Common Misconceptions of Cognitive-Behavioral Therapy

In this previous post I provided an overview of cognitive-behavioral therapy (CBT), a therapeutic approach based on the idea that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. To follow up, I thought it would be useful to address some of the common misconceptions people have about CBT. Given how popular it is, there is plenty of information about CBT on the web, not all of it good or accurate.

CBT teaches you to think positively.

Because CBT theory emphasizes the interaction of thoughts and emotions, a major component of therapy is challenging unhelpful patterns of thinking (i.e., cognitive distortions), such as all-or-nothing thinking (“My girlfriend recently broke up with me, I’ll never find anyone to love me”) or catastrophizing (“Since I got a bad grade on this test, I’ll likely fail this class and won’t graduate”). Because the vast majority of these distortions are negative, many people assume that one goal of CBT is to replace negative thoughts with positive thoughts. However, that is not quite correct. The key is the word “distortion” – the goal of therapy is to challenge thoughts that are not rational, helpful, or based on evidence, and replace them with more adaptive thinking. See this video from the Beck Institute for a great explanation of this issue.

CBT is rigid and manual-based.

A common misconception of CBT is that it is a rigid, one-size-fits-all therapy based on manuals. I believe this belief is popular because there are a variety of CBT manuals for therapists attempting to learn the technique and for use in clinical trials evaluating the effectiveness of the therapy. However, well-trained therapists are skilled in tailoring the approach to the needs of individual clients, and most will also incorporate techniques from other therapy approaches as needed (see my example below of how to use motivational interviewing and CBT together!).

CBT only works with motivated clients.

Because it often includes exercises (homework!) done outside the therapy session, it’s commonly assumed that CBT is only effective with very motivated clients. There are a few reasons why this is not true. First, any therapist, regardless of their orientation, should be trained in how to engage clients through the careful use of language, matching their interpersonal style to that of the client, or by leveraging the rapport built in the therapeutic relationship.

Second, many therapists are trained in a range of therapeutic approaches and can combine approaches as necessary to meet the needs of their client. One approach I’ve found effective is blending techniques from Motivational Interviewing with CBT. It’s a relatively common approach (common enough for an entire book to be written about it!). The thing I like most about motivational interviewing is that it is a “meet your client where they are at” approach that is supportive, gentle, and non-judgmental.

Lastly, one nice feature of CBT is the notion that the therapist and client work on small, approachable goals throughout therapy. A client is not asked to take on more than feels manageable or reasonable, and they get to quickly see tangible results of their efforts. This is reinforcing and often strengthens motivation.

CBT is only supported for use with anxiety and depression.

Cognitive behavioral therapy was developed by Dr. Aaron Beck, who originally applied his theory to the treatment of depression. Since then, it has also become recognized as the gold standard for the treatment of anxiety. However, CBT is recognized as an effective therapy for a wide range of psychological disorders including schizophrenia, ADHD, and eating disorders. See this analysis by the American Psychological Association evaluating the evidence supporting the use of CBT for a variety of disorders.

I hope that you have found this blog post helpful today. If you are in the Austin area and contemplating starting psychotherapy, I am happy to speak with you on the phone to answer any questions you may have, including those about CBT. Please reach out to me at or 512-521-1531.

A Primer on Cognitive-Behavioral Therapy

Is it just me or does it feel like it has been raining forever in Austin? We’ve had fewer opportunities to spend outside, we are seeing much less of that beautiful Texas sunshine, and our already terrible traffic has been worse than usual. Maybe you were already struggling with feelings of depression or anxiety, and the weather has sent those feelings into overdrive. You’re at a point that it feels like too much to deal with on your own and you are considering psychotherapy. My blog post today will give you a primer on cognitive-behavioral therapy, a treatment that my clients and I have found highly effective and helping to overcome a variety of problems.

Cognitive-behavioral therapy, or CBT, is based on the notion that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. Let’s take a look at an example:

Lindsey was scheduled to meet Justine for lunch at 12:00 p.m. It is now 12:30 and Justine has not shown up for lunch. Lindsey has the thought “she blew me off – what a terrible friend!” This thought leads to her feeling angry (emotion) and ignoring Justine (behavior). However, what if instead she had the thought “something bad must have happened!” This thought would lead to her feeling worried (emotion) and calling Justine to see if she is okay (behavior). Depending on the thought that Lindsey has, the same scenario can lead to very different emotions and behaviors.

So, if we can change the way we think and what we do, we can change the way we feel! Psychotherapy can provide you with step-by-step instructions on how to do that. Some strategies that are used in CBT include modifying things you are doing (and may not be aware of!) that are contributing to your symptoms, learning new ways to cope with distressing feelings, and identifying and changing thoughts that are irrational and/or not helpful to you.

Does this sound too simple or good to be true? The proof is in the pudding! Over 1,000 research studies have examined CBT, and it has consistently been found effective for a variety of problems, including, but not limited to, depression, anxiety, substance use disorders, bipolar disorder, schizophrenia, anger, stress, and chronic pain. Due to this wealth of support, CBT has been identified as an “evidence-based therapy.” The National Institute of Mental Health strongly supports the use of evidence-based therapies (including CBT) for many reasons, with one of the most compelling being to prevent a situation where you spend months or years in psychotherapy and don’t feel like you are getting any better!

If cognitive-behavioral therapy sounds like something you are interested in trying or learning more about, I’ve included some helpful links below. If you are in the Austin area, feel free to give me a call at 512-521-1531 or email me at to discuss your situation and see if I may be able to help you.

Psychology Today Find a Therapist Tool

Association for Behavioral and Cognitive Therapies

Beck Institute for Cognitive Behavior Therapy

Mayo Clinic