3 ms·

CBT is freaking awful. The reason it took off is that a lot of studies showed a very strong effect pretty early on. But none of the meta analysis show efficacy

CBT is freaking awful. The reason it took off is that a lot of studies showed a very strong effect pretty early on. But none of the meta analysis show efficacy in CBT long term, and even worse, many CBT practitioners are unskilled and not even using it properly. However it's my opinion that CBT even if used exactly to gold standards is very unhealthy, overprescribed in a lot of situations it shouldn't be, and is based on some really faulty assumptions. Number one, a lot of people with mental health issues have undergone trauma. CBT is completely useless in this case but yet gets overprescribed like everything else. The ABC model in CBT (Activating Event, Belief, Consequences) sounds like on the surface that it makes sense but it's a very very basic view of how the brain and body works. Here's how it's supposed to work. A) You see a spider. B) You think spiders are gross and scary and the scary could bite you. C) You are scared and run away. In reality, trauma and fear work at the speed of light through your sympathetic nervous system and hit your lizard brain before you are making any conscious thought whatsoever. Feelings like fear, disgust, and so forth are very primal and lizard brainy and it really doesn't do any good to dissect them with our Big Simian Brains. It just causes more problems because the solution is acceptance and understanding the nature of emotions. 100% agree by this statement by the pt: "CBT as a modality is based around gaslighting" That's exactly WHY it works so well and you see that great effect in the studies. Gaslighting works as a means to control people. For a while, until their world falls apart worse because you're programming yourself to tell you a different delusional reality, just in this case since it's "positive" it's supposed to be OK. News flash, if you can't get your basic needs met, you shouldn't be using CBT. Use all the CBT you want, it's not going to change the fact that you don't have enough to eat, you're about to be homeless, you're in an abusive relationship, and so on. In this case CBT was inappropriately prescribed to someone with chronic pain and trauma and big Psych is terrified to let this narrative out - that CBT is routinely used on people who don't have cognitive distortions. To get an idea of how ridiculously overprescibed this is, check out this video, where an actual MD with a vitamin deficiency was pressured by his sleep doctor to try CBT for his insomnia https://www.youtube.com/watch?v=d_qKA6KTvs8 https://www.youtube.com/watch?v=d_qKA6KTvs8 Thankfully he knew, AS A DOCTOR, that the advice he was given was full of crap. But people who have already been marginalized, and are often women, people of color, and so on? God forbid we're questioning CBT and have valid reasoning behind it, that just means that you're resisting treatment and it's something further to put under the microscope. If you push your problems down it makes it worse. The therapies we should be using should be about acceptance, distress tolerance, communication skills, and things like inner child work such as internal family systems therapy or somatic work. Things like DBT which have a mindfulness component, is about acceptance and dialectics - two things can be true rather than overanalyzing the crap out of everything, and IFS as well as EMDR and other body based work are evidence based to work against trauma as it exists biologically. CBT does not. Everyone has trauma from childhood and even if you don't have mental illness there are weird things around from that time which make you regress and feel bad about yourself. The key is working with that stuff and actually accepting those parts of yourself and loving them which CBT DOES NOT DO. It pushes things down. Props to this author. We need more people speaking out against CBT. It causes people to give up on therapy and think it's a sham. This kind of disgusting behavior where the patient's experience is invalidated because god forbid that further puts cracks in the wall in the CBT model which we've invested so much in!

