(+ a bonus post at the end!)
Cognitive behavioral therapy, or CBT as it’s more commonly known, is the go-to treatment option for anxiety disorders and depression. I’ve seen a couple of therapists who utilize CBT in their practice and have even attended some CBT groups.
For those of you who are unfamiliar with CBT, it’s a form of therapy where you learn to train yourself to learn how to recognize negative thoughts that lead to anxious or depressed states. You also learn to change typical behaviors you might do as a result of the thought or associated feeling. It wasn’t a total bust for me, because I did learn that I was having a lot of negative thoughts that mentally healthier people don’t have as often. Part of the CBT curriculum involves learning about anxiety and depression, what causes it, its symptoms, and other useful facts. But for me that only went so far. It never actually cured me or my anxiety. In fact, I would go so far as to say it delayed my cure. However, it is an evidence-based practice so maybe it does work for some people… I’ve never met them… Here are 5 reasons why I dislike CBT and think it’s a waste of time and money:
1. It takes a lot of work. Therapy is a lot of work in general. You dig to places of your psyche that most people would much rather pretend didn’t exist. What’s different about CBT is that one of its major components is homework, done outside of therapy. You have worksheets you’re supposed to fill out each day related to your negative thoughts and emotions. It’s hard to keep track of it all. You’re supposed to memorize what all the negative thought patterns you may experience are called, for example “mind reading” when you automatically assume you know what someone else is thinking (usually in regards to negative thoughts about you), or “all-or-nothing thinking,” which is when you think that a situation, person, etc. is either ALL good or ALL bad. There was a list of about 10-12 thought patterns I was supposed to recognize, but I found myself having to look them up every time I tried to do a worksheet. Most of the anxiety I experienced was social, and the therapists wanted you to fill out the thought worksheets in the midst of an anxiety or depression episode. It’s not really ideal to whip out a piece of paper and fill it out while hanging out with friends… all in all the system isn’t very effective.
2. It makes it seem like controlling your anxiety/depression is your choice. I had a really severe case of anxiety that I honestly did not have much control over. When I was in a CBT program at an outpatient mental hospital, the therapists/health educators made it seem like anxiety was akin to an unhealthy habit I’d picked up that I just needed to unlearn. I worked really hard because of course I didn’t want to be suffering from anxiety forever. And yet no matter how hard I worked, the anxiety still stuck around. The therapists meant well but the program just made it seem like if you weren’t getting better it was really your own fault.
3. You are told that you won’t notice the effects right away. Kind of like when you start taking antidepressants (which also didn’t really work for me), and you’re given a timeline of noticing positive effects within 4-8 weeks. CBT gives you a similar timeline of about 6-12 weeks before you’ll notice many positive effects. This adds another layer of difficulty to someone who is already depressed or anxious and may find it hard to do much of anything and are in a state of mind that can make them feel like giving up hope more easily.
4. Some concepts of CBT made my anxiety worse. Part of CBT is exposure, or at least to not avoid activities that you once partook in. The theory behind exposure is that by exposing yourself to a feared situation, your brain will learn that it will survive, and therefore your anxiety should decrease. Let me tell you, at the height of my social anxiety I still participated in social events and tried making new friends even though my anxiety increased maximally in those situations. For me, no matter how long I stayed at these events my anxiety did not decrease. In fact, the longer I stayed, the more negative my thoughts became, until by the end of several occasions I felt like not much more than an exhausted puddle of anxiety. It made me feel extremely frustrated and hopeless.
5. It doesn’t get to the root of the problem. It’s well-known that our modern society is plagued with mental health problems. Clearly modern science isn’t as effective at treating mental illness as we would like to believe. CBT takes a scientific approach to anxiety and depression, basing it on the fact that anxiety and depression have symptoms experienced by the person suffering. CBT tries to stop these symptoms in their tracks, by changing the way the brain responds to certain situations. The logic behind it makes sense, but from my own personal experience, it just doesn’t get to the root of the anxiety and depression. This relates to #2 above, but anxiety and depression didn’t just form overnight or by chance. Sure, genetics may play a role, but what I’ve found from my own research (and believe me, I’ve extensively researched the topic in looking for a cure), all of these dysfunctions result from trauma. As I’ve mentioned in previous posts, trauma can come in all different shapes and sizes, from witnessing war to being rejected on the playground. Everyone has experienced some form of trauma, and we are especially vulnerable during early childhood. What we learn during that time actually molds the way our brains function for the rest of our lives. Unless those patterns are disrupted. Hence where CBT seems like it would be a viable option. However, what CBT gets wrong is that it fails to acknowledge the past. Part of CBT is actually to forget about the past. Meanwhile, the root of the trauma lies in the past. The symptoms of anxiety and depression are there for a reason–they are telling you that something is wrong. In order to get rid of the symptoms, you have to treat the root of the problem.
