Casually scrolling through instagram, I came across a reel where a person was talking about CBT, and felt like it was gaslighting. I was really intrigued by their experience of it. This immediately got my therapist brain fired up with many thoughts. I have heard similar concerns from clients, speakers at conferences and seminars that say CBT just didn’t work for them or worse was harmful for them.
This made me think - CBT is widely considered the go-to therapy. First time therapy seeking clients often ask for this therapy as they have been informed by a psychiatrist or a friend, but they themselves know very little about it. In the past few years, due to its popularity, CBT has even been used as a synonym for all talk therapies.
Cognitive Behavioural Therapy in a nutshell is a simple model that explores how cognition, emotion, and behaviour are related.
- Automatic Thoughts: These are immediate, spontaneous interpretations of events that shape both emotions and actions. For example, if someone crosses you in the hallway and doesn't say hello, an automatic thought might be "they hate me," which could lead to negative emotions and avoidant behaviour.
- Cognitive Distortions: These are errors in logic that lead to erroneous conclusions.
- Underlying Beliefs or Schemas: Underlying beliefs shape the perception and interpretation of events.
An oversimplification of this therapy would be - ‘thoughts create our reality’. Like the quick formula would be:
Change your thoughts (especially “faulty beliefs”) + your feelings = behaviour will improve i.e. problems solved.
No therapy is that cut and dry, If we look at the context behind this therapy - It is the most well researched therapy method out there but how did it get there and why is it preferred over other therapies?
Here is a little bit of history: Aaron Beck noticed that his depressed patients frequently expressed ideas or "cognitive distortions" which were not backed by real life evidence. Hence, making him see depression more as a cognitive disorder rather than as a mood disorder. Many years later, Beck did more complex testing of clinical interventions that included cognitive, emotional, and behavioural components. And ta-da CBT was born. Beck developed a model that psychologists defined as an “empirically validated psychological treatment” ; these are therapeutic techniques that have been tested multiple times and have been shown to be valid and effective. The nature of CBT makes it easier than most therapies to test because of it’s detailed treatment protocol manual which is why it is the most well researched therapy out there.
The popularity of cognitive behavioural therapy (CBT) can be attributed to -
- Availability - In 2005, with the increased demand for psychotherapy, the UK government wanted to increase the accessibility of psychological therapy. CBT was their first choice because it worked well with these concerns and they put in millions of pounds to train CBT therapists.
- Quick outcomes at a reasonable price- The therapy is targeted, brief and can yield effects rather quickly. As well as the fundamental ideas are simple to comprehend and learn.
- Evidence based - Since it is well researched, it very naturally lends itself to scientific testing.
- It provides measurable outcomes - The goal of cognitive behavioural therapy is to gauge your progress. It is more outcome focused.
So, CBT does work (at least according to research)!
‘But will a quick-fix sustain all your mental health problems?’
Like any other psychotherapy one must be aware of its ‘potential misuse’. CBT focuses on thinking errors, it can be used to correct or reframe someone's thinking and even invalidate or gaslight someone into doubting their own personal reality. This is especially true when it is not done in collaboration with the client. It is easy to assume that your ideas must be incorrect, especially when someone you trust tells you so!
One of the major drawbacks of CBT is that it doesn’t work well for individuals with complex mental health needs like -
- It’s a manualized approach that might not cater to the nuanced experiences of neurodivergent individuals. Many neurodivergent individuals, especially autistic people have written a lot about their experience of CBT and how it has affected them.
- It doesn't address any systemic or familial issues that could significantly affect someone's health and well-being.
- It addresses an individual's thinking therefore might not work well with traumatic experiences as trauma causes emotional and bodily dysregulation that hinders a person's capacity for rational thought.
It is important and necessary for therapists to be mindful of their approach and to be flexible in incorporating various therapeutic tools as needed. The key role of curiosity and exploration of the client's experiences and tailor-made collaborative treatment planning is necessary in the therapeutic journey.
As a therapist I use sprinkles of CBT in my practice. It is a valuable approach in certain situations with tools that can be effective and easily learnt. It irks me that it has become the flag bearer for psychotherapies because using only CBT without acknowledging my clients’ whole experience feels like a puzzle with many important missing pieces, leaving both of us unable to see the bigger picture or make sense of the world around us.
