Cognitive Behavioral Therapy (CBT): The Pros and Cons

Cognitive Behavioural Therapy (CBT)
Table of Contents

What is Cognitive Behavior Therapy?

Cognitive behavioral therapy, or CBT, is an evidence-based talk therapy approach that centers on the connections between thoughts, emotions, and behaviors.

While CBT is an effective treatment for mood, personality, and anxiety disorders, it isn’t suitable for everyone. Understanding the pros and cons of CBT can help you decide if the approach is right for you.

The benefits of CBT therapy

You can increase your self-awareness

In the CBT model of mental health, depressive and anxiety symptoms result from negative thinking patterns. Many of these patterns are based on faulty beliefs that may have been learned early in life [1]. 

These thoughts can cause negative feelings, such as shame or anger. In turn, these intense emotions can impact behavior. This can create a cycle of mental unwellness.

For example, someone who struggled in school as a young child may internalize the belief that they are not intelligent. This may lead to feelings of frustration and discouragement. As a result, this person may lose interest in school or avoid learning new skills. This, in turn, lowers their academic performance, reinforcing their belief and further driving harmful thoughts (I’m stupid) and behaviors (avoiding homework).

CBT-Model

CBT therapists work with their clients to identify and challenge these underlying beliefs. Once clients uncover these beliefs, they can consciously reframe their thoughts and establish a healthier thinking pattern.

If we go back to the example above, CBT will help clients recognize situations where their belief doesn’t hold. For instance, they may have a natural aptitude for art and design. Thus, they can reframe their belief from “I am not intelligent” to “I have intelligence in many areas.”

This new belief can lead to feelings of pride and enthusiasm. As a result of this more positive thinking pattern, the client may decide to pursue an education in architecture.

CBT can not only increase your self-awareness but also improve your ability to understand others. You will begin to notice the links between someone else’s behaviors and their cognitive processes. This will increase your emotional intelligence and improve your relationships. You can learn more about this process in this video:

The Thought-Emotion-Action cycle & Emotional Intelligence.

You can reduce your physical symptoms

CBT also focuses on the link between behaviors and emotions to manage anxiety disorders like phobias [2]. When you are in a situation that makes you feel afraid, your body releases a stream of chemicals that ignite your fight-or-flight response.

If your stress response is activated, you may experience several somatic symptoms:

  • Shaking
  • Fast Heartbeat
  • Digestive problems
  • Chest tightness

Sometimes, these symptoms can appear without any apparent external trigger. This can lead to a maladaptive thought process where the person blames their heightened fear on their environment. As a result, they may become withdrawn and isolated in an effort to manage their anxiety [3].

It is easier to apply CBT techniques when your stress levels are lowered and your body is less reactive. For this reason, a CBT therapist will teach their clients relaxation exercises that inhibit the stress response [4].

There are several categories of relaxation strategies:

CalmingWhite noise/ambient sounds, calming scents like lavender and chamomile
PhysicalDeep breathing, gentle exercises, stretching, and sensory activities, such as holding hands under warm water
CognitiveAffirmations, meditation, recentering exercises (focus on present)

Using a combination of these exercises every day can reduce your baseline anxiety rate.

You can make progress in a short time

CBT is designed to be a short-term intervention. Clients usually meet with their therapist weekly or bi-weekly for up to five months. Depending on the issue and the client’s background, people can see progress in as few as five sessions.

Short-term therapies like CBT are best for people who exhibit the following ten criteria, taken from the Suitability for Short-Term Cognitive Therapy Rating Scales:

  1. The ability to identify automatic thought processes
  2. The ability to identify and talk about emotions
  3. Accountability and responsibility over one’s own emotional development
  4. A willingness to apply cognitive strategies in therapy
  5. An ability to establish a positive and safe relationship with the therapist
  6. Ability to maintain healthy relationships with others
  7. The issue at hand developed within the past six months
  8. Defense mechanisms do not interfere with the therapeutic process
  9. Remain focused on the problem at hand
  10. Believe change is possible

Depending on the situation, the therapist may work with the client to improve some of these areas before turning to their thought patterns. For example, the therapist may help a client describe their emotions with more nuance or address their doubts about CBT therapy.

You can use CBT techniques in the real world

In addition to in-person sessions, CBT therapists also assign their clients thought exercises to complete in their own time.

These exercises are highly structured and ask clients to record their thoughts, identify their feelings, and actively challenge or replace unproven beliefs.

Initially, clients will write out this process in a journal. Over time, these thought processes become automated. This enables clients to use what they learned in session in real world situations.

Thoughts on Trial is an exercise commonly used in CBT to challenge automatic negative thoughts and beliefs [5]. Imagine your thought is in a courtroom, and both sides must present proof to support or invalidate the underlying beliefs. After weighing the evidence, you can rationally decide to adapt your thought.

