Rethinking CBT: A Path to Empowered Healing or a Dead End Street?

By Samantha Coleman, 29/10/23

Hey everyone!

Introduction

Have you ever experienced that initial lift from CBT, only to find yourself back where you started? I’ve trodden that path. It’s like those fad diets promising the world yet leaving you at square one.

So, you’ve done CBT. You felt better for a bit, and then—bam!—you’re back to square one. Sound familiar? That’s because CBT, for all its hype, often turns out to be a temporary high. Where’s the long-term healing? As a therapist, I’ve heard the words, “What’s the point?” far too often when discussing conventional CBT-based healthcare routes. 

Let’s dive straight into a long overdue conversation. Cognitive Behavioral Therapy (CBT) – it’s everywhere in mental health care, but let’s be honest, does it truly serve as the fix-all solution it’s often portrayed as? Or are we merely clinging to a well-marketed illusion?

Could it be that CBT, often celebrated as the pinnacle of modern psychological interventions, is just a “quick fix” without any lasting benefits? That’s a bit jarring.

I’m not here to rehash the old “CBT vs. Other Therapies” argument. 

No, I want to delve deeper, challenge assumptions, and perhaps make you question what you thought you knew about mental health treatment.

What is CBT?

CBT emerged as a structured, short-term, goal-oriented psychotherapy treatment. Its fundamental premise revolves around the idea that our thoughts, feelings, and behaviours are interconnected and that altering negative thought patterns can lead to changes in emotions and behaviours. 

In therapy, typically spanning 6-12 sessions, the therapist guides you to assess and adjust the validity of your thoughts, encouraging more realistic or balanced perspectives or attitudes. 

From there, your shift in perspective leads to a sense of calm about your situation, influencing you to behave differently and make better choices moving forward. Between sessions, therapists assign up to ten different types of homework tasks*, such as thought records or skills practice, to reinforce these changes.

 Therein lies its appeal: it’s a tangible, pragmatic approach that offers quick results.

We’ve come to believe that CBT serves as the go-to solution for various mental health issues, including anxiety and depression, and is often praised for its short-term effectiveness. Indeed, statistics reveal that around 40% of individuals report improvement after a typical CBT course. But this is where things get a bit murky.

The improvements don’t seem to last. Research has shown that two years down the line, those who underwent CBT are no more likely to have recovered than those who received no treatment at all*.

The Hidden Costs of CBT

Now, I don’t know about you, but that makes me raise an eyebrow. Are we, as a society, investing time, hope, and vast sums of money into a therapy that’s just a temporary fix? (Or, worse, a “pseudo-fix”)?

And we’re not talking about small change here. The UK Government has committed up to £400 million on treatment programmes predominantly based on CBT*. 

Other therapies consider the more profound underlying issues that shape your conscious reality and daily lived experiences. So – why is CBT so prevalent and the go-to treatment for the NHS? And – are we overlooking its limitations? 

Because it’s quick, cheap, and appeals to policymakers. In contrast, therapies more effective in the long term often require more sessions and, by extension, more resources. 

Let’s be candid: CBT’s popularity is primarily due to its cost-effectiveness and time-limited nature. Time is money – they say. 

 Are we prioritising economic factors over comprehensive, personalised care? The focus on cost and efficiency might inadvertently sideline other therapeutic approaches that, despite requiring more time and resources, could offer more profound long-term benefits.

Now, let’s pause for a second. It’s important to remember that many people have found solace and improvement through CBT. It’s not some evil scheme. But it’s a potential massive oversight in our approach to mental health treatment—a one-size-fits-all method that might be leaving many behind.

If you’ve suffered from long-term mental health issues, inevitably, you’ll find yourself feeling increasingly disillusioned, invalidated, and hopeless. 

It’s understandable to feel frustrated and begin to distrust “the system,” especially when the only “help” you receive fails to delve deep enough and doesn’t offer substantial or lasting relief.

Is it an ineffective “quick fix”? 

Initially, CBT’s efficacy seems indisputable. Numerous studies have underscored its effectiveness in providing short-term relief for mental health concerns.

