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The most dangerous thing about CBT is that it's not exactly clear what it is—or is not. > CBT as a modality is based around gaslighting. It’s all about telling

The most dangerous thing about CBT is that it's not exactly clear what it is—or is not. > CBT as a modality is based around gaslighting. It’s all about telling a patient that the world is safe, bad feelings are temporary, and that pain (emotional or physical) is a “faulty or unhelpful” distortion of thinking. That’s literally in CBT’s definition on the APA website. I wonder whether there will ever be a mode of therapy that doesn't seem to lose favor after a decade.

treis 5y ago
CBT is well established and is a decently effective tool. The description given by the author is in accurate. At it's core, CBT is about identifying bad thought patterns and acknowledging that they don't match reality. Useful for someone with body image issues. Probably less so for someone experiencing chronic pain from an underlying physical issue.
- firecall 5y ago
  Indeed. I don't want to move into Ad Hominem attacks, but the article really reads like the author is setting out to mischaracterize CBT because of their own bitter experiences. But that's just the 'feeling' I get from it and I'm biased already having had a positive CBT experience :-)
Jtsummers 5y ago
> a form of psychotherapy that integrates theories of cognition and learning with treatment techniques derived from cognitive therapy and behavior therapy. CBT assumes that cognitive, emotional, and behavioral variables are functionally interrelated. Treatment is aimed at identifying and modifying the client’s maladaptive thought processes and problematic behaviors through cognitive restructuring and behavioral techniques to achieve change. Also called cognitive behavior modification; cognitive behavioral therapy. https://dictionary.apa.org/cognitive-behavior-therapy https://dictionary.apa.org/cognitive-behavior-therapy It seems they deleted that definition from their site. And having been through CBT as part of treatment a couple times over (now) almost twenty years, I've never been told that "pain is a 'faulty or unhelpful' distortion of thinking." It's the response to things that have always been the focus (that is, the pain is real, but the response is what's "maladaptive" to use the term in the current APA definition).
cupcake-unicorn 5y ago
I've noticed in general that a good place to look is in the therapies that are used in treating personality disorders, people with eating disorders, C-PTSD, PTSD, and trauma. Right now that's DBT for emotional regulation, but for the trauma itself, EMDR, somatic therapies, motivational interviewing, and things like Internal Family Systems therapy. CBT DOES NOT WORK for this population. DBT has been proven as well as EMDR but the other things need to be looked into further. A lot of these share biological tricks (the eye movement and work with your body) and the rest of them have borrowed things from mindfulness and work on radical acceptance and dropping judgement rather than overrationalizing. CBT at its core is constantly causing you to overthink and judge your own actions which is not something you want to do to someone who's already doing that. CBT doesn't really stand up against severe mental illness, so why should we expect that it's good for the average person who's suffering from some mild depression and anxiety? We have gold standards that can help people who suffer from some of the most treatment resistant forms of mental illness. Someone with severe CBT who responds to say, IFS after 20 years, you know that's not a placebo. This stuff needs to be studied more drawing from what we know about the populations who suffer the most, because we know that's not a placebo effect or a one off when we see people go into remission.
- firecall 5y ago
  "CBT doesn't really stand up against severe mental illness, so why should we expect that it's good for the average person who's suffering from some mild depression and anxiety? " Because the two are very different things! So very different!
  - cupcake-unicorn 5y ago
    I mean, yes, but also any therapeutic modality that works with these populations is tapping into some consistent realities about human nature that can be applied generally. The reality CBT is tapping into is that gaslighting someone into toxic positivity (or gaslighting someone at all) will show effects for a few weeks, but it's not long term. Our society doesn't value teaching children soft skills like healthy communication, or understanding what emotions are and distress tolerance around them. These are very basic things that a lot of people only learn after they get into therapy. And they help everyone if applied correctly. The skills you learn in DBT are skills that can help EVERYONE. When you learn how to communicate better at a gold standard you help yourself and the people around you. If we have a gold standard that can be applied to the most severe cases and help, and this isn't based on anything specific to those disorders but rather taps into some very core "how to be human and deal with weird lizard brain hurty emotions" stuff we need to start using that. Using our brains to rationalize our way out of emotions got us to where we are as a society now and it's pretty unhealthy.
firecall 5y ago
I wasnt aware that CBT was used for pain management! I've seen a therapist, ostensibly for depression, that used CBT techniques. My experience has been a positive one! I take issue with the article in the way it cuts a path from the very broad overview statements on the APA website to asserting that CBT is "built to be dismissive and invalidating". There is so much to take issue with in that article: "CBT is based on the premise that any patient coming into therapy is experiencing distorted, “faulty,” “catastrophizing” thinking. CBT therapists are trained to convince patients that they’re overreacting and that they’ll feel better when they realize they’re overreacting." IMHO that is a totally unreasonable way to characterise CBT. The use of the word "overreacting" suggests that a therapist is seeking to invalidate the patients experience. That invalidating approach is not built into CBT, and if the author has experienced that, then I'd say that was rather unfortunate and the therapist is at fault, not the practice of CBT. CBT aims to get people functioning and coping by equipping them with strategies that work, for them. It's an individual approach that takes time and discovery. Anyway.... On the APA website, they do provide some more background: CBT treatment usually involves efforts to change thinking patterns. These strategies might include: Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.Gaining a better understanding of the behavior and motivation of others.Using problem-solving skills to cope with difficult situations.Learning to develop a greater sense of confidence in one’s own abilities. CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include: Facing one’s fears instead of avoiding them.Using role playing to prepare for potentially problematic interactions with others.Learning to calm one’s mind and relax one’s body. Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy. CBT places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior. CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.

