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CBT is Like Shopping at 7-11 for Your Mental Health Needs

One of the things that drives me crazier than usual is this notion that anxiety is in overwhelming proportion amenable to rational thought on the part of the person suffering from the anxiety disorder. It’s a persistent idea. It’s also wrong.

Cognitive behavioral therapy: What they don’t tell you, why you should find out

Large segments of society and government sit in the somewhat jaded but still pro-positive thinking/CBT camp. (CBT essentially being the idea that rational interventions can identify and mitigate harmful cognitive feedback loops.)
The problem? This has increasingly led to the use of CBT as a catch-all for people with mental health issues with the expectation that it will make them well and do it darn quickly.

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CBT seems like a tailored, streamlined mental health treatment that should work sufficiently well for most. Plus insurance companies love it. The underlying premise is, however, not so much brain-centered as it is economically and emotionally motivated.
I’m the last person to suggest either of those motivations are inherently bad. They’re not. But when it comes to things like treating anxiety and depression, emotional and economic efficiency shouldn’t be top of the list. Making them so endangers lives but nobody wants to think about that much, ‘k.

Brains require more than brief, ‘rational’ interventions. If you don’t believe me, please watch this amusing and informative TED talk by a cognitive neuroscientist:

Rebecca Saxe: How we read each other’s minds


After you’ve watched that. You did watch it? I know it’s long. Think about how many years we spend learning apparently simple skills like:

  • How to relate to each other;
  • How not to freak out and think the world is ending when someone leaves;
  • How to answer questions in our own lives whilst feeling confident about that and possibly creating our own small miracles of nature in the process.


How to tell your mental illness really does exist

Suppose one day, in your 20s, or when you pop out one of those small miracles of nature, a whole bunch of those skills get wiped out. Without warning, or preparation. “And there’s no manual”, as Ruby Wax would say.
You didn’t have a stroke but in terms of your ability to function mental illness can have similar effects. A stroke might be easier; Nobody would tell you to “perk up”.

In any event, you’ve crashed and now you get to pick up the pieces. Most people do not know how to do this. Again,  no guidebook. Maybe they keep quiet, until it turns into ‘I seem to be in the hospital. Er, maybe there’s really something wrong?’. It’s about that time someone offers 6 to 8 sessions of CBT with a side of medication.

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CBT is not the magic bullet of mental health recovery

What isn’t often mentioned is that to work well, and not remain simply a semi-functional bandaid that comes off when wet, CBT needs continual reinforcement over the long-term. That 6-8 therapy sessions with some dude you’ve never seen before but to whom you’re supposed to reveal your innermost thoughts, no matter how terrible they may seem, probably won’t fix mental illness.

Regardless of efficacy or efficiency the government, my neighbor, my family have no right to tell me that 6-8 sessions should be quite sufficient to undo the damage. It’s unlikely I’ll begin to understand the magnitude of what I’ve lost in 6-8 sessions, let alone fix anything. Can I pick up a few helpful tools? Sure but it’s still the equivalent of shopping at the 7-Eleven for all your mental health needs.

19 thoughts on “CBT is Like Shopping at 7-11 for Your Mental Health Needs”

  1. I agree that some therapists are not being trained as well as they might. I think there is also a perception now by the public that cbt can cure all in 6 sessions. However, I feel for longstanding or recurrent problems cbt on its own is not enough.

  2. I can see and understand both sides of the argument. As a cbt therapist starting out thirteen years ago, I came to realize that cbt wasn’t the answer to all people and all illnesses. I then started using schema focused cbt in conjunction with standard cbt. I find that the combination works really well. I use schema therapy for longer term problems and have had good success using it briefly as well. Another problem which I see in the private sector is people buying into the hype surrounding cbt. They have high expectations of success in relatively few sessions and it doesn’t matter how severe there illness is.

  3. Kate,

    I see your point. 6-8 sessions probably won’t cut it. But I’d say that’s not an indictment of CBT, but of cost-cutting insurance companies.

    When I was suffering from depression and anxiety, I underwent two years of CBT from an outstanding psychologist, and it changed my life. I gained a measure of control over my thoughts, and thus my emotions, I never dreamed possible. Before this therapy, I thought emotions were a roller-coaster ride we have no control over–that all we can do is enjoy the good times, hang on for dear life during the bad times, and more or less muddle through the rest. I was 56 when I started CBT. I’m so grateful for it and for my wonderful therapist. It was a lot of hard work, pretty much every hour of everyday for two years, but I quickly started to see progress and that motivated me to trust it and keep at it. It’s still work, often hard work, but using CBT I can choose my thoughts, keep perspective, alleviate anxiety, maintain much better control over my emotions, and avoid falling back into the dark pits of depression. I doubt there is actually a cure for depression, but CBT keeps it at bay and lets me live my life.

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