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Cognitive Behavioural Therapy (CBT) is widely recognised as a gold-standard treatment due to its evidence-based effectiveness for a variety of psychological disorders. It is particularly effective when addressing anxiety and obsessive-compulsive disorders.
It is not unusual to encounter clients who tell us they’ve tried psychological therapy via CBT, but it hasn’t been effective. There are a range of reasons why this might be so.
This article focuses on the challenges that can arise when CBT isn’t applied properly.
Cognitive Behavioural Therapy
Challenges to its success
Therapist Competence: The effectiveness of CBT relies heavily on the therapist's skill and understanding of the method. There may also be a lack of confidence in applying some strategies, such as Exposure and Response Prevention. Inadequately trained or confident therapists may not apply CBT techniques effectively, leading to suboptimal outcomes.
One-Size-Fits-All Approach: CBT is intended to be personalised to your unique symptoms and circumstances. It is not ideal to take a one-size-fits-all approach without adequately considering your individual needs. There is no one set way of applying CBT, and the strategies applied need to be based on a thorough understanding of you and the most effective ways to help you.
Client Engagement: CBT requires active participation and homework. If patients are not fully engaged or lack motivation, the therapy may be less effective. Certainly this is true of almost any therapy. Part of CBT is to encourage and foster this motivation, but it does rely upon client engagement.
Overemphasis on Rationality: It is certainly very helpful to challenge unrealistic thoughts and appraisals. Often, however, this might come at the expense of addressing the underlying processes that lead to what might be an unhealthy pattern of unrealistic appraisals. Furthermore, there are times in which it is entirely counter-productive to spend long periods challenging the content of ‘negative thoughts’. Instead, it is far more worthwhile challenging the need to address the thought at all. Just because a negative thought presents itself, doesn’t mean it requires your attention.
Underemphasis on Rationality: There can at times be too much focus on ‘positive thinking’. There can be too much focus on ‘not feeling anxious/sad’. This is the unrealistic. The ‘rational’ reality is that negative/unpleasant/bad things do happen, and it’s healthy to have anxiety, sadness, anger and all of the emotions sometimes considered ‘negative’. However, we want to have them in a healthy way, and in proportion with whatever is happening in life to provoke them.
Cultural Sensitivity: CBT must be adapted to fit the cultural context of the patient. Therapists who fail to consider cultural factors may not fully address the patient's needs.
Used When it’s NOT the Gold-Standard: While CBT is effective for many conditions, it is not the gold-standard for all of them, and it may not be appropriate or sufficient for complex cases with multiple comorbidities or deeply entrenched patterns of behaviour. For example, Dialectical Behaviour Therapy has been demonstrated to be a more effective framework to treat Borderline Personality Disorder.
Cognitive Behavioural Therapy
Brief reminder of its strenghts
Evidence-Based: CBT is one of the most researched forms of therapy, with extensive studies supporting its effectiveness in treating conditions like depression, anxiety, OCD, PTSD, and others.
Structured Approach: CBT is known for its structured, goal-oriented approach. It helps people identify and challenge distorted thinking patterns, and then make more realistic appraisals more accessible.
Skill Building: CBT equips people with coping strategies and problem-solving skills that are practical and applicable to everyday life.
Empowering: It emphasises collaboration. Through active participation, people are helped to take control of their mental health both in the short-term and in the long-term. You will effectively become your own therapist.
Time-Efficient: Compared to some other forms of therapy, CBT is generally short-term, making it a practical option for many people. Remember though, the lessons learned and the changes made are long-term.
Summary
...and suggestions
In summary, the strengths of CBT in treating anxiety and mood disorders are compelling. It’s a well-researched, evidence-based treatment option that’s been shown to be the most effective treatment options for these conditions.
However, it’s not always successful. There are several reasons why this may be so, including inadequate delivery by the therapist and lack of client engagement.
If you’re unsure about your treatment, it’s healthy and entirely appropriate to discuss with your therapist their choice of treatment framework, whether it’s gold-standard, and how it’s specifically being tailored to you. At Boyce & Dale Anxiety and Mood Disorders Clinic, this discussion will occur upon meeting you and understanding your presenting concerns.
If we feel CBT offers you the best chance of overcoming your challenges, but you’ve tried it before without luck, we’ll do a few things. First, we’ll ask about what exactly you tried, and what did or did not work for you. Then, we’ll explain our rationale for CBT and link it specifically to your needs. Nothing will be done without explaining exactly why we’re doing it.
We’re confident that upon this rationale, you’ll see that we have a clear, evidence-based plan for your specific needs. Then, we can get on with helping.