How Cognitive Behavioral Therapy Addresses Deeper Issues

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One reason I started this blog was to refute and clarify certain myths or exaggerations about cognitive behavioral therapy, commonly referred to as CBT. One of my favorite myths, if there is such a thing, is that CBT does not address deeper psychological issues. By deeper psychological issues, I’m referring to problems that cut across situations or times in one’s life such as difficulty making friends or trouble feeling motivated. This myth likely originates in the liberal challenging of negative, automatic thoughts (assumptions) in the moment that characterizes CBT. By focusing on what is happening in the moment that someone feels depressed or anxious, it can often seem as though CBT is ignoring broader problems.

First, I want to acknowledge the kernel of truth in this myth. CBT does focus predominantly on what a person is thinking or doing right in the moment they feel depressed or anxious, especially during the first sessions. This helps the client learn the core CBT skills and can be more concrete and easier to remember than experiences from several years ago. Another reason for this myth is the limited number of therapy sessions in most clinical trials of CBT. Most clinical trials limit the number of sessions to 12, 16, or 20, and, depending on the person, that might not be enough time to address deeper issues.

However, CBT can address deeper psychological issues. One way is through core beliefs. These are people’s thoughts that span multiple parts of their lives. Core beliefs usually influence the negative automatic thoughts that people have in any given situation. For example, someone who is depressed might have an automatic thought that they messed up a project at work. Their core belief could be that they will never be good at anything. After a person has succeeded in challenging some negative, automatic thoughts, CBT will often switch gears to core beliefs in an attempt to address the deeper issue that triggered those thoughts.

Another way that CBT addresses broader psychological issues is through examining the source of the core beliefs. Usually, the source can be found in childhood or teenage experiences; this can be a single formative event or several small events that happened over time. Let’s consider a person with depression who thinks they messed up a project at work and that they will never be good at anything. This person may have had a teacher who was overly strict and criticized every mistake they made. Or the person’s first boss may have been perfectionistic and demanded every report be written a particular way without any guidance beforehand on what to do. In CBT, it can be very helpful for clients to identify the source of the core belief. They might realize that it’s not actually their belief but a belief they inherited from someone else, making it easier to distance themselves from it.

So, in the end, CBT is interested in your childhood as it relates to why you are seeking therapy.