Busting Common Myths About Cognitive Behavioural Therapy

Getting straight facts about psychotherapy and how to choose the right approach can be difficult and confusing. Over recent years, some therapists from the psychoanalytic and psychodynamic fields have attempted to undermine Cognitive Behavioural Therapy by claiming that CBT is superficial, that it’s less affective at treating long-term problems and that it provides a one size fits all approach.

These claims have almost always been levelled by therapists who have no formal CBT qualifications and are usually from other psychotherapeutic traditions.

Common criticisms have included bias research methods, that CBT outcomes are exaggerated and that there is a system-wide conspiracy against other forms of psychotherapy.

Drawing on the hundreds of Randomised Control Trials and meta-analyses conducted over the last 40 years, this blog will attempt to cut through some of the myths and misconceptions, outlining some simple facts about CBT and how it works.

Is CBT Superficial?

Whilst it is true that a CBT Psychotherapist will not ask you to enter into open-ended therapy for months or even years, the process does involve a thorough assessment of the problem and a highly structured plan to specifically address the client’s goals.

Unlike some of the other talking therapies, CBT provides a hands-on practical approach to problem solving and change. This means that the techniques and exercises are designed to be applied in a practical way that directly influences how we think, feel and act in day-to-day life. This helps to convert the psychological work done in therapy sessions, into real improvements in people’s personal, social and working life. 

We find that when clients approach us to start CBT, they want more than personal insight. In other words, they want to understand and actually take practical steps to change or improve the problem. Understanding the background factors that have contributed to the development of the problem is also an essential step in this process. 

Far from being superficial, CBT teaches clients how to convert personal insight into tangible improvements in dealing with distress, solving problems, improving relationships and changing behaviour. CBT is oriented to helping people to manage problems and live a more meaningful and fulfilling life.

Can CBT Deal with Deeply Rooted Problems?

The claim that CBT can’t deal with deeply rooted or long-term problems is an ill-informed criticism often levelled by therapists from other approaches. This claim ignores the wide range of scientifically acknowledged research studies undertaken since the 1970s on deeply rooted psychological problems including the treatment of childhood trauma, long-term depression, psychosis and personality disorders. It also overlooks the contribution made by CBT models like Schema Therapy which is designed to integrate deeply rooted attachment and relational factors.

The fact is that CBT is successfully used as both a short-term intervention or as a longer-term approach. In spite of criticisms from other less researched therapies, CBT has been used to treat long-term problems with depression, deeply rooted anxiety, trauma and problems with self-esteem since its inception in the early1950s and 1960s. 

CBT actually provides a flexible model that can be right-sized to meet the specific needs of the client. This means that problems like panic disorder or stress can be successfully treated in as few as six sessions, but that deeply engrained and complex issues such as long-term depression, trauma, personality disorders, psychosis and eating disorders have more clinically involved protocols. 

The bottom line is that the approaches used in CBT have been clinically tested and shown to have a positive outcome for short-term and long-term problems alike.

Does CBT Provide a One-Size-Fits-All Approach?

Another common criticism is that CBT is overly simplistic. This claim demonstrates the fundamental misconception that Cognitive Behavioural Therapy is just one simple model. Again, this criticism tends to be made by therapists or organisations with a lack of training, knowledge or experience of the wide range of CBT interventions and models.

CBT is not just one simple approach, it is an umbrella used to cover a wide range of clinically proven Cognitive and behavioural therapy models. it is a therapeutic tradition focused on the relationship between cognitive, behavioural, emotional, physiological and environmental factors.

In addition to the mainstream version of CBT originally developed by Ellis and Beck in the 1950-s and 1960s, CBT now includes a wide range of approaches developed to treat different types of psychological, emotional and behavioural problems. Some of the more well-known approaches include:

• Rational Emotive Behaviour Therapy (REBT); developed in the 1950s and combining an active-directive therapy with a philosophical perspective to change behaviour and emotion in the service of living a more meaningful life.
• Cognitive Therapy; Developed in the 1960s and introducing the concept of how thoughts directly influence emotions and behaviours. This work has also been proven to have a direct influence on the structure and architecture of the brain itself. 
• Schema Therapy; this enriches short-term CBT with developmental approaches from Attachment Theory, Object Relations Theory and Gestalt Therapy. Schema Therapy provides a contemporary analytical approach to CBT by exploring and changing early formed beliefs and unhelpful patterns of behaviour. 
• Dialectical Behaviour Therapy (DBT); originally developed in the 1980s and shown to be highly affective for severe mood regulation problems. DBT is used in the treatment of personality disorders, bipolar depression and other mood regulation issues including eating disorders and anti-social behaviour.
• Compassion Focused Therapy (CFT); This was developed to support people suffering from treatment resistant issues often involving shame, disgust and high levels of self-criticism. CFT combines our understanding of western neuro-science, evolutionary psychology and mindfulness based philosophical practices.
• Acceptance and Commitment Therapy (ACT); This is a modern form of CBT focused on the development of psychological flexibility. Rather than changing negative or unhelpful thinking patterns, ACT focuses on reducing the struggle and unhooking from negative thoughts and feelings. ACT uses six key psychological processes in therapy to normalise and reduce resistance to distressing experiences in the service of living a richer, meaningful and fulfilling life.
• Mindfulness Based Cognitive Therapy (MBCT); This integrates Eastern perspectives and meditation techniques into modern Western scientific approaches to stress reduction and emotional resilience. Mindfulness has been scientifically proven to improve recovery from a wide range of psychological and physical problems including pain management, stress, depression and anxiety conditions.

So, in summary, far from providing a simplistic one size fits all approach, CBT is a sophisticated model of therapy involving a wide range of scientifically tested interventions. These different models of CBT are commonly linked by their focus on thoughts, feelings, behaviours, physiology and the relationship to the environmental context.

What is a BABCP Accredited Psychotherapist?

CBT Psychotherapists qualified and accredited to the rigorous standards laid down by the British Association of Behavioural and Cognitive Psychotherapy (BABCP), have been required to demonstrate post-graduate level academic qualifications, observed assessments and ongoing supervised clinical practice. In most cases an accredited CBT therapist will have undertaken additional advanced psychological training for three-five years to achieve the depth of knowledge and expertise required to be a BABCP accredited CBT Psychotherapist.

For clarity, this is not the same as BACP registration or accreditation. Although confusing the BACP (as opposed to the BABCP), covers counsellors and therapists from other fields.

In spite of the frequent criticisms levelled by members of the counselling community, there are many counsellors offering CBT without the necessary training, experience or professional post-graduate qualifications. The fact is that BABCP accreditation sets a highly rigourous standard of assessment and observed practice which is difficult to achieve.

BACP registration/accreditation does not mean that you are working with an accredited  CBT expert. If in doubt, ask your therapist for confirmation of their qualifications and check your therapist using the UK register at http://cbtregisteruk.com/AccreditedMemberSearch.aspx

In the final analysis our advice is to follow the evidence when choosing therapy. Whilst this blog does not seek to attack other models of therapy, it encourages the reader to think for themselves and separate facts from opinions. This in itself is a key skill in CBT.

You can find out more about our approach to CBT and explore a wide range of free Cognitive Behavioural Therapy resources and assessments by visiting https://www.thinkcbt.com