1. Chapter 12
Common CBT Myths

2. Common CBT Myths
It is especially important that those entering training in CBT are made aware of such myths in order to avoid any possible self-fulfilling prophecies and/or negatively biased influences
The following myths are truly myths – that is, they are not true

3. CBT Is Too Rigid/Mechanical/ Technique Focused
Cognitive and behavioral therapies (now CBT) were the first theoretical therapeutic approaches to use manual- based treatment, which may have resulted in precipitating this myth
Some therapists not familiar with CBT have a false belief that a too scientific an approach means no flexibility, creativity, or innovation in therapy

4. CBT Is Too Rigid/Mechanical/ Technique Focused
Ironically, CBT manual-based treatments have enhanced flexibility, creativity, and innovation for a verity of disorders across diverse client populations
With CBT there is a balance between the science and the art of therapy
However, priority is not put on how creative therapists feel about themselves; priority is put on providing the best possible care for clients based on evidenced-based practice
The art comes in when it is necessary to be flexible and innovative

5. CBT Focuses Only on Thoughts and Excludes Emotions
The development of this myth may also be an emotional response in and of itself: emotions must receive attention in therapy!
CBT often begins with emotions before transitioning to thoughts
A key way to identify automatic thoughts and core beliefs is by eliciting strong emotions
Thereafter, clients learn that modifying thoughts will moderate the intensity of their emotions
It is impossible to ignore emotions in CBT

6. CBT Therapist-Client Relationships Are of Little Value
Such Rogerian conditions as empathy, genuineness, and unconditional positive regard are important for the therapist-client relationship
However, these common factors are necessary but not sufficient for long-term change for most clients
The specific factors of CBT are necessary for true change, but they are of little value if there is a poor quality therapist-client relationship

7. CBT Therapist-Client Relationships Are of Little Value
A vital component of the therapeutic relationship in CBT is collaborative empiricism, which requires clients to trust both the therapist and the techniques that are implemented
Collaborative empiricism is the driving force for behavioral experiments and developing new thoughts and core beliefs
Research shows that collaborative empiricism is most effective when there is a strong therapeutic relationship that is valued by clients
Thus, not only is the therapist-client relationship of great value for CBT, it is necessary for efficient and effective therapy

8. CBT Treats Only Surface Symptoms, Not the Source
This is an “old-school,” unsupported view that initially developed when behaviorism began to establish itself in response to psychoanalysis (i.e., science vs. nonscience)
Historically, psychoanalysis has focused on the id, ego, superego, and repression (to name a few)
However, these are essentially made up constructs to explain internal distress (i.e., neuroses) that actually do not exist and have no empirical support (there is some support for an unconscious but not in the Freudian sense)

9. CBT Treats Only Surface Symptoms, Not the Source
Behaviorism took the opposite approach by focusing only on what is observable and measureable, which naturally fits within the scientific method, allowing for experiments
The rise of behaviorism resulted in complaints (i.e., myths) that it only treated the symptoms, but not the source (“symptom substitution”)
These complaints have been shown to be unfounded, as behaviorism has continuously demonstrated its effectiveness to treat many problems, especially anxiety- related distress

10. CBT Treats Only Surface Symptoms, Not the Source
Research strongly supports that CBT treats well beyond symptoms relative to other therapeutic approaches
In fact, many times, treating what would initially be considered “only the symptoms” is actually treating the source
The premise of the CBT theoretical model is that distress largely comes from how one appraises and responds to one’s environment
Changing thoughts and how one behaviorally interacts with the environment does produce long-term change
Thus, by definition, CBT treats the whole person

11. CBT Does Not Consider the Past Important
CBT does largely focus on the present and future change over time but also acknowledges the importance of the past and, when necessary, will explore specific relevant events
Compared to other theoretical approaches, CBT is different in how the past is perceived and how information about the past is used in conceptualizing clients’ distress and problems
For example, other approaches (e.g., psychoanalysis) focus heavily on the past and believe that what happens as a child largely determines who we are as adults and that we are continually working on our conflicts

12. CBT Does Not Consider the Past Important
CBT recognizes that the past does play a role in shaping us, but it is a continuous process (and not an end all)
For example, core beliefs, often formed due to significant past events, are an important part of CBT in understanding how clients perceive themselves, the world, and their future
While past events can inform conceptualization, the present is used to solve current problems, modify relevant cognitions, and apply new behaviors while also planning for the future (e.g., troubleshooting, generalizing change)