Automatic ThoughtEvidence ForEvidence AgainstYour verdictWhat might be a more accurate reframing?
“Nobody likes me at work”– I don’t get asked to go out for after-work drinks– My boss wrote in my review that I am a team player, and people like working with me

-I have received birthday gifts from coworkers

-My coworkers start conversations with me and ask me about my life
– My coworkers are interested in me but may not invite me out for drinks for a different reason-My coworkers like me but may not know that I would like to spend time with them outside of work

-I can ask others if they want to go out for drinks instead of waiting to be invited

Once you complete the exercise, you have an action plan that you can then carry out in the real world. In addition, this same process can be used for other negative thoughts and help you identify healthier responses.

You learn to be your own therapist

The primary goal of CBT therapy is to give you a toolkit of exercises and cognitive strategies to counter thoughts and beliefs that do not serve you. When you are facing a period of high stress or uncertainty, you can return to these tools to help you process the situation.

For some people, the skills they learn in a short CBT session are enough to help them navigate the rest of their lives without therapeutic support. In fact, many people achieve effective results by completing a CBT workbook on their own [6].

The downsides of CBT therapy

You may experience a spike in anxiety

In order to benefit from CBT, you must be able to analyze your emotions, thoughts, and beliefs. Many of these cognitive processes are deeply ingrained and automated. It is also normal for people to suppress or ignore their negative emotions [7].

While going through CBT, clients must bring these intense feelings to the surface in order to examine them. Therefore, the sessions and homework may also focus on emotionally challenging scenarios and topics.

Many people report an increase in their negative emotions or thoughts in the first few sessions [8]. Some people also notice a greater intensity in their somatic symptoms. While this usually subsides after a few sessions, some people may stop therapy before they experience results.

You have to apply what you learn to see results

To benefit from CBT, you must already accept that the approach works and that you are willing to work on your issues. Sessions with the therapist are designed to complement out-of-session homework and exercises. You will see minimal progress if you do not have the time, cognitive or emotional space to complete these exercises.

For the same reasons, CBT is not recommended for individuals with certain conditions, such as dyslexia or autism [9]. However, the approach can be adapted to accommodate people with learning disabilities or challenges.

You may have other issues that CBT cannot address

CBT is present-focused, meaning that it mainly deals with current events and situations. While many of the beliefs we hold are formed in childhood, CBT puts more emphasis on actions that can be taken today.

CBT alone would not be suitable for individuals with complex mental health histories. People with life-long symptoms or negative thought patterns would benefit from approaches that include inner child work, such as schema or trauma-informed therapies [10].

CBT also falls short of addressing issues that arise from external circumstances. For example, CBT is not appropriate for individuals in toxic family dynamics or living in traumatic circumstances.

Sources

[1] Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT. 2013;6(9):579-585. doi:10.1177/1755738012471029

[2] American Psychological Association. (2017, July). What Is Exposure Therapy? Https://Www.apa.org. https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy

[3] Fritscher, L. (2008, February 19). 5 Common Effects of Phobias on Your Emotions and Personality. Verywell Mind; Verywellmind. https://www.verywellmind.com/psychological-and-emotional-effects-of-phobias-2671693

[4] Relaxation Skills for Anxiety. (n.d.). Michigan Medicine University of Michigan. https://medicine.umich.edu/sites/default/files/content/downloads/Relaxation-Skills-for-Anxiety.pdf

[5] Court Trial Thought Challenging Record. (n.d.). Psychology Tools. https://www.psychologytools.com/resource/court-trial-thought-challenging-record/

[6] Seth J. Gillihan PhD. (2016, September 13). Therapy Without a Therapist? Psychology Today. https://www.psychologytoday.com/us/blog/think-act-be/201609/therapy-without-therapist

[7] Cullen, M. (2020, January 30). How to Regulate Your Emotions Without Suppressing Them. Greater Good. https://greatergood.berkeley.edu/article/item/how_to_regulate_your_emotions_without_suppressing_them

[8] Cognitive Behavioral Therapy (CBT). (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt

[9] Devine, D. (2018, October 15). Can CBT work for people with learning disabilities? | LDT. LDT. https://www.learningdisabilitytoday.co.uk/can-cognitive-behavioural-therapy-cbt-work-for-those-with-learning-disabilities

[10] Kopf-Beck, J., Zimmermann, P., Egli, S. et al. Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC Psychiatry 20, 506 (2020). https://doi.org/10.1186/s12888-020-02880-x

Alisha Verly Jensen
Alisha Verly Jensen
I am a freelance wellness writer passionate about positive psychology and gentle productivity. I enjoy studying personal development and sharing what I’ve learned to help others create a balanced and fulfilling life. When I am not writing, I am tending to my garden.