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 firstname.lastname@example.org or 512-521-1531.