveloped coping skills

“Cognitive behavioral therapy is acknowledged as one of the most efficient methods applied for the treatment of various types of personality disorders,” said Michael Anderson, a licensed professional counselor and clinical director at Healing Pines Recovery in Elizabeth, Colorado.

“Most of the patients seek to understand which thoughts, emotions, and behaviors are unhelpful and offer methods to help change their behavior,” he said.

Elvis Rosales, a licensed clinical social worker and clinical director at Align Recovery Centers in Sonoma, California, adds that CBT helps people recognize that unhelpful patterns aren’t fixed and can be changed.

“The key is helping people gain insight into how their thoughts influence their emotions and behaviors and then giving them tools to actively modify these patterns,” he said. “For example, in cases of borderline personality disorder, CBT can help individuals manage overwhelming emotions, reduce impulsive behavior, and improve relationships.”

Each person’s diagnosis is individual and requires a customized treatment approach, even when it comes to CBT. CBT has a variety of techniques and methods of application. Not every personality disorder will be treated with the same CBT approaches.

Anderson and Rosales said several CBT techniques are commonly seen in personality disorder treatment:

  • Cognitive restructuring: This approach helps you identify unhelpful, false, or negative thoughts and replace them with constructive ones.
  • Dialectical behavior therapy (DBT): DBT was developed specifically to treat borderline personality disorder (BPD). It teaches mindfulness training, distress tolerance, emotional regulation, and interpersonal skills.
  • Schema therapy: This one focuses on healing and restructuring negative patterns ingrained from childhood.
  • Exposure therapy: Used in personality disorders where extreme fears or anxieties drive behaviors, this CBT approach involves controlled exposure to the circumstance or situation causing psychological distress.
  • Cognitive interpersonal therapy: This one focuses on identifying unhelpful patterns and recognizing how they affect your relationships with others as well as your thoughts about yourself.
  • Behavioral activation: You’re encouraged to identify and engage in activities that are positive as a way to improve thought patterns and address challenges with social withdrawal.
  • Behavioral reversal: Practicing new beneficial behaviors with your therapist in a safe and supportive environment can help form them into habits.
  • Thought recording: Keeping a journal of your thoughts is used to help you gain insight into patterns of unhelpful thinking.
  • Socratic questioning: Your therapist asks thought-provoking questions to help you examine your personal beliefs.

CBT treatment in personality disorders can vary depending on your individual diagnosis and personal experiences. Your doctor or therapist may use certain CBT elements, like mindfulness, alongside other techniques, like exposure therapy, or may use CBT alongside other psychotherapy frameworks.

Rosales points out that the effectiveness of CBT depends on consistency and long-term commitment.

“Since personality disorders are often intertwined with a person’s identity, the process takes time and involves a lot of repetition,” he said. “I think it’s important to manage expectations here. CBT is unlikely to ‘cure’ a personality disorder entirely, but it can significantly improve quality of life and interpersonal functioning.”

CBT isn’t always suitable for personality disorder treatment.

Anderson explains CBT is an active therapy, so it’s least suited for people who are unmotivated toward change since lack of motivation interferes with performance.

CBT for personality disorders often requires more time than CBT for other mental health conditions, given the deep-seated nature of personality traits.

Rosales also notes CBT requires a certain level of insight and self-awareness. If a person is unable or unwilling to reflect on their own thought patterns, like in narcissistic personality disorder, CBT may not be as effective.

Similarly, in personality disorders where manipulative behaviors and a disregard for others are primary traits, like in antisocial personality disorder, CBT alone might not be sufficient for treatment.

Both experts agree that CBT may not be as effective if you’re experiencing psychosis, a state of altered reality perception. While CBT has adapted forms for psychosis (CBT-P), personality disorders with features of psychosis may require stabilization before initiating therapy.

“Patients with severe psychotic symptoms may require CBT only after symptoms have been controlled,” Anderson said. “Since the patient could be very distracted, stabilizing the patient may offer a better setting for cognitive behavior therapy.”

How to find a CBT therapist

CBT is a common therapy framework widely available in many areas. To find a therapist near you, consider:

  • getting a referral from your primary doctor
  • connecting with your local health and human services office
  • visiting TherapistLocator.net, a directory from the American Association for Marriage and Family Therapy
  • using the Psychologist Locator tool from the American Psychological Association
  • learning more on Healthline’s mental health hub

CBT is a framework of psychotherapy that focuses on identifying and restructuring unhelpful ways of thinking and behaving. It’s an effective treatment option for many types of personality disorders, though it may not be suitable for everyone.

If your therapist recommends CBT, they will work with you to create an individualized treatment plan that considers your diagnosis, symptoms, and personal experiences. Many elements of CBT can be mixed and matched and used alongside other psychotherapy frameworks.