Everything You Need to Know About CBT

Elliott L. Conklin, Psy.D.
May 22, 2024

Cognitive Behavioral Therapy (or “CBT”) is a form of psychotherapy that focuses on the interplay between thoughts, feelings, and behaviors. Its fundamental premise is that our thoughts influence our emotions and actions, and by modifying thought patterns, we can bring about positive changes in our emotional well-being and behavior.

This approach emerged from the work of pioneers like Aaron Beck and Albert Ellis in the 1960s, who challenged the prevailing psychoanalytic paradigm with their emphasis on the present and the cognitive processes underlying psychological distress.

Unlike some other forms of therapy that delve into the depths of one’s past or unconscious mind, CBT is more present-oriented and structured. It equips individuals with coping strategies and techniques to identify and modify unhelpful thought patterns, thereby alleviating symptoms of various mental health conditions, such as depression, anxiety, and others. Since its inception, new “waves” of CBT-based models have been developed, including Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MCBT).

As much as CBT has been touted as the epitome of evidence-based therapy, it’s important to exercise caution regarding the claims made about its support in the scientific literature. The last several decades have produced a movement for more empirically supported treatments (ESTs), which has most certainly resulted in a more scientifically rigorous model for treating mental health disorders. However, this movement, which champions CBT as a prime example of an evidence-based approach, has been characterized by a set of flawed assumptions and narrow criteria that impede a nuanced understanding of therapeutic efficacy.

A central flaw among some empirically supported protocols is the rigid insistence on manualized treatments and randomized controlled trials (RCTs) as the sole arbiters of empirical validation. While randomized control trials do serve as a gold standard for some types of research (e.g., drug development), they can be clumsy in areas of study where there is less control over treatment delivery (Remember, therapy isn’t a pill!). Such a mechanistic approach gives these treatments an air of medical authority without delivering much on substance.

A lot of hot air has been devoted to the outcomes of these narrow methods without any significant progress in understanding what underlying mechanisms in therapy actually work. Marketing and media campaigns have emerged from the EST movement to claim certain brands of therapy as “empirically validated” while ignoring the swath of data supporting other approaches (e.g., Psychodynamic, Relational, Parent-Child Interaction, Interpersonal Therapy, Play Therapy) that are equally effective. This dogmatic adherence to specific methodologies is unscientific; it fails to capture the complexities of therapeutic practice and discounts a wealth of evidence from the many research methods that contribute to our collective knowledge.

While the merits of CBT and its evidence base are certainly debatable, one factor that cannot be overlooked in any form of therapy is the therapeutic relationship itself. Numerous studies have highlighted the profound impact of the client-therapist alliance on treatment outcomes, regardless of the specific therapeutic approach employed.

The therapeutic relationship is a dynamic, interpersonal process that transcends mere technique or manualized interventions, which is why it is garnering more attention in the scientific literature. It involves empathy, trust, and a genuine human connection between the therapist and the client. Without this crucial foundation, even the most rigorously “empirically supported” techniques may fall flat.

In essence, while CBT undoubtedly has its merits and a solid evidence base, it is not the be-all and end-all of therapeutic approaches. True healing often lies in the synergy between evidence-based techniques and the art of cultivating a profound therapeutic alliance – a delicate dance that defies rigid categorization or dogmatic adherence to specific methodologies.

At Kingsbury, we apply a more nuanced lens to decisions about when to apply the techniques of CBT and other approaches. We consult with our colleagues and discuss our conceptualization of what underlying mechanisms are at play. These conclusions are typically integrated into an individualized treatment plan. So, when a client calls to say “my doctor recommended CBT. Do you all do that?” The answer is yes. But the follow up is always “let’s talk more and see if that’s what you need most right now.”