Cognitive Behaviour Therapy – is this really the best we have?

According to articles from reputable publications cognitive behaviour therapy has been found to be an effective treatment for: alcohol and drug use dependency, anger problems, anxiety disorders, bipolar affective disorder, depression, eating disorders, hoarding, marital problems.
Also: obsessive-compulsive disorder (OCD), panic attacks, perinatal mental health problems, phobias, post-traumatic stress disorder (PTSD), psychosis.
As well as: schizoaffective disorder, schizophrenia, self-harm, sleep problems, stress.

It’s a regular one-stop-shop for mental health and well-being remedies, as effective as, or more effective than, other forms of psychological therapy or psychiatric medications. An absolute modern marvel.

At the heart of CBT is cognitive therapy – exploring what you think, and behaviour therapy – exploring what you do, and it is grounded in specific theories.

Psychological problems are based on:
  • faulty or unhelpful ways of thinking
  • learned patterns of unhelpful behaviour
Faulty thinking and behaviour can be helped by:
  • identifying links between thoughts, feelings, and behaviours
  • learning to recognise distortions in thinking and to view situations more realistically
  • learning problem-solving skills to cope with difficult situations and making a conscious effort to change unhelpful thinking patterns
  • facing up to fears instead of avoiding them
  • learning to develop a greater sense of confidence in one’s own abilities
The core strategies:
  • therapist and client work together on specific problems, setting clear goals, within a structured format
  • negative thought patterns and behaviour are identified and challenged
  • emphasis is given to what is going on in your current life, rather than what has led up to any difficulties
  • focus is primarily on developing coping skills to change thinking about problematic emotions
  • preparation for potentially problematic interactions may be done through role play
  • learning mind and body relaxation techniques and maintaining regular patterns of eating, sleeping, and physical exercise
  • learning to identify potential triggers, e.g., stress, caffeine, alcohol and/or drug use
  • positive engagement with homework exercises, e.g., worksheets or keeping a diary
Positive outcomes:
  • dealing positively with unhelpful thinking and behaviour will relieve symptoms
  • relieving symptoms will lead to a more effective life
  • you become your own therapist

WOW! or WHOA!

Consider the language the therapists use: “catastrophising”, “generalising”, “inappropriate coping strategies”.
Emotive. Critical. Disempowering. Negating.
Consider the process used: in-session you go through everything you’ve done wrong since the previous meeting; between-sessions you keep a journal to record every negative thought, reflect on what you’ve done wrong, and re-phrase in terms of what you should have done.
Consider the format: you lay out your individual, personal difficulties before a therapist who has been trained in one very specific therapy.
At best cognitive behaviour therapy is patronising and belittling. At worst it leads to self-doubt through manipulation and mind games.

Here are a few reasons for my take on CBT.

The use of CBT for bipolar affective disorder.

Bipolar is identified by mood changes that are severe and long lasting with changes in thoughts and behaviours affecting day-to-day functioning; moods can switch from deep depression to mania with little warning and psychotic hallucinations and delusions may be present. There is evidence that genetic, biological, clinical, and life event factors may be the cause. “It’s very good for helping me not listen to my self-critical voice” – that’s OK if it is the kind of internal monologue that a lot of people experience, but not if it is a psychotic interlude. When a psychotic episode has you convinced that you are evil and should punish yourself through self-harm, is it helpful to consider those thoughts in terms of distorted thinking that should be viewed more realistically? Not only are you evil but wrong and worthless.
In order not to feel so bad about yourself the first defence is to lie. And, of course, you know that if you own up to this then the greatest weapon the therapist has will come down on you: you do not want to get better, you feel safe in the system. You are wrong and worthless. And now it’s official. [I have bipolar and have been on the receiving end of CBT.]

Physical problems obscured by the mental health diagnosis.

One attendee at a bipolar therapy group experienced long periods of depression with a few manic episodes. The various treatments that had been tried were of little benefit but, more by luck, he found his own cure: his mood improved when he ate iron-rich food and he was diagnosed with anaemia. [I went to the same group.]

A young woman, diagnosed with paranoid schizophrenia, was obsessed with her pulse rate fearful that something was wrong with her heart. Because of her mental health history, she was advised against, sometimes quite strongly, from this constant checking. She was under 40 when she died from a heart problem. [She was a dear friend who I met in hospital and went to therapy groups with.]

Rational, extreme emotions obscured by mental health blinkers.

A brilliant man (poet, walker, choral singer, Oxford graduate, lawyer) had been diagnosed with manic-depression in his late teens, long before it was relabelled ‘bipolar’. Not long after his 21st birthday and graduation, his son was diagnosed with leukaemia and given a life-sentence of six months. The father spent every possible moment at his son’s bedside, and spiralled into a rapid decline when the end came. Within two years he had become institutionalised. He died in hospital a few years later, an absolute wreck of a man. He was treated for bipolar, but he died of grief. [He was a dear friend over many years – we met at art therapy, he introduced me to a U3A writing group and a walking group, and supported me when I was struggling.]

External, natural forces

It is well-documented that animals are affected by natural phenomena, like cats ‘running up’ curtains in a storm. What about human animals? I am quite seriously affected by changes in air pressure, with very painful ears and severe mood changes.

Unexpected life-changing events

CBT has been hailed as a therapy with universal benefit. “It got me from being suicidal and on long-term sick leave, to fully functioning and in a successful career.” In a therapy group of five individuals, each person also receiving 1-2-1 therapy and psychiatric support, only one recovered and returned to full-time working and independent living. That person had experienced a breakdown after her husband of many years left her. The others in the group had long-term mental health illnesses. [I was one of the other four.]

End thoughts

I know that CBT works for some people. I also know that some people feel that the fault is with them if it doesn’t work. But, most importantly, I believe that any health fix that works so well for so many conditions is probably too good to be true.
Look to yourself for self-approval. Others may be too busy looking inwards to see your reality.
Seek out the good in yourself. Others may be too busy proving their own worth to recognise yours.
Strive to better the person you were yesterday. Others may be too busy trying to keep you at your worst.
Know your own worth. Maz, X