Is Cognitive Behavioral Therapy Effective?

Cognitive behavioral therapy (CBT)A therapist listens to his client seeks to help people identify negative or unhealthy thoughts, replace those thoughts with healthier thoughts, and in so doing, change their behavior and feelings. People don’t have to spend endless sessions discussing painful childhood memories, and the formulaic nature of CBT offers some people reassurance.

Preliminary studies of CBT showed impressive improvements in symptoms of conditions ranging from depression to personality disorders, leading to a surge in therapists who offered CBT. This type of therapy continues to be one of the most widely used evidence-based treatments available.

According to famed British psychologist Oliver James, though, CBT is a “scam” that does little to address underlying psychological issues. James, a psychodynamic therapist, argues that until people understand what led to their psychological troubles, those troubles are likely to reoccur.

GoodTherapy.org CEO and founder Noah Rubinstein, LMFT, LMHC, takes a similar stance with regards to addressing underlying issues in therapy.

“I am certainly not an expert on what research has shown about the efficacy of CBT, and I certainly don’t want to throw the baby out with the bathwater. CBT is an evidence-based, short-term therapy that has helped many people. However, on a theoretical level, I’ve always considered CBT to be a surface-level treatment rather than a method for lasting changes,” Rubinstein said. “In my experience, the only way to make lasting change is to help people tend compassionately to the more vulnerable feelings that protective functions, or defense mechanisms—such as depression, anxiety, self-criticism, anger, or addiction—are shielding us from.”

CBT’s Short-Term Effectiveness

There’s no question about CBT’s short-term effectiveness; even James admits that people receiving CBT can see remarkable improvements in a short period of time. So effective is CBT in the short term, in fact, that CBT self-help manuals such as David Burns’s The Feeling Good Handbook have become bestsellers. Because CBT teaches people how to detect and stop automatic negative thoughts, it’s especially popular for treating depression and anxiety. Some therapists, regardless of therapeutic modality, even insist that their clients use CBT principles to treat these conditions. 

Can Short-Term Behavioral Interventions Provide Lasting Results?

When researchers evaluate the long-term effects of CBT, the treatment looks less promising. James points out that psychodynamic psychotherapy yields better results in the long term because it helps people address the root causes of their distress. Several studies support this claim. For example, a 2003 meta-analysis that compared CBT and psychodynamic therapy for depression across several studies found that people who used psychodynamic therapy had larger improvements. Another study of marriage therapy evaluated the effects of behavioral versus insight-oriented marital interventions. CBT relies on behavioral interventions, while psychodynamic therapy is built on insight. Thirty-eight percent of couples who used the behavioral strategies were divorced four years later, compared to just 3% of couples who relied on insight-based approaches.

Rubinstein takes the view that conditions such as depression and anxiety protect us from the vulnerable feelings associated with the true source of our distress.

“For example,” Rubinstein said, “the man with depression who’s shut down, can’t get out of the bed in the morning, and has given up might be protecting himself from trying, failing, and once again feeling that terrible worthlessness he’s felt in the past.” Like James, Rubinstein sees CBT as a short-term fix that “helps to eliminate the problematic, surface-level protective behavior.”

Indeed, one of the selling points of CBT is that it doesn’t require a long-term commitment to therapy. Many CBT programs take only a few months, and some promise near-immediate results. A study published in Psychological Medicine in 2008, though, found that long-term approaches may be preferable. That study compared long-term psychodynamic therapy to two short-term therapies: short-term psychodynamic therapy and solution-focused therapy. While the short-term approaches produced more immediate results, those results faded over time. At the three-year mark, people who had undergone long-term therapy saw more improvements. Although this study didn’t evaluate CBT, it does suggest that dedicating more time to gaining insight can be valuable.

Laura Reagan, LCSW-C, a GoodTherapy.org Topic Expert on trauma and posttraumatic stress, blends CBT with a variety of other techniques. She sees CBT techniques as effective and essential, though she acknowledges that CBT may not be best for addressing long-term issues.

“In my practice with trauma survivors, focusing only on changing thoughts and behaviors through CBT without using a more depth-oriented approach will result in only temporary improvement of symptoms which are likely to return, as the underlying problem has not been addressed. I use CBT skills as part of my work with clients to challenge negative cognitions about the traumatic events experienced.”