However, it’s this very emphasis on the short term that warrants a critical lens. The durability of CBT’s effects remains under-explored. While you may experience relief post-treatment, the long-term sustainability of these benefits needs to be clarified. 

What’s Wrong With CBT?

Does CBT provide a fleeting layer of positivity over the bedrock of your psyche? 

The big question is: Are we mis-selling mental health treatment to those in need? Are we, as a society, so enamoured with the idea of a quick fix that we’re ignoring the complexities of the human mind?

Are we treating every unique, complex individual with the same CBT toolkit? Isn’t that like trying to fix every problem with duct tape?

While CBT might give you a temporary glow, it fails to address the deep-seated issues—the root causes of your problems, which often stem from traumatic or depriving experiences—past experiences of having your fundamental needs denied, neglected, misused, or invalidated. 

Does CBT miss the point and fail to address our needs – or worse, exacerbate our problems?

Going Through the Motions

For many years, my clients have frequently reported feeling patronised during the CBT process – if not by the therapist, then by the nature of the “homework” – and resort to “going through the motions” with it. 

Consider the “response bias” or, more specifically, the “social desirability bias.”* 

Here, survey respondents actively give answers they think are socially acceptable or desirable instead of what they honestly believe or feel. 

Our desires to conform, to be liked, or to avoid criticism or judgment powerfully influence us – particularly if our defences are low and there’s a power imbalance. 

Worse yet, with poor mental health, we lack the self-advocacy, self-worth and motivation to seek out appropriate help, let alone challenge the system – including our therapist or the efficacy of the work. 

Desperate for help, you’ll accept whatever’s available, especially if you risk losing healthcare support for not engaging with, agreeing with, or responding to the treatment.

Neurodivergent Concerns

Neurodivergent clients have even more concerns – from finding the “homework” yet another demand they can’t cope with to turning the activity into a perfectionist, hyperfocused, cerebral exercise aimed to impress their therapist (or avoid rejection – same thing). 

Our mental health is a complex, magnificent tapestry that requires nuanced and diverse approaches. Isn’t it time we advocated for therapies that honour our unique complexities?

Empowerment stems from questioning, from seeking paths that resonate with our unique selves. Your mental landscape isn’t a standard road.

Is CBT Based on Mistaken Assumptions About Our Minds?

CBT works on the assumption that our thoughts are the main culprit and prime mover* of our mental health struggles and woes. I can’t entirely agree.

Emotions are the prime mover of our lives. Thoughts are the “aftermath” of our emotions – the narratives we create that emerge from the bedrock of our feelings. 

Whatever you feel, your mind weaves and constructs a complex reality – and so the story of your life unfolds – springing from (based on) pure emotions*.

CBT’s primary focus on thoughts over emotions presents a challenge that can detract from the therapy’s long-term effectiveness. Concentrating mainly on modifying thought patterns and largely neglecting the underlying feelings causing them may, at best, offer a temporary respite from distressing symptoms. 

This approach resembles an illusion, tricking you into momentarily forgetting your genuine emotional experiences without truly addressing or resolving them. Our wounds persist beneath the surface, unhealed and liable to resurface when the fleeting relief inevitably gives way.

Human psychology is incredibly complex and diverse. Can a single therapeutic approach adequately address the nuances of everyone’s psychological makeup? This homogenisation of treatment risks overlooking the unique, contextual factors contributing to our conscious landscape.

Final Words

This debate isn’t just academic. It has real-world implications for millions struggling with mental health issues. It’s a call for a more nuanced, personalised approach to treatment—one that doesn’t just aim to patch up our problems temporarily but seeks to understand and address their roots.

While CBT has undeniably contributed positively to psychotherapy, a critical examination reveals significant gaps. This critique isn’t a call to abandon CBT but an invitation to balance. It’s crucial to integrate CBT’s strengths with other therapeutic approaches that delve deeper into the complexities of the human psyche. In doing so, the psychological community can offer a more nuanced, comprehensive, and ultimately effective spectrum of mental health care.

Remember: empowerment comes from daring to question and daring to seek more. So, let’s keep this conversation going. Demand more, question the norms and always remember: your story is yours alone, and it deserves nothing but the utmost respect and care.

Thanks for reading,

Samantha Coleman

October 29th 2023