CBT Doesn't Work

Cognitive-behavior therapy will go the way of low-fat pudding.

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Imagine you’re afraid of girls, too afraid to even think to ask one out. So you see a psychologist to figure out what could possibly make veritable self-castration feel like the best option for you. Though he only tells you there’s no rational reason to be afraid of girls, then he recommends you talk to more of them.

Imagine you’re a compulsive eater. Of course you’ve read every book on diet but it doesn’t help because of you cannot win against this demonic, inner urge. You see a psychologist to get to the bottom of the irrationality and she recommends you swap the cookie sleeve for broccoli.

Imagine your husband threatens to leave you unless you learn to control your violent temper, a problem you’ve had since childhood when your father left. You see a psychologist to finally work through some of the latent pain that may be at the root of these outbursts, and he recommends a breathing technique.

This kind of symptom-focused therapy, which has become known as cognitive-behavior therapy, is insulting. It’s even more insulting to graduate students because we’re forced to learn this intervention a mainframe could do.

To think we can solve our psychological issues with a decision in the moment, is to not only be a computer but an outdated computer. The human equivalent is someone who is high in conscientiousness and low in openness, the two marked traits of cognitive behavior therapists.

Even the idea behind CBT is self-refuting—if we change our psychology with a decision in the moment, then there would be no such thing as a psychological disorder. That’s the point of psychology—to help us make decisions we already know we need to make. The anxiety itself keeps us from asking out girls, the compulsion itself keeps us from changing our diet, the rage itself keeps us from an equable presence.

At the risk of sounding glib, CBT doesn’t work. The therapeutic technique that has been championed as the go-to scientific approach to therapy doesn’t work.

It gets a lot of funding, though. And insurance won’t cover therapy unless it’s CBT, so what happened?

What happened is the 1970s. Psychoanalysis was shown to be unreliable, given its—literally—subjective nature in that its practice depends on the subject. To defend their field, psychologists scrambled to get a more science-y therapeutic practice together so they could get a piece of the NIH bloat that occurred at this time.

The initial CBT studies were biased from the beginning because if this new, concrete-bound therapy wasn’t shown to work, then psychology may have gone the way of phrenology. Psychologists, because of the incentives, unconsciously became hustlers for their profession.

The initial CBT studies were only compared to psychoanalysis, which has been notoriously touchy when put under the lens of science.

In every study that pitted CBT against an array of anxious or depressive disorders, simple group therapy worked as well as group and CBT in combination. And it works better than CBT alone. Yet the idea behind group contradicts CBT. Instead of directed intervention at a specific thought and action, group lets the participants talk with little input from the psychologist. Sometimes no input from what I hear because, hey, insurance is paying for it so no one cares.

Yet group still works better than the more logical CBT because this is how psychology works. Our freedom of action and so ability to change comes first from emotional literacy. The trick is to understand the syntax of emotions so we can learn the language.

A comparable scientific debacle occurred with the high-carb, low-fat diet craze. Remember that? In the 90s and early aughts, when people thought a diet of low-fat pudding and Snackwells was going to make them look like a Fight Club poster?

There was a health problem. Westerners were getting fat and dying and we needed a solution, any solution, so scientists latched on to the low-hanging fruit, the most intuitive answer: People were fat because they ate too much fat. Even the wrong answer looks better, in the short term, than no answer at all. Besides, the researcher gets paid either way. And we’re talking grants from the NIH that could engender generational money. We thought we got rid of the rite of lordship bestowals with the founding of America but it’s only taken a different form.

Thus begets a vicious cycle: money pours into research, skews research, “evidence” makes us feel good, which demands more financial support. Not to mention the unseen catastrophe: our country’s PhD-level minds now spend their precious time proving a false idea correct to get more money rather than seek new solutions. It’s why symposiums resemble congressional gripe-fests about who gets what money rather than the Lyceum.

The solution is to understand why group works better than CBT. Why simply putting yourself in a room of people and listening makes it more natural for the incel to ask the girl out, the binger to put the food down, and the rager to mellow out.

We need to understand emotions, how they operate, how they affect us outside of our awareness. We need a structure to the emotions so we can work with them and not merely try to change them. And then we need a process through which we become more literate with emotions, and so reality.

To all the burgeoning psychologists out there, your professors are dinosaurs. It's on us to wake up the field out of its CBT slumber. Otherwise, we’re going to feel stupid when the most scientific therapy is debunked and the welfare runs dry—about as stupid as we feel when we think about all those Snackwells we ate.