Rubinstein agrees that underlying problems need to be addressed for lasting change, “I don’t agree with everything Freud postulated, but he did believe that if you eliminate a defense mechanism, another will take its place, and I think that is the problem with CBT in terms of its long-term effectiveness. Therapies that help people to resolve the deeper and more vulnerable feelings that fuel defense mechanisms offer potential for long-lasting change.”

Is It a Scam?

While CBT doesn’t work for everyone, it’s far from a scam. James is a well-respected therapist, but he’s also a practitioner of psychodynamic therapy, so his opinion is by no means free of bias. While some studies have shown that psychodynamic therapy is more effective in the long term, others show that the two approaches are equally effective. Few studies show that CBT doesn’t work at all, and several studies suggest that CBT can work in the long term. A study that evaluated people who had been treated with CBT for social anxiety found that, even three years later, they were able to use what they had learned in CBT to more effectively cope with anxiety. A 2006 review of recent studies found that CBT may help reduce depression relapse rates, particularly when researchers compare the effects of CBT to the effects of medication alone.

Carey Heller, PsyD, a GoodTherapy.org ADHD Topic Expert who uses CBT as well as other forms of therapy in his practice, highlights the importance of a strong therapeutic alliance. He explains, “Many studies have shown that the quality of the relationship between the therapist and the patient/client is one of the best predictors of treatment outcome. Thus, the specific type of treatment, whether it is CBT, psychodynamic, or an integrative approach, is not the only determining factor in whether treatment will be successful for a specific individual. I feel it is more important to find a clinician who you feel comfortable with and can look at your unique needs in determining the best treatment approach to help you rather than just seeking out a specific type of treatment on your own.”

References:

  1. Hope, Jenny. (2014, November 10). ‘CBT is a scam and a waste of money’: Popular talking therapy is not a long-term solution, says leading psychologist. Retrieved from http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html
  2. Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive–behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64. Retrieved from http://dx.doi.org/10.1037/0022-006X.64.4.724
  3. Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M., . . . Renlund, C. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(05). doi: 10.1017/S003329170700164X
  4. Leichsenring, F. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. American Journal of Psychiatry, 160(7), 1223-1232. doi: 10.1176/appi.ajp.160.7.1223
  5. Snyder, D. K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-term effectiveness of behavioral versus insight-oriented marital therapy: A 4-year follow-up study. Journal of Consulting and Clinical Psychology,59(1), 138-141. doi: 10.1037//0022-006X.59.1.138

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  • Lora

    Lora

    November 25th, 2014 at 11:10 AM

    I certainly don’t think that it is a scam because obviously a lot of people have benefited form the treatment.

    But I do agree that the longer term care is probably better for behavioral improvement over the long term and could be a whole lot more beneficial than something that simply promises a quick fix.

  • Catherine Boyer, MA, LCSW

    Catherine Boyer, MA, LCSW

    November 25th, 2014 at 2:12 PM

    Nice, balanced article. It certainly matches my clinical experience. CBT techniques are useful, but more profound and lasting change requires deeper work.

  • Abe L

    Abe L

    November 25th, 2014 at 7:26 PM

    i think it’s important for people/therapists to think in terms of integrative therapy where approaches are not seen as mutually exhaustive but all part of the healing process… even Beck agreed that relationship is the key to promoting change.

  • Laura

    Laura

    November 26th, 2014 at 9:22 AM

    CBT worked for me. It is part of the destroy depression system which is written by a former sufferer of depression. It teaches a simple 7-step process to eliminate depression from your life and worked when Antidepressents failed to do so.

  • karen

    karen

    November 26th, 2014 at 2:42 PM

    You don’t think that this should be dismissed simply because it can be shorter term in duration than other forms of therapy?
    This is what might actually make it more appealing to many people

  • Mark

    Mark

    November 27th, 2014 at 5:35 AM

    It is interesting to see how Oliver James brings the subject up and by raising awareness and using a headline it does get people talking. I can only speak from my own experience as a Clinical Hypnotherapist and say that I see increasing numbers of clients who have had CBT and found it did not work with them in the long term because they did not seem to have found the ways to live their lives and manage the stress once it had finished. Interesting debate to be sure.

  • james

    james

    November 28th, 2014 at 6:06 AM

    I tend to think it might work for a few things but there is a few that it just will not work..

