What I think about Cognitive Behavioural Therapy

Cognitive Behavioural Therapy hasn't done much for me, but I have been impressed by Dr Matina Sotrilli, Stuart Colquhoun and Nicki Makin. CBT is good for people with phobias or obsessions, which was what it originally was intended for. When used for depression, it can help some people but not others. If someone is depressed for a reason, let's say they have a dysfunctional relationship, then CBT can help to get them sorted out. When they have removed the problem in their life then they can become happier. But I would not call this depression.

Where CBT may not be able to help is where someone does not have an obvious problem that can be solved. CBT therapists don't seem to recognize that many people lack motivation or enthusiasm, and cannot clearly articulate goals or aims.

If someone went to a CBT therapist and said "I long to have an active social life, but my shyness holds me back", the therapist would know just what to do. They would call it Social Phobia, and they would have a way of dealing with it, just as they would with any phobia.

What they don't know how to deal with is someone who has no interest in a social life. I don't know if I have social phobia. I know that when I am with my family I do not have social phobia, and yet I have no enthusiasm to be with them.

I noticed a subtle difference in attitudes between 2 CBT therapists I have talked to. One of them, Stuart, seemed to feel that if someone has no motivation to do something, that is not a problem. If you don't want to do it, then don't do it. The other, Nicki, seemed to feel that you just have to get out there and start doing things.

My therapist, Matina, wanted me to do some kind of activity, and we agreed that a Spanish evening class could be good. I went to the class for a while and then got fed up and stopped going. I think that what was meant to happen is that I would get to like it and gain confidence and my life would change, but this hasn't happened.

One of the problems that I have is that I feel that I am stupid although I know that I am not. Because of the way that I was treated by parents and teachers as a child I developed a deep-seated feeling that I am not intelligent. This can make me want to try and prove that I am intelligent and to show off to other people. I try to stifle this tendency as it does not make me popular.

I tried to explain this to my CBT therapist, but I can see now that this contradicts the most basic tenet of CBT, which is that people will think and feel the same way. To some types of therapist, what I said about my thoughts and feelings could have been the starting point of a discussion, but with CBT it was just a dead end.

My therapist said to me on several occasions that in time new ways of thinking would begin to alter deep-seated negative feelings. She said that I have to give it time. However, I have known that I am intelligent since secondary school, and it hasn't sunk in yet (I am nearly 50). How much longer do I have to wait for it to 'sink in'?

CBT is good for phobias or obsessions, and this is what it was originally intended for. It is very successful for this. So it is surprising that CBT doesn't seem to be used in the same way for depression as it is for phobias or obsessions.

If someone had a phobia of spiders, you would not expect them to be cured by telling them that spiders in this country cannot harm you and in any case they are probably more frightened of you than you are of them. If someone had an obsession with hand washing, you would not expect them to be cured by telling them that not all bacteria are bad and they can harm their bodies natural ability to defend itself. In both cases the person will probably say that they know this already.

Yet with depression, CBT therapists do think they can cure someone by telling them that their thoughts are incorrect. I do not believe that you can change somebody's feelings by changing their thoughts, at least not directly. By changing someone's thoughts you may in time change that person's actions. By changing someone's actions you may in time change that person's feelings. But that is not the same thing as changing mood, or enhancing motivation.

I saw Dr David Burns on TV recently. He is the originator of CBT for depression. He said that he helped a woman who had low self-esteem by helping her to see that she had many accomplishments, including being able to speak 5 languages. Well, not everybody speaks 5 languages. Not everybody has had a career or a marriage or a family. How are you going to help them?

Perhaps some people cannot think one thing and feel another. Perhaps I have a more complex personality than other people. It doesn't work for me. The literature says that it works for about half of people. Perhaps it would be possible to work out what sort of people can benefit from CBT and what sort do not.

I think that many people are diagnosed with depression when they do not really have it. Depression is when someone is unhappy, but not for any obvious reason. If someone is unhappy because they always have only dysfunctional relationships, or they have a phobia or an obsession, or they merely lack direction in life, I would not call this depression.

I have read 'The Feeling Good Handbook' by Dr David D Burns, and I started re-reading it recently. This is the best-known book on CBT.

Put this information together and you come to the conclusion that CBT is little or no better than a placebo. Especially when you consider what has been said in the media recently about the effectiveness of anti-depressants (early 2008).