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Why Cognitive Behavioral Therapy Didn't Work for Me

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If you recently started therapy for symptoms of depression and/or anxiety, there is a very good chance your therapist is doing cognitive behavioral therapy with you. CBT is one of the most popular therapies out there, but it doesn’t work for everyone. Cognitive behavioral therapy didn’t work for me, even though my therapist tried for years.

Luckily, I finally got a new therapist who took a different approach, and I started getting the help I really needed.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy, or CBT, is a form of therapy that focuses on the connection between your thoughts (the cognitive piece) and your actions (the behavioral piece). According to the American Psychological Association, these are the core principles behind CBT:

  • Psychological problems are based, at least partly, on faulty thought patterns
  • Psychological problems are also at least partly based on unhelpful behavior
  • It is possible for people suffering from psychological problems to learn better ways to cope with these faulty thought patterns and unhelpful behaviors

If I had known this about CBT when my therapist was trying it with me, I could have immediately told you it wasn’t going to work very well for me.

Here’s why: I don’t have “unhelpful behaviors.”

What Happens When You Use CBT to Treat Someone Who Doesn’t Follow Its Core Principles

I don’t mean to say that I’m a perfect angel who never messes up or behaves in a way I wish I wouldn’t, but one of the reasons my mental health issues are still undiagnosed is because my behavior is so disconnected from my thoughts or feelings.

When I am depressed, I feel depressed. I feel heavy and hopeless, I feel destructive and angry and self-loathing, but I don’t act on any of those feelings. At all. I shower, I do the laundry, I play with my son, and all the while I feel like every cell in my body is on fire.

According to CBT, because I don’t exhibit signs of unhelpful behavior, that would mean I don’t have “psychological problems.” Except my psyche is so divorced from my body that I don’t know how to act on my feelings in a way that feels safe.

Except even though I don’t act on them, my feelings have a nasty habit of devouring me, consuming me, destroying me.

Except it cannot be normal to feel this way. It just can’t be. No matter how I act, I know how I feel.

At least, I do now.

That wasn’t always the case. I used to be so afraid that nothing was really wrong and I was just… bad at being a person, that I was constantly trying to prove that I really did have “psychological problems.” Under CBT, I had to start producing some unhelpful behavior for my therapist to work on, or I just didn’t really seem all that mentally ill.

Here’s something else I know now: any treatment that makes your patient feel like they have to “act” mentally ill is not the right treatment for them. And my therapist should have seen this after a few sessions, instead of letting this go on for years.

Therapies That Have Actually Helped

Cognitive behavioral therapy didn’t work for me, so I found different types of therapies to try instead.

First, I focused on Dialectical Behavioral Therapy (DBT). I got started with this type of therapy because it was technically created for people with borderline personality disorder, a diagnosis I often think I have. But regardless of diagnosis, its principles have helped me so much. Here are the core principles DBT is built on:

  • Distress tolerance
  • Mindfulness
  • Emotional regulation
  • Interpersonal effectiveness

I know this because I’ve had other therapists who have done DBT work with me, but also because I bought the “Dialectical Behavioral Therapy Workbook” for just $18. These principles are so much better aligned with my actual problems. I mean, improving my distress tolerance alone has made my life approximately a million times better. I still struggle with mindfulness and interpersonal effectiveness though. My issues relating to others and feeling truly safe with them led me to another great type of therapy: schema therapy.

There are very few therapists in my area who are familiar and well-versed in schema therapy, and I haven’t had the chance to work with one yet, so instead, I’ve been doing some schema therapy on my own in addition to my normal therapy sessions. Schema therapy relies on these core principles:

  • Self-defeating core themes that reoccur throughout a person’s life
  • Emotional states that cause a habit-based behavioral response
  • Environmental factors that caused a person to develop these core themes and habit-based behaviors when they were young

Most of what I know about schema therapy I’ve learned from The Psychology, Trauma, and Mindfulness Centre, if you want to check out their amazing resources too. This therapeutic style relies a lot on trauma work and attachment theory. It doesn’t just look at the problems you’re having now, like CBT or even DBT, it looks at you as a whole person, with a past that inherently informs your present.

Right now, this is the therapy style that is most beneficial to me. My therapist isn’t a schema therapy expert, but she’s working on some of the core principles with me anyway and I feel like I’m making so much more progress in just a few months than I did with years of CBT.

What To Do If Cognitive Behavioral Therapy Isn’t Working For You

Figuring out if therapy is working for you is tricky. I have an older post on how to spot red flags and good signs in therapy, but if you’re pretty sure CBT just isn’t doing it for you, then you need to do one of two things:

  1. Tell your therapist you’d like to try a different type of therapy (this is a great option if you like your therapist as a person, but just don’t feel like you’re getting what you need from therapy);
  2. Say goodbye to your current therapist and get a new one who does different types of therapies (this is a good option for people who just don’t feel like they click with their current therapist, in addition to the CBT issues).

I know both options are hard, but trust me, it’s better not to waste your time on a therapy (or therapist) that isn’t working for you. And in the meantime, check out some of the resources I linked above, they might be a huge help.

If this was a helpful guide to CBT and other alternative therapy schemas, let me know in the comments below. What kinds of therapies have you tried? Are you thinking about starting therapy? I’m always happy to do therapy talk!

A version of this article was previously published on the author’s blog, Healing Unscripted

Getty image via Olga Strelnikova

Originally published: October 28, 2020
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