Cognitive-Behavioral Therapy - CBT

The main criticism often leveled at cognitive behavior therapy (CBT) is that the empirical evidence for this treatment approach has been overstated, mainly by the CBT therapists themselves, it may be useful for some conditions [anxiety, phobias and depression] but not all conditions and it requires a lot of time, effort and compliance from the individual. CBT has become a favored treatment choice for a wide variety of ailments, including anxiety, phobias and depression but is not a panacea and it is not suitable for everyone.

It is claimed 'CBT is constantly evolving by what is called 'empirical evidence' or 'evidence-based-practice' and this form of psychotherapy is constantly synchronized with the latest recommendations from the research suggesting what works best'. However what works best for one person make not work for another and the skills and knowledge of one therapist are never the same as another and therefore it can never be a 'standardised system' which is necessary for 'empirical evidence'.

For example, it once thought it was good practice to encourage someone to see a counsellor / psychotherapist immediately after a trauma (such as a sexual assault or following an assault). We now know that according to various reports it is not helpful and in one study they found it to be unhelpful or counter-productive, which coincides with constant changing medical advice.

Traumas have happened for millions of years and humans have developed successful ways to deal with these events at a pace that suits that individual. To encourage a person to talk about a difficulty when they are not ready might actually lead to a crisis that they can not control. The best approach is to give the person some time to deal with the situation, in their own way, and if the person is still effected by the event (after 3-6 months), professional help can then be useful, which contradicts the notion CBT is an effective treatment tool.

CBT is supposed to use the evidence from research and clinical studies to formulate ideas and procedures for best practice. These are then applied on an idiosyncratic basis to individuals within therapy but as stated, what works for 'one' person may not work for 'many' others.

Another potential criticism is that CBT is a non-humanistic approach to treatment. Behavioral medication strategies can at times seem mechanistic, sterile and impersonal and therefore not suitable for many people. Cognitive-behavioral approaches typically include a range of skills to foster or maintain abstinence and to prevent relapse. These typically include strategies for:

1. reducing availability and exposure to the substance and related cues,
2. fostering resolution to stop substance use through exploring positive and negative consequences of continued use,
3. self-monitoring to identify high risk situations and to conduct functional analyses of substance use,
4. recognition of conditioned craving and development of strategies for coping with craving,
5. identification of seemingly irrelevant decisions which can culminate in high risk situations,
6. preparation for emergencies and coping with a relapse to substance use,
7. substance refusal skills, and
8. identifying and confronting thoughts about the substance.

The techniques of teaching these coping responses include a combination of direct verbal instruction, modeling of appropriate skills through role play and rehearsal of the skills within the therapy session. Material discussed during sessions is typically supplemented with extra-session tasks (i.e., homework) intended to foster practice and mastery of coping skills. However, for this to be successful it requires the commitment and dedication of the individual but most people with drug or alcohol problems find it very difficult to acquire these skills and often drop out of these structured programs or refuse to attend them.

Cognitive–behavioral treatment for alcohol dependence: a review of evidence for its hypothesized mechanisms of action

Objective. The review examined support for the hypothesis that cognitive-behavioral treatment (CBT) for alcohol dependence works through increasing cognitive and behavioral coping skills. Method. Ten studies were identified that examined the hypothesized mechanisms of action of CBT. These studies involved random assignment (or its near equivalent) of participants to CBT and at least one comparison condition. Results. Although numerous analyses of the possible causal links have been conducted to evaluate whether CBT works through increasing coping, the results indicate little support for the hypothesized mechanisms of action of CBT. Conclusions. Research has not yet established if CBT is an effective treatment for alcohol dependence. Negative findings may reflect methodological flaws of prior studies. Alternatively, findings may indicate one or more conceptual assumptions underlying CBT require revision.

Critics say 'despite claims CBT is 'empirical evidence' or 'evidence-based-practice' there is little in the way of published material to support this, it may help some of the people, some of the time, but is not a standardise system as portrayed'.