6. It doesn’t involve the body. As researchers are discovering, emotions and mental health are not just for the sphere of the brain. Terms like “heartbreak” and “knot in my stomach” exist for a reason–we feel emotions in our bodies. We might be able to understand and rationalize them in the brain, and for those of us with mental illnesses, the symptoms we feel most acutely impact the way our mind functions. But I, along with a number of scientists, doctors, and mental health professionals who study and or/practice the topic, believe that emotions are stored in the body on a cellular level. When mental illness strikes, the emotions are often trapped and need to be released. CBT does not involve the body at all, and this is why I believe it can never fully relieve anxiety and depression.
7. It doesn’t work for everyone. As I’ve mentioned several times throughout this post, CBT did not work for me. I felt more educated about the physical and emotional causes of my anxiety, but I didn’t see any other tangible results. In fact, it might have increased my sense of hopelessness over time. All I can say is, I’m incredibly grateful I found EMDR, which has brought me back to a point where I feel like a human being again. The anxiety disorder I experienced was no joke, and maybe CBT works for small amounts of anxiety or depression but based on the number of people in my group therapy session at the mental hospital who were back for a second stint, I cannot recommend that form of therapy.
I have a little bonus post that I’d like to share. I know that for the amount I tout the greatness of EMDR, it probably seems like someone is paying me (they are NOT). I just feel like I found a wonder cure. So without further adieu, I want to list 5 reasons why I love EMDR, corresponding to the 5 reasons why I dislike CBT.
1. The only work you’re required to do is in the therapy session. Unlike CBT, although EMDR can be extremely emotionally draining, you don’t have to think about it once you leave your therapist’s office.
2. You realize that anxiety/depression is not your choice. I don’t think anyone in their right mind would choose to have anxiety or depression. Since I started feeling better so quickly using EMDR, I learned that it really wasn’t up to me whether or not my anxiety symptoms occurred.
3. I noticed the effects relatively quickly. Even during my EMDR sessions, I would feel immediate relief. My anxiety would disappear because I was processing the emotions that caused them, rather than focusing on treating the symptoms. It would take several sessions before I noticed huge changes, but any relief was welcome with the amount of suffering I endured.
4. EMDR can worsen symptoms of anxiety and depression, but only for a short period of time. Immediately following a session and sometimes up to a few days after a really intense session, I often feel really sad, and less often feel increased anxiety. However, in the grand scheme of things, it’s really worth it because after that phase of processing, I feel a lot better than I did before the session. With CBT I could never be sure whether or not I would feel better.
5. You definitely get to the root of the problem. In fact, you get to roots of the problem you didn’t even know were still affecting you. When the root of the problem is resolved–voilla! Your anxiety and depression revolving around particular triggers vanishes, one by one.
6. You involve bodily sensations. As I mentioned above, when mental illness strikes, lots of stressful emotions are often trapped in the body and need to be released.The mechanism for this is yet to be discovered, but EMDR, along with other types of therapies (EFT for example) involves checking in with your body and noticing the sensations that accompany emotionally powerful memories. This starts to allow those emotions to be released, and allows you to be more cognizant of when you are storing lots of stress and emotions in the body.
7. It works so well for me! Yay! And many others. I feel better than ever with EMDR. It’s not the only form of psychotherapy I refer to, but I find that I don’t need to notice negative thoughts because I just don’t have them anymore. I am still in therapy and still have more work to do, because I am still discovering triggers. But little by little, day by day, I feel mentally and emotionally healthier than ever. Not only has it impacted my anxiety, but also the way I respond to others. I am less prone to rage, personalizing the feelings of others, and jealousy. These are things that I no longer believe are innate in human beings. I recognize my feelings a lot more easily and feel less of a need to react. I still have a long way to go but I am noticing little differences in these areas. The brain is a crazy thing. I think that I’ve developed so many triggers over the course of my life that it was difficult to distinguish what was my normal personality and what was a learned reaction. But I’m starting to feel whole again, and the anxiety has subsided substantially.