As the home of Cognitive Behavior Therapy, we are frequently made aware of myths and misconceptions about CBT, along with criticisms among professionals and the general public. Previously we responded to the myth that CBT can only be practiced in a clinical setting, and the myth that CBT is superficial. Recently, we have heard CBT criticized as being outdated and generally harmful, specifically in relation to the treatment of trauma.   

At Beck Institute, and at universities and institutions throughout the world where CBT is researched and practiced, we welcome valid and thoughtful criticism of CBT to help us refine treatment, broaden its application, make it more accessible and affordable, and so on. Sound criticism helps move the field forward. Sometimes criticism is not valid, i.e. when it is based on low quality or biased research, or worse—no research at all. 

CBT is the most widely practiced and heavily researched form of psychotherapy, and is considered the current “gold standard.” As practitioners we must share the common goal of helping our patients feel better faster, and ensuring they remain healthy and well long term. Clinical practice guidelines for PTSD call for CBT that is “trauma-focused” meaning CBT treatment that directly addresses the trauma memory. This is different from “trauma-informed” approaches that may or may not be based on a cognitive conceptualization. 

CBT for PTSD involves addressing not only the trauma memory, but also negative beliefs about the trauma, unhelpful responses to the traumatic event, and safety behaviors that clients adopt following the event. CBT therapists typically employ exposure-based techniques to help clients process the trauma, decrease avoidance of the trauma memory, re-engage in meaningful activities, reconnect with loved ones, and reclaim their lives.  

However, CBT clinicians also integrate techniques from other evidence-based modalities within the context of a sound cognitive conceptualization. This creates an atmosphere of cooperation as opposed to competition. There is room for techniques from trauma-informed approaches, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, Motivational Interviewing, Mindfulness-based approaches, and many others to be applied within CBT treatment. There is also a great deal of research showing that CBT is effective for trauma as a standalone treatment. Below are a number of references on the short- and long-term efficacy of CBT for trauma. 

Hoppen, T. H., Jehn, M., Holling, H., Mutz, J., Kip, A., & Morina, N. (2023). The efficacy and acceptability of psychological interventions for adult PTSD: A network and pairwise meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 91(8), 445–461. https://doi.org/10.1037/ccp0000809 

Öst, L., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., & Wergeland, G. J. (2023). Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care: A systematic review and meta-analysis. Behaviour Research and Therapy, 166, 104323-104323. https://doi.org/10.1016/j.brat.2023.104323 

Paiva, J., Melani, M., Gonçalves, R. M., Luz, M. P., Mendlowicz, M. V., Figueira, I., von Arcosy, C., Ventura, P., & Berger, W. (2022). Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: A systematic review. Jornal Brasileiro De Psiquiatria, 71(2), 149-160. https://doi.org/10.1590/0047-2085000000375 

Murray, H., Grey, N., Warnock-Parkes, E., Kerr, A., Wild, J., Clark, D., & Ehlers, A. (2022). Ten misconceptions about trauma-focused CBT for PTSD. The Cognitive Behaviour Therapist, 15, E33. doi:10.1017/S1754470X22000307 

Sijbrandij, M., Kunovski, I., & Cuijpers, P. (2016). EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS. Depression and Anxiety., 33(9), 783–791. https://doi.org/10.1002/da.22533 

Mueser, K. T., Rosenberg, S. D., Xie, H., Jankowski, M. K., Bolton, E. E., Lu, W., Hamblen, J. L., Rosenberg, H. J., McHugo, G. J., & Wolfe, R. (2008). A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76(2), 259–271. https://doi.org/10.1037/0022-006X.76.2.259