Why CBT Might Not Be Working for You

Many people are familiar with cognitive behavioral therapy (CBT) and have even been referred to this form of psychotherapy and treatment by their physician. I have had many prospective clients reach out to me and say, “My doctor told me I need cognitive behavioral therapy,” without really knowing much about this modality or why it was recommended in the first place. And while this form of therapy is evidence-based and has been found effective for treating anxiety, depression, and other mental health challenges—it also has its limitations. Let’s discuss why CBT may not work or be working for you.

Reality-Checking Our Thoughts

CBT is grounded in the theory that we can change how we feel and interact with the world by challenging our negative beliefs and thinking habits. CBT techniques such as evidence gathering, thought stopping, and cognitive reframing are used to help us identify and replace unhelpful or irrational thoughts that result in unwanted feelings or patterns of behavior. Basically, the goal of this modality is to reality-check our thoughts to experience emotional relief and improve our overall functioning.

For example, let’s say that you are late to work and think to yourself, “I’m such a failure; I can’t do anything right.” This negative thought would most likely cause unpleasant feelings such as shame or anger and consequently lead you to behave in a way that reflects how you are feeling in that moment. You might then have a shorter fuse, feel less motivated, or misinterpret interactions with your coworkers. Through CBT, you would challenge this initial thought and replace it with a more helpful one like, “I’m rarely late and this doesn’t reflect who I am,” which would result in less-disruptive emotions and behaviors.

For many individuals, CBT is an effective modality and can help to manage anxiety, phobias, and mild to moderate depression. It offers a straightforward approach with concrete tools and techniques to apply to everyday life stressors and experiences. However, CBT isn’t always enough or sufficient for individuals who have experienced trauma or have complex trauma.

Impact of Unresolved Trauma

When we have unresolved trauma—adverse experiences that threaten our sense of safety and well-being—we experience the impact of these experiences in our everyday life. This is because trauma results in changes in our neurobiology and nervous system. Events that may have occurred in our “past” can continue to show up in the present day—in our perceptions of events and core beliefs and in our emotional and physical response to stressors. Things that may seem minor or benign to others can feel very charged to those of us who have a trauma history and result in feelings of distress and overwhelm. And it can be incredibly difficult to think “rationally” or “reasonably” when we are activated and in this state of distress.

Let’s go back to this example of being late to work and having the thought, “I’m such a failure.” If you have unresolved trauma and past experiences around this theme of “failing” or being “not good enough,” it may be difficult to challenge this thought or approach this experience objectively. This stressor (being late to work) is likely to have more emotional charge and activate similar thoughts, feelings, and sensations from past experiences that have not been resolved. While you might know that logically this event does not make you a failure, your activated state and dysfunctional memory network could be telling you otherwise. In this case, CBT may be limited in its effectiveness, as it does not address the root of the issue.

Alternatives to CBT

So, if CBT just doesn’t seem to be “working,” and you are hitting a wall in therapy, it doesn’t mean that there is something wrong with you—It’s not you; it could be the modality. You may want to consider a trauma-focused modality such as Eye Movement Desensitization and Reprocessing, brainspotting, Internal Family Systems, or cognitive processing therapy. These alternative treatments have been developed to address the complex nature of trauma including the emotionality and deep-rooted beliefs that often persist long after a traumatic event or series of traumatic events.