Addressing the Disadvantages of Cognitive Behavioral Therapy

“How can the brain understand itself?”

Cognitive behavioral therapy (CBT) became an option for individuals struggling with mental problems or traumas after Aaron Beck discovered an advantage to breaking the “automatic thoughts” that run through depressed brains in the 1960s. The foundation of CBT is “change your thoughts and change your life”. This kind of therapy has been very helpful for people who need to change their negative thought processes. However, simply telling a person to stop thinking they are a piece of shit and expecting that to work by itself is borderline patronizing. “You know you’re not a bad person, so stop saying you are.” The idea of disrupting negative thoughts that have no logical basis can be effective, but how effective is it really? CBT is extremely simplistic in its expectations of changing human behavior, when the human mind is not simple.

There has been a movement towards understanding that the brain is not just thoughts, feelings, and emotions wrapped into a wrinkly orb in our skulls. As science treads into newer territory, the understanding of how our physical body affects the mental brain is becoming more clear. The limbic system (the hippocampus, the amygdala, the prefrontal cortex, and more) within our bodies drives emotional responses, and the presence of a limbic system is what separates humans from reptiles, who do not understand very human emotions like attachment or separation. The limbic system makes humans…feel. And physical events in a person’s life can damage the limbic system (multiple studies have shown that post-traumatic stress disorder (PTSD) affects the size of a person’s hippocampus) so much that their brains, their emotional responses, are not going to make logical sense. So when CBT attempts to use logic to change the brain’s thinking, it is ignoring very physical manifestations of trauma.

This blog post is inspired by “The Body Keeps the Score” and interactions with my therapist, who understands that CBT, while effective for some, does not work for me. He rarely recommends books but understood that I would appreciate the scientific approach to understanding emotional responses as explained in “The Body Keeps the Score”. I can lead myself through CBT with loads of logic and positive self-talk, but that doesn’t change my limbic system’s reactions and desires for situations that, while horrible for me, are comfortable. Mental logic and physically driven emotion don’t always line up, which is where CBT will fail.

So what is the solution to the failed application of CBT? There are a few ways to physically change your body’s reactions without relying solely on logical thoughts. Stimulating the mind-body connection is one of the most effective ways to address a damaged limbic system that produces irrational emotions (yoga, meditation, neurofeedback therapy). Listening to your emotions and sitting with them instead of trying to override them with logic (this one was big for my therapist to try and get through my thick skull) is another one. Society tends to be drawn towards motivational speakers and positive self-talk instead of addressing the underlying issues (people who are always preaching “good vibes only” and trying to “fake it till you make it” regarding happiness irritate me because they are subscribing to over-the-counter CBT, which falls vastly short of real mental improvement). The paradox of logically understanding everything is okay with a limbic system that does not think everything is okay sends me spiraling down a path of “I shouldn’t feel this way because it isn’t logical.” My therapist will say “but you DO feel this way, so stop being so mean to the part of you that doesn’t feel okay by trying to beat it into submission. Stop writing off your emotions.”

And this leads into a portion of the book that makes me so uncomfortable…because it requires me to think about addressing my younger self, whose physical limbic system was vastly impacted, with empathy and kindness. Some therapists will ask you to imagine that your younger self is sitting in an empty chair and ask how you would treat your younger self. Adults tend to be hard, especially emotionally hard on their younger selves, and one of the last ways to address a flawed limbic system is to try to work kindly with your younger self. My therapist started trying this approach with me this week (kinda interesting because he knows I’ve read the book so he knows I know what he is trying to do) …and it was horrible. I was so uncomfortable with the idea of facing my younger self. I was unfortunately also aware of how I was physically reacting (which is extremely important to the therapy and merging the physical and emotional reactions). I couldn’t make eye contact, I shrank into myself, I was embarrassed, I felt sick to my stomach and panicky, and I wanted to run away. My therapist was just gently pressuring me into that scenario, probably because he knows I am going to overthink it this entire week and be more prepared next time, and he said “I hate to keep knocking on this door with you but we need to address it at some point.”

Anyway, even just writing that makes me all panicky.

Expecting simple therapies such as CBT to change a person’s limbic system is expecting logic to override a physically damaged system. While the phrase “mind over matter” holds some weight, it is not kind to try to beat our emotional brain into changing a physical body without addressing the physical-mental connections and problems.