treis 5y ago

CBT is well established and is a decently effective tool. The description given by the author is in accurate. At it's core, CBT is about identifying bad thought patterns and acknowledging that they don't match reality. Useful for someone with body image issues. Probably less so for someone experiencing chronic pain from an underlying physical issue.

firecall 5y ago
Indeed. I don't want to move into Ad Hominem attacks, but the article really reads like the author is setting out to mischaracterize CBT because of their own bitter experiences. But that's just the 'feeling' I get from it and I'm biased already having had a positive CBT experience :-)

Jtsummers 5y ago

> a form of psychotherapy that integrates theories of cognition and learning with treatment techniques derived from cognitive therapy and behavior therapy. CBT assumes that cognitive, emotional, and behavioral variables are functionally interrelated. Treatment is aimed at identifying and modifying the client’s maladaptive thought processes and problematic behaviors through cognitive restructuring and behavioral techniques to achieve change. Also called cognitive behavior modification; cognitive behavioral therapy. https://dictionary.apa.org/cognitive-behavior-therapy https://dictionary.apa.org/cognitive-behavior-therapy It seems they deleted that definition from their site. And having been through CBT as part of treatment a couple times over (now) almost twenty years, I've never been told that "pain is a 'faulty or unhelpful' distortion of thinking." It's the response to things that have always been the focus (that is, the pain is real, but the response is what's "maladaptive" to use the term in the current APA definition).

cupcake-unicorn 5y ago

I've noticed in general that a good place to look is in the therapies that are used in treating personality disorders, people with eating disorders, C-PTSD, PTSD, and trauma. Right now that's DBT for emotional regulation, but for the trauma itself, EMDR, somatic therapies, motivational interviewing, and things like Internal Family Systems therapy. CBT DOES NOT WORK for this population. DBT has been proven as well as EMDR but the other things need to be looked into further. A lot of these share biological tricks (the eye movement and work with your body) and the rest of them have borrowed things from mindfulness and work on radical acceptance and dropping judgement rather than overrationalizing. CBT at its core is constantly causing you to overthink and judge your own actions which is not something you want to do to someone who's already doing that. CBT doesn't really stand up against severe mental illness, so why should we expect that it's good for the average person who's suffering from some mild depression and anxiety? We have gold standards that can help people who suffer from some of the most treatment resistant forms of mental illness. Someone with severe CBT who responds to say, IFS after 20 years, you know that's not a placebo. This stuff needs to be studied more drawing from what we know about the populations who suffer the most, because we know that's not a placebo effect or a one off when we see people go into remission.

firecall 5y ago
"CBT doesn't really stand up against severe mental illness, so why should we expect that it's good for the average person who's suffering from some mild depression and anxiety? " Because the two are very different things! So very different!
- cupcake-unicorn 5y ago
  I mean, yes, but also any therapeutic modality that works with these populations is tapping into some consistent realities about human nature that can be applied generally. The reality CBT is tapping into is that gaslighting someone into toxic positivity (or gaslighting someone at all) will show effects for a few weeks, but it's not long term. Our society doesn't value teaching children soft skills like healthy communication, or understanding what emotions are and distress tolerance around them. These are very basic things that a lot of people only learn after they get into therapy. And they help everyone if applied correctly. The skills you learn in DBT are skills that can help EVERYONE. When you learn how to communicate better at a gold standard you help yourself and the people around you. If we have a gold standard that can be applied to the most severe cases and help, and this isn't based on anything specific to those disorders but rather taps into some very core "how to be human and deal with weird lizard brain hurty emotions" stuff we need to start using that. Using our brains to rationalize our way out of emotions got us to where we are as a society now and it's pretty unhealthy.

firecall 5y ago

I wasnt aware that CBT was used for pain management! I've seen a therapist, ostensibly for depression, that used CBT techniques. My experience has been a positive one! I take issue with the article in the way it cuts a path from the very broad overview statements on the APA website to asserting that CBT is "built to be dismissive and invalidating". There is so much to take issue with in that article: "CBT is based on the premise that any patient coming into therapy is experiencing distorted, “faulty,” “catastrophizing” thinking. CBT therapists are trained to convince patients that they’re overreacting and that they’ll feel better when they realize they’re overreacting." IMHO that is a totally unreasonable way to characterise CBT. The use of the word "overreacting" suggests that a therapist is seeking to invalidate the patients experience. That invalidating approach is not built into CBT, and if the author has experienced that, then I'd say that was rather unfortunate and the therapist is at fault, not the practice of CBT. CBT aims to get people functioning and coping by equipping them with strategies that work, for them. It's an individual approach that takes time and discovery. Anyway.... On the APA website, they do provide some more background: CBT treatment usually involves efforts to change thinking patterns. These strategies might include: Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.Gaining a better understanding of the behavior and motivation of others.Using problem-solving skills to cope with difficult situations.Learning to develop a greater sense of confidence in one’s own abilities. CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include: Facing one’s fears instead of avoiding them.Using role playing to prepare for potentially problematic interactions with others.Learning to calm one’s mind and relax one’s body. Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy. CBT places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior. CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.