Whether you’ve been to therapy or not, you’ve probably heard about cognitive-behavioral therapy (CBT). It’s a popular type of therapy that many, many therapists use to help their clients treat everything from severe anxiety to debilitating depression.
But even though CBT is widespread, it’s still highly misunderstood—even by the professionals who practice it. Numerous myths still abound. Below, two psychologists who specialize in CBT share the facts behind the most common misconceptions.
Myth: CBT is a rigid, one-size-fits-all approach where a clinician applies a specific technique to a specific problem.
Even though CBT features structured protocols for different disorders, it is not an inflexible treatment that ignores clients’ individuality. In fact, CBT requires that clinicians have a detailed and deep understanding of every client and their individual needs. Because, of course, every person is different. Every person has a different history, different circumstances, different qualities and traits, and different factors that maintain their symptoms. CBT allows for nuance.
According to psychologist Kevin Chapman, Ph.D, “CBT is a collaborative, time-limited, ‘real-world’ approach that requires an understanding of the empirical literature and significant creativity.”
Each week Chapman, an expert in anxiety-related disorders, finds himself on bridges and interstates and inside caves. He finds himself watching vomit videos, and watching clients interact with strangers (for social anxiety). He finds himself walking in malls (for agoraphobia), and using straightjackets (for claustrophobia). He finds himself using virtual reality exposure therapy (for phobias) and drinking strong coffee in an elevator (for panic)—along with all sorts of other scenarios and situations that don’t include being inside an office.
As he added, “CBT is refreshing to implement and never leads to boredom in my practice.”
Myth: CBT is simply shifting negative thoughts to positive ones.
Because one part of CBT focuses on identifying and challenging negative thoughts, many people assume that clients simply learn to think positively about their problems, and their lives, said Simon Rego, Psy.D, chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York City.
“In actuality, CBT teaches patients to look at their lives as realistically as they can.” This might mean making changes and/or changing the way they think—if their perspective is distorted or problems can’t be changed, he said.
CBT helps clients explore more flexible ways of thinking. For instance, a client stutters and has social anxiety. The stuttering typically happens while he’s giving a speech, and understandably, increases his anxiety. Simply thinking “I won’t stutter, so I shouldn’t be worried” isn’t helpful (or realistic, since he has ample evidence that he’ll likely stutter).
The therapist helps the client consider other perspectives, such as he can complete the speech while stuttering, and that others may be understanding. They also might work together on giving a speech in a graduated fashion, Chapman said. This might mean giving the speech in front of the therapist; using virtual reality to give the speech to a group; giving the speech to three people; and so on, he said.
Myth: CBT does not believe in an unconscious.
CBT doesn’t believe in the concept of the unconscious that Freud originated. However, CBT does acknowledge that many thought processes take place outside our awareness, Rego said. Take driving or typing as examples.
“CBT does not believe these thought processes are being ‘repressed,’ but rather that they exist, just below the surface of our awareness, and are available on reflection.” He noted that many CBT treatments include an early step where the therapist helps clients access and interpret thoughts they might not be initially aware of.
Myth: CBT ignores emotions.
“CBT is very interested in emotions,” Rego said. That is, CBT focuses on teaching skills to help improve emotional states. It does this by focusing on the connection between thoughts and emotions, and the connection between behavior and emotions.
Rego explained it in this way: CBT helps clients change how they think, which can change how they feel. And it helps clients change the actions they take, which also can change how they feel.
Myth: CBT isn’t concerned with a client’s past or their childhood.
CBT starts by first addressing the factors that are currently maintaining a client’s problem. That’s because “what starts a problem—things in the past—may be very different than what maintains a problem—things that the person now thinks and does…,” Rego said. However, when necessary, therapists do delve into the past. For instance, a therapist might help a client struggling with social anxiety to examine their early experiences along with how their family contributed in shaping their anxiety.
CBT is powerful for many reasons. It has been studied for decades, and has a plethora of research to substantiate its effectiveness. As Rego said, it’s been shown to be effective with a wide range of psychological disorders and ages; in different contexts, such as inpatient and outpatient settings; in both individual and group formats; in weekly and daily doses; with and without medication; in both short and long term; and even in different countries.
According to Chapman, research also has found that brain chemistry actually changes when individuals change their thoughts and/or their behavior. (See here, here, here and here for examples of research.)
Rego and Chapman stressed the importance of seeing a CBT practitioner with the proper training. (“Many therapists now state that they offer CBT, without having been properly trained to do it,” Rego said.) They suggested starting your search at the Academy of Cognitive Therapy; the American Board of Professional Psychology; and the Association for Behavioral and Cognitive Therapies.