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CBT Myths Debunked
CBT is arguably the most popular form of psychotherapy among clinicians and the general public alike. With this popularity, many of the nuances of CBT can be lost in translation when simplified descriptions about it get passed around, leading to misconceptions. Here we debunk the most common myths about CBT.
Myth: CBT is rigid.
It’s true that the CBT studied in research is often manualized, meaning that the content, goals, and sequencing of sessions is consistent across therapy recipients in the study. This structured approach ensures that when we’re studying the impacts of CBT, we can say that everyone received all of the key ingredients of CBT. However, in real-world clinical practice, it’s a minority of CBT that follows a manualized protocol.
More typically, the content of a session is determined during the personalized agenda setting, when the therapist asks the client which problems they want to address in the session to improve their week ahead. The choices around how to use session time are guided by an individualized case conceptualization, meaning that CBT is flexibly tailored for each unique client’s specific circumstances and goals. This flexibility continues if an unexpected issue arises during a session, when the client and therapist would collaboratively make a decision about whether to revise the agenda to make room for the new topic or whether the matter can wait until the next session. So although the structure of CBT is a constant, it’s never so confining as to limit clients’ changing goals or priorities.
Fact: CBT can be flexibly tailored for each client’s unique needs and goals.
Myth: CBT is gimmicky. I can learn it from a workbook.
The perception of CBT as gimmicky comes from the large number of cognitive and behavioural strategies and techniques used in CBT, many of which can indeed be learned from a workbook. This myth is perpetuated when well-meaning therapists describe themselves as providing CBT just because they’re using a few cognitive or behavioural strategies, even if they're not incorporating all of the other key ingredients that define CBT.
Contrary to how the CBT name is sometimes misused, CBT is more than a collection of strategies thrown at a problem to see what sticks. CBT—delivered as a whole treatment package—involves a trained professional deciding when and how to present specific skills or psychoeducation to a client based on their evolving case conceptualization, in collaboration with the client, with attention to building a strong therapeutic relationship, and in consideration of the scientific literature about treatment that has worked for individuals with similar difficulties. As soon as these key ingredients are lost and cognitive or behavioural interventions are presented in a mechanical way, it’s no longer CBT.
Fact: If it feels like a gimmick, it’s not CBT.
Myth: CBT is about pretending things are great when they’re not.
Given that CBT is based on the idea that our thoughts about situations drive our reactions, some people assume that CBT teaches clients to feel better by changing their negative thoughts into positive thoughts. These people would be wrong: CBT teaches clients to identify, evaluate, and update their thinking to account for all the facts of the situation, be they positive, negative, or in between.
In other words, CBT helps people catch negative thoughts that are extreme, misleading, inaccurate, or unhelpful and replace them with thoughts that are more balanced. Importantly though, in situations where the exploration of the evidence leads to the conclusion that the negative thought was accurate, CBT wouldn’t have clients ignore the problem. Instead, CBT clients learn how to respond to their negative thoughts and circumstances in a more effective way, for example by focusing on the part of the problem that is under their influence instead of ruminating about the part of the problem they can't change.
Fact: CBT helps you think more accurately and effectively.
It’s true that CBT’s primary focus is on the present and future, where change can still happen; no amount of therapy can change the past, and the historic factors that may have caused a problem to develop aren’t necessarily the same things that keep a problem going. Nonetheless, clients might discuss their pasts during CBT to understand the “good reasons” they developed their current response styles or belief systems, which can help develop their self-compassion as they move forward with the change process.
Clients might also look backwards during CBT to start uprooting some of the deep-seated beliefs that are colouring their current experiences, for example, by incorporating a broader range of prior life experiences into their belief systems or by attaching more balanced meanings to their painful life experiences. With any shifts in perspectives gained through discussions about the past, CBT therapists help their clients plan how to use these new beliefs in their lives moving forward. As an analogy, CBT is like a good driver who travels safely to their destination while checking their rearview mirror but not staring into it.
Myth: CBT ignores the past.
Fact: CBT incorporates the past when doing so helps clients move towards their current goals.
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