CBT May Not Suit Everyone

CBT: An Effective Treatment for Many Mental Health Issues, But Not Suitable for Everyone

Imagine seeking help for anxiety, only to find that your treatment makes you feel worse. This is a concern for some people who undergo cognitive behavioural therapy (CBT).

CBT is one of the most revolutionary approaches to treating mental health problems. It is a widely used and effective treatment for many mental health conditions, including anxiety and stress-related disorders.

For many patients, the therapy leads to significant improvements in mental health. But evidence also suggests it may worsen some patients’ symptoms.

How CBT Works

CBT focuses on changing negative thought patterns and behaviours. This is done by helping patients identify and challenge distorted or unhelpful thoughts and beliefs, replacing them with more realistic and positive ones.

Additionally, CBT involves practising new behaviours and coping strategies in real-life situations to reinforce positive change and reduce symptoms of anxiety, depression, or other mental health issues.

CBT in Practice

In England and Wales, medical guidelines from the government’s National Institute for Health and Care Excellence recommend CBT for a wide range of psychological and long-term physical conditions, from anxiety and depression to chronic pain, irritable bowel syndrome, and tinnitus.

This wide range of uses makes it seem like CBT could fix just about anything. As a clinical psychologist using CBT with my patients, I can attest to its efficacy. But I’ve also seen that it doesn’t work for everyone.

Expertise is Everything

CBT is a structured therapy that relies heavily on the expertise of the therapist to guide the patient through the process. If the therapist lacks experience or is not well matched with the patient, the therapy may not be as effective. Worse still, it could lead to misunderstandings and frustration, potentially exacerbating the patient’s condition.

There is an important difference, though, between negative or unwanted effects caused by poorly delivered therapy on the one hand, and side-effects, which can occur even when therapy is done correctly, on the other.

Limitations of CBT

For some therapists, recognising that their work might have negative consequences for their patients might be difficult to accept. This may lead to hesitancy in acknowledging when it happens, potentially attributing the fault to the patient instead. But, even in cases when CBT is conducted correctly, side-effects such as worsening of symptoms and increased distress are sometimes reported by both patients and therapists.

One possible reason is that CBT requires patients to confront their negative thoughts and feelings head on. This can be challenging and, in some cases, overwhelming. Consider people who have experienced complex trauma, for example. Simply modifying thought patterns does not tackle the deep-seated emotional pain and relational issues that underpin their symptoms, which are often rooted in early childhood.

Not Suitable for Everyone

The cognitive aspect of CBT has faced further criticism, especially regarding its potential to induce rumination. This tendency to overthink painful past events is a known feature of depression, and focusing intensively on why one’s thinking might be maladaptive could exacerbate this issue.

Research suggests that CBT may, in some cases, intensify worries and low mood by promoting rumination, particularly in people with obsessive traits.

CBT interventions generally require robust cognitive resources, including memory, attention, and the ability to form abstract concepts. Elderly patients, those suffering from dementia, people dealing with anxiety after a stroke or traumatic brain injury, or patients with lower intellectual functioning may find CBT challenging.

Research suggests that intact cognitive functions, as measured on psychological assessments, can significantly influence the efficacy of CBT.

Conclusion

Despite all these issues, it’s important to recognise how effective CBT is in many cases. Even in instances where there is an initial increase in distress, these effects are usually temporary rather than permanent. Research has shown that long-term significant improvements in mental health are observed after a course of CBT – even among those who initially report worsening symptoms.

Strategies including screening for CBT appropriateness, educating patients about CBT before therapy begins, adapting the approach to individual needs, and ensuring adequate training and supervision of therapists, are likely to minimise side-effects and maximise the benefits of CBT.

FAQs

Q: Is CBT an effective treatment for mental health issues?
A: Yes, CBT is a widely used and effective treatment for many mental health conditions.

Q: Why might CBT not work for everyone?
A: CBT may not work for everyone due to various reasons, including the therapist’s expertise, the patient’s cognitive resources, and the therapy’s limitations.

Q: What are the limitations of CBT?
A: The limitations of CBT include its potential to induce rumination, its focus on rational thinking, and its requirement for robust cognitive resources.

Q: Is CBT suitable for everyone?
A: No, CBT may not be suitable for everyone, particularly those with complex trauma, obsessive traits, or cognitive impairments.

Q: Can CBT worsen symptoms in some cases?
A: Yes, CBT may worsen symptoms in some cases, particularly if the therapist lacks experience or the patient’s cognitive resources are limited.