It’s hard to dislike good ol’ CBT, arguably the most well-known and well-studied mental health intervention. Studies have repeatedly validated CBT as an effective treatment for many mental health issues. For instance, CBT has about the same efficacy as SSRI-class drugs for depression, a stat that makes insurance execs happy.

I’m not here to bash CBT. I’m just here to point out that it has an insidious dark side and can be evil.

CBT isn’t really evil, clinically speaking. Should we be putting all our resources into building CBT up as a gold standard, though? The insurance companies would probably say yes.

CBT Can Help Us Cope

CBT aims to identify maladaptive thoughts and behavior patterns and challenge our belief in our negative thoughts. In CBT, therapists help us reframe the unhelpful thought patterns and change the maladaptive behaviors into more helpful thoughts and behaviors.

According to the American Psychiatric Association, one premise of CBT is that “people suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.”

At its very core, CBT is a coping strategy, not a healing method. I don’t want to dismiss the entire CBT practice by reducing it to a quick fix method. The changes can often take time and can be profound in the right context. However, CBT’s premise suggests that certain psychological states like depression and anxiety are wrong and should be changed by changing our thoughts and behaviors.

CBT does not generally view depression or anxiety as helpful states of being. We develop depression and anxiety to adapt to an environment in which we feel unsafe, unseen, or traumatized. 

That seems pretty helpful to me. Mental health disorders are often simply mechanisms that defend us from external threats to our identities, autonomy, and self-esteem. Are they ideal? Not necessarily? Is it okay to want to heal ourselves to move past these states of being? Absolutely. 

Our depression, anxiety, personality disorder, or other psychological adaptation got us through overwhelming situations when we lacked any other way to get through. 

CBT can help alleviate the unpleasant and often dangerous symptoms of unhelpful psychological states. As CBT teaches us to challenge and reframe our negative thoughts into more positive thoughts, our symptoms are predictably alleviated. And this can be easily measured. Yes, this is why insurance companies love it. CBT is a nice, predictable way to improve certain check boxes of mental health. Job done, right?

But, the techniques learned from CBT may take the place of the hard work, which involves learning to tolerate emotional pain, listen to it, get to know it, and address it head-on.

CBT Can Mask Deeper Issues

One of my favorite CBT techniques is supposed to deal with ruminating negative thoughts. A  straightforward question posed by a CBT therapist might go like this: “What would you be thinking about if you were not obsessively thinking about how your boss embarrassed you in that meeting?”

Now, this mind trick is not without merit. It can helpfully place an event in a larger context and let us examine it from a more objective point of view. It may also suggest that feeling the pain of humiliation is something we should avoid at all cost. Believing humiliation is a “bad” emotion that must be fixed tends to add shame on top of the original feeling. We view ourselves as broken because we can’t get over this event.

And here comes CBT to the rescue, right? Once we find a thought that we can replace the humiliation with, we cling to it so that we move past the rumination, and mask the unpleasant feeling. But masking the humiliation does not make it disappear, especially if we add on a bit of shame for feeling it in the first place. 

Other mental health interventions may look a lot different. An Internal Family Systems (IFS) therapist may encourage us to connect with the part of ourselves that felt humiliated by our boss and possibly learn the unique internal attitudes we hold that seem to be intolerant of the part of ourselves that feels humiliation.

Through IFS, we can sort through the conflicts within ourselves and look to find the root cause of the humiliation, knowing that feeling humiliation is supposed to be a helpful process, one that is rooted in keeping us safe. Knowing that these feelings exist to help us, even if currently they are not serving us well, can alleviate the secondary effects, like shame, that insidiously keep us from healing.

An attachment-based therapist may look to the attachment styles we picked up as kids, explore early attachment wounds, and identify the relationship patterns we reenact in our lives now that keep us stuck.

There are lots of effective, non-CBT mental health treatments and interventions that can better address the root of long-term mental health problems. But, often, these deeper interventions take more therapy sessions than insurance is willing to pay for.

Are they worth it over CBT? It all depends. CBT can be a godsend in some contexts, such as  overcoming the acute phases of unwanted compulsive behaviors. For instance, reframing cravings from thinking of the cravings as “pain to endure” to thinking of the cravings as “proof that I am abstinent” can help change a negative mindset into a positive one.

But, after the acute phases of addiction, when someone returns to their life and begins to engage in subtle ways of undermining themselves, people-pleasing or fawning, or behaving passive-aggressively, the compulsive cravings may return unexpectedly. Discovering why we turned to our compulsive behavior is a lengthier intervention than typical CBT. In this case, an integrated approach of CBT and attachment-based work may be the path forward for complete healing. 

Can CBT be the answer? Yes. Can it also undermine progress without other complementary interventions? Probably. Is it evil? Well, evil sounds a little too much like shame language for me to use.