firecall 5y ago
"CBT is freaking awful" For me, that is too broad a statement! Having had CBT therapy here in Australia from experienced qualified Doctors, I can say it's been excellent. But I was being treated for a "Nervous Breakdown", and CBT helped me get my life back on track and functioning again before I burnt my life down! However, I can't see how it would work for everything and chronic pain seems like a bad fit. ANAD.
- cupcake-unicorn 5y ago
  I'm glad it helped, but I'm curious how many years out you are? CBT doesn't show efficacy in meta analyses in the long term say 2 years out or so. I'm glad that you were able to get good treatment - I think also the clinical standards here are pretty abysmal, so in the US if you're getting CBT you're most likely dealing with serious insurance issues that limit the quality of care. In addition post pandemic even paying out of pocket it's harder and harder to find therapists with any spots :( All bets on quality are off if your only options are one of the larger clinics in a big city. At least that's been my experience. CBT does show efficacy in the short term, no one is contesting that. But I think that's also kind of why it's "awful" - because people get so excited about it that it's touted as some magic bullet, or cure all. The effects from CBT were so strong that a whole industry popped up around it and we're seeing it increasingly applied to things that it shouldn't be applied to and people silencing the narrative from those who are trying to speak out against it. CBT is a tool and it's appropriate for certain situations. But the issue with CBT being overused and in the hands of untrained professionals who are overeger to apply it to a variety of situations it's completely inappropriate in is very, very problematic. I'd guess that's a bigger issue here in the US. For example you're absolutely not supposed to use CBT if you're homeless, can't get enough to eat, and so on, and this is in the training manuals. You need to have your basic needs met. But it's routinely used anyway. A tool this powerful and with this evangelical of a base behind it is dangerous. It's the same problem we were seeing with the sugar and alcohol industry getting involved in clinical studies. We're losing sight of the science behind it because it turned into an industry that's being threatened. But thanks, it is good to hear it's helping people and get a data point there. Anecdotally I've only heard negative/neutral personal experiences with it, and although the majority of those experiences were from people with more serious mental health challenges I did hear from people who were dealing with transient issues who had no luck from it - again could be quality issues and some of them could have fared well with CBT at gold standard. I feel like increasingly we're hearing the industry champion CBT rather than the patients so as a patient your story is important too.

firecall 5y ago

"CBT is freaking awful" For me, that is too broad a statement! Having had CBT therapy here in Australia from experienced qualified Doctors, I can say it's been excellent. But I was being treated for a "Nervous Breakdown", and CBT helped me get my life back on track and functioning again before I burnt my life down! However, I can't see how it would work for everything and chronic pain seems like a bad fit. ANAD.

cupcake-unicorn 5y ago
I'm glad it helped, but I'm curious how many years out you are? CBT doesn't show efficacy in meta analyses in the long term say 2 years out or so. I'm glad that you were able to get good treatment - I think also the clinical standards here are pretty abysmal, so in the US if you're getting CBT you're most likely dealing with serious insurance issues that limit the quality of care. In addition post pandemic even paying out of pocket it's harder and harder to find therapists with any spots :( All bets on quality are off if your only options are one of the larger clinics in a big city. At least that's been my experience. CBT does show efficacy in the short term, no one is contesting that. But I think that's also kind of why it's "awful" - because people get so excited about it that it's touted as some magic bullet, or cure all. The effects from CBT were so strong that a whole industry popped up around it and we're seeing it increasingly applied to things that it shouldn't be applied to and people silencing the narrative from those who are trying to speak out against it. CBT is a tool and it's appropriate for certain situations. But the issue with CBT being overused and in the hands of untrained professionals who are overeger to apply it to a variety of situations it's completely inappropriate in is very, very problematic. I'd guess that's a bigger issue here in the US. For example you're absolutely not supposed to use CBT if you're homeless, can't get enough to eat, and so on, and this is in the training manuals. You need to have your basic needs met. But it's routinely used anyway. A tool this powerful and with this evangelical of a base behind it is dangerous. It's the same problem we were seeing with the sugar and alcohol industry getting involved in clinical studies. We're losing sight of the science behind it because it turned into an industry that's being threatened. But thanks, it is good to hear it's helping people and get a data point there. Anecdotally I've only heard negative/neutral personal experiences with it, and although the majority of those experiences were from people with more serious mental health challenges I did hear from people who were dealing with transient issues who had no luck from it - again could be quality issues and some of them could have fared well with CBT at gold standard. I feel like increasingly we're hearing the industry champion CBT rather than the patients so as a patient your story is important too.