  • Chad

    Chad

    January 9th, 2015 at 4:58 AM

    When it works, it is because people are working with a skilled practitioner and engaging in the actual assignments. Most people who leave therapy do not maintain the regimen that led to change. Very similar to medications. When medication is helping people often feel less in need of medication, stop taking it, and guess what – symptoms come back.

  • Mark Powlett

    Mark Powlett

    January 10th, 2015 at 2:53 AM

    Your make a really good point Chad. All therapy is dependent on the will of the client. You must want to make a change and be prepared for the fact it wont happen by magic. The therapist can help you, but they can’t make you change things, you must do that with your own efforts and commitment.

  • nomis

    nomis

    September 13th, 2015 at 1:01 AM

    I have spent twenty years in these therapies, utter waste of time.

    Nothing but patronising bullying and dismissive dustbin diagnosis in the end. Which is probably the real reason why CBT seems to work.

    I would strongly suggest looking into this as there seems to be dire respect for long term sufferers.

  • CJ

    CJ

    June 18th, 2016 at 3:05 PM

    I received almost 10 mts of treatment from a Mental Health Clinician/Social Worker in a large Toronto hospital ( anxiety/depression ). She was caring, loving , really good ( I pointed out to her, that her web presence was greatly manipulated by someone(s). Never took it seriously. For she was very pretty, I did a great deal of flirting , which she never stopped , refused nor reported. I stopped taking all SSRI drugs my family doctor prescribed, for they all enhanced dry mouth, insomnia, and reduced night urination. In he 10th month of therapy, there was a 30 days gap, while she attended some Mindfulness Meditation conference. She returned totally changed, reprogrammed – soon after a Hospital Administrator suddenly stopped the therapy on the phone. They threw me under the bus. No paperwork, closure or Progress Report was issued. I discovered online, that she works Part Time in a private health clinic as Psychotherapist. Since she became unavailable, thru the hospital, I sent her a letter to the Clinic, asking for a closure, and a copy of the Final Report – had no other choice. She called the cops for me harassing her. I had to agree to the police, that I never approach or recognize her when meeting. She and her “supporters” put chains on me – I realized that during the 10 month therapy she has made huge professional mistakes, and her local Social Worker Association could look into this after the police releases a shortened copy of her Harassment Report. Meantime the hospital is quiet about the whole thing.
    Lawyers are telling me – let it go!
    This could become your story – be super careful!!!!!!!!!!!

  • Lottie

    Lottie

    January 11th, 2017 at 3:22 PM

    Just saw this article on a psychotherapist’s site whose podcast I like. Looking at CBT and Integrative Psychotherapy – mindfulnessandpsychotherapy.com/difference-integrative-psychotherapy-cbt-cognitive-behavioral-therapy/

  • CJ

    CJ

    January 12th, 2017 at 1:59 PM

    Thanks
    my comment and experience is, that most therapists do not have the clue,what is wrong with the patient,
    and/or how to help him/her.
    Hence the heavy duty – try this or try that method – pills ,that make things worse.
    Can not sleep, can not pee, gets me dizzy .
    Best regards

    CJ

  • Liv S.

    Liv S.

    February 25th, 2019 at 12:26 PM

    It was nice that you talked about how this kind of therapy might not work for everyone but that it’s been proven that it can still help some people. My son has been needing therapy for some time so I’ve been doing research to see how to find the best therapist that can help. Thank you for explaining how it works and for explaining that it’s worth trying it because it has the chance of really helping someone change.

  • Jess

    Jess

    August 17th, 2019 at 11:39 AM

    I think CBT gets labelled as “a scam” because it’s frequently advertised as the method to treat anything and everything, and many therapists will use a generic CBT toolbox for a wide variety of different issues (not all of which may be appropriate for the client’s specific issues).

    In my experience, one of the big risks of CBT is it requires the therapist to accurately identify the issues in the client’s life. If the therapist doesn’t understand what’s going on properly, they can end up labeling the client’s accurate understanding as a cognitive distortion. Therapy ends up not working because the therapist is encouraging the client to “correct” their thinking to something that isn’t actually an accurate reflection of reality. Either the client fails or resists accepting the “correction”, or further dysfunction then pops up because of the client’s inaccurate responses to reality (as encouraged by the therapist).

    That was my experience with CBT. It’s very easy with CBT to label any issues in therapy as further manifestations of the client’s distorted thinking, or even to say that a client who challenges the therapist’s assumptions is “not ready to get better.” It ends up not helping because it’s addressing the wrong problem.

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