It seems low levels of any disorder can be ''kept in a place'' but medicine seems to minimize to the point of eradication.CBT is not capable of such MAGIC, besides is there not a little of the ancient thought behind the therapy, like ''it's your problem figure it out''. Anxiety is a constant and one tires quickly having to constantly engage it. -Hope the discomfort was momentary and the response will be a framed gem on my wall. With a handshake in thought- David

I don't care what any research study suggests; I have been in CBT for over ten years and it has kept me out of the hospital. I have found that the techniques I use, like thought-stopping, help me considerably in battling my anxiety and depression. I believe that CBT is a much more practical and less time-consuming way to fight mental illness than more classical therapies.

Wendy Aron, author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness.
www.wendyaron.com

While I agree that the results could be better, I want to say that as a trainer and supervisor of CBT, I have seen it practiced poorly and elegantly, and I suspect that, as the adage goes, "It's the singer, not the song," that is, the person providing the therapy (whatever standardized approach) and their fit with their client, may be more important than modality.

However, a good theory, like that evoked by rational therapies clearly work even when performed poorly.

Same goes for meds. They carry great side effects for some, and provide relief for others, with no effect for ther rest. I recommend clients find someone they like and respect, who treats them professionally and informally.

As someone who has never benefitted from CBT, but instead got good results from a more psychodynamically-oriented therapy, I'm SO glad that a group of professionals finally stepped up and admitted recently that CBT is NOT the fabulous, wonderful miracle cure for all mental illnesses. In fact, I find it a condescending and very non-empathetic therapy approach, one that focuses more on the logical mind than the emotional one.

Frankly speaking, I am quite intelligent, and my mind is usually quite adept with logical skills -- in fact, these days, now that my emotional state is better, I can do the CBT type things on myself. But when my emotions are very strong and unbalanced, none of that works. Basically, my mental illnesses prevented me from being able to use CBT at all, because when people tried to use logic on me, I saw that as a way for them to subdue me, control me, and get me out of the way. In other words, CBT was something I felt internally to be a method of abandonment, and proof that nobody truly cared about me at all.

CBT tries to teach that thinking better will fix all your emotional problems, but for me that is so far from the truth that it's actually laughable. For me, fixing the emotional problems has been the key to fixing the thought problems. The EMOTIONS had to come first, not the thoughts, and certainly not the behaviors.

I suspect that the sharp rise in CBT practice came about in response to the many clients who are forced into therapy and insurance companies that are unwilling to pay for prolonged treatment. I work with clients who have been forced to seek short-term treatment and they are looking for a direct approach. Many are uncapable or unwilling to do the insightful work required of a client engaged in psychotherapy. The mistake is made when just because CBT has improved the short-term outcomes for a specific population, it is assumed that it must be a superior treatment for all. Although I find CBT to be the most effective with many of my clients, when I sought therapy myself, I wanted a traditional psychotherpay approach and truely enjoyed and benefitted from being challanged on a deeper level, exploring my roots, and seeking refined, personal insights.

I think it's also worth mentioning here that there are varieties of CBT as well. As a nurse-specialist who practices third-wave or third-generation CBT emotion is very much at the heart of my practice. It is the core of what CBT is about. Developing a therapeutic alliance with my service user is vital in the success of the therapeutic venture.

As for psychosis CBT is useful for psychosis. I have had good outcomes for individuals with diagnoses of psychotic disorders. Including the big toughie - delusional disorder. Adapting mindfulness based cognitive psychotherapy into my practice has had great results for many of my service users with problems diagnosed as psychosis by my medical colleagues. Not all, but many.

CBT is often portrayed as non-humanistic and non-emotive, as cold. It very much depends on the practitioner, their skill-base and approach within the CBT framework. I would rather throw away the label of CBT (something espoused by Beck it's creator) and work under the banner of 'empirically grounded therapy'.

I also work systemically and psychodynamically. The individual without reference to their social context and environment within their relationships and treated with CBT without a systemic view is often drawn back into patterns of illness by virtue of unchanged relationships, dynamics, conexts and environments.

I agree with the thrust of the original article, but would argue against complaints that CBT is without emotional sensitivity. Some CBT practitioners, with a behaviourist hang-over, or an over-dependancy on working rigidly within the given model of treatment may fall into these traps. Integrative, creative CBT therapists in the third-wave of practice are far less likely to fall into this kind of trap.

Niiki, I totally agree with you. CBT techniques are great when I am well or very mildly depressed or triggered, or by my clients who are doing well (I'm a psychiatric social worker) or just beginning to decompensate. But the therapy's base idea is that depression and anxiety are thought disorders, that flawed thinking is always present before AND the cause of mood symptoms. This foundation premise is simply untrue.

It is evident to most anxious and depressed people and most insightful mental health workers that the mood actually drives the thoughts when symptoms increase, and not the other way around. CBT simply doesn't work well when the mood symptoms assert themselves. And I think it definitely can be (and sometimes is) used in a blaming and dismissive way. This is even mre true of DBT, but that's another story for another day. Behavioral modalities easily fall into the trap of being a fancy way of expecting mentally ill people to pull themselves up by their bootstraps and get over it already. All they have to do is think properly use coping skills. If they don't improve in six sessions they "aren't committed to change." I see this a lot in mental health workers who have never been mentally ill, poor, in chronic pain or traumatized. They take much greater stock in CBT and DBT coping skills than the modalities can realistically fulfill.

CBT works extremely well for situational,mild depression or anxiety. It can be very effective in helping couples or families challenge their assumptions and understand their relationships better. An example would be a person who has felt rejected and unloved for 20 years because their partner always turns away from them after lovemaking or at night. When they finally ask (with the CBT therapist's guidance) and examine the assumption with the partner, they find out that s/he injured a shoulder as a kid and it hurts to lay flat or on the injured side. They decide to switch sides of the bed and voila! 20 years of pain and sorrow caused entirely by flawed thinking eliminated and a partnership renewed.

And don't even get me started on mental/psychiatric illness treatment reframed as "behavioral health."

CBT can be effective, but YOU have to do the work. This means YOU have to take responsibility for YOUR illness.
Many people are reluctant to accept this.