13. CBT Is Simply a Fancy Approach to Positive Thinking
This myth appears to be largely due to the lack of knowledge of the actual mechanisms of change for CBT
Generally, positive thinking is making a negative thought positive simply by changing the words
For example, instead of thinking, “I’m a bad person,” think, “I’m a good person”
The example focuses only on the surface outcome and ignores the internal process of change

14. CBT Is Simply a Fancy Approach to Positive Thinking
CBT focuses on “realistic thinking” by having clients modify their invalid negative automatic thoughts so that they are more accurate with adaptive behaviors and consequences
Notice that the focus is on valid thoughts, not to be more “positive”
If modification results in a positive thought, it was the natural outcome of the actual process of change by examining the nature and validity (or lack thereof) of the initial thought

15. CBT Is Simply a Fancy Approach to Positive Thinking
In other cases, some negative automatic thoughts are valid because the situation is not positive (e.g., may cause actual physical and/or psychological harm)
Trying to think positive for valid negative automatic thoughts can actually cause more harm than good
If clients are experiencing valid negative automatic thoughts, the focus should be not on making them positive but rather on learning ways was to cope and acceptance
False positive thinking can actually result in clients feeling frustrated and reduce their motivation and hope for change

16. CBT Is Only for Intelligent/Psychologically Minded/Motivated People
This myth may have developed due to the logical nature of CBT and the importance of clients being active participants in their own therapy
There is no doubt that individuals who are more intelligent, self-aware, and motivated, are in a better position to more readily engage and “pick-up” on certain CBT concepts
However, this is no different than any other theoretical orientation

17. CBT Is Only for Intelligent/Psychologically Minded/Motivated People
CBT is malleable enough to adapt to a wide range of levels of intelligence, cognitive functioning, self- awareness, mental health distress, and motivation
There is extensive research demonstrating the effectiveness of CBT with a variety of populations: young and older people, individuals with learning disabilities, psychosis, personality disorders, and substance abuse

18. CBT Is Adversarial
The perception by those who do not have a sophisticated understanding of CBT is that therapists argue with their clients and tell them that their thoughts are wrong
This also comes from a lack of understanding of the collaborative nature of CBT, where feedback is continuously provided and elicited
Or maybe watching too many old videos of Albert Ellis, who had a more direct and confrontational approach!

19. CBT Is Adversarial
Challenging thoughts and the collaborative nature of CBT does not involve arguing with clients
CBT therapists may notice that clients have clear maladaptive thoughts (i.e., cognitive distortions) but do not state to their clients that their thinking is wrong
CBT therapists validate clients’ feelings and try to understand the development and maintaining factors of related thoughts
If therapists find themselves arguing with their clients, they are not appropriately implementing CBT techniques

20. CBT Is Quick to Learn and Easy To Practice
This view may stem from an earlier stated myth that CBT is rigid/mechanical/technique focused (assumes that there is a prescribed mechanistic approach)
Not only is CBT a flexible therapeutic approach, but it takes much skill to balance the science-art relationship
Having solid common factor skills, the primary focus of some therapeutic approaches, is one thing
However, CBT goes well beyond these basic skills with its own specific factors and techniques requiring extensive training, practice, and supervision to master

21. Why Care about These Myths?
Well-trained CBT therapists represent how other mental health professionals (and clients) perceive CBT
When reasonable, you should address these stated myths to reduce ignorance and increase quality care for clients
You will be working for agencies with other mental health providers, some of whom may be using therapeutic approaches that are not evidence-based practices
You will want to make sure that the decisions made in your agency are based on science and facts, not on anecdotes and false assumptions

22. Why Care about These Myths?
Overall, the therapy provided for our clients should be based on therapeutic approaches supported by science
*Doing otherwise, knowing that evidence-based practices are available, is unethical
You can have a role in refuting such myths and making sure that clients receive quality care by educating other therapists through your interactions and participating in trainings
You can also demonstrate the effectiveness of CBT by having others observe your therapy sessions (“showing” can be more effective than “telling”)

23. Common CBT Myths Discussion Questions 11.1 (p. 327)
Activity 12.1: Refuting CBT Myths (p. 327)