Why CBT doesn't work - and what to do about it

A lot of people have found cognitive behavioural therapy (CBT) very helpful. However, others have had different experiences, seeing little benefit or just giving up half way through a course of treatment (this occurs in one in five cases¹).

Why does CBT fail in these instances? And what can we do about?

You have to do homework

CBT is all about doing the homework. Whether this is specific exercises that your therapist gives you, or whether it is simply a case of applying the things you learn in CBT, depends on your specific treatment.

But one thing is for certain: you do not get the benefit purely from attending the sessions. You may get some benefit, but you certainly will not get most of it.

The problem is that this is not what many people expect when they go to a therapist for treatment.

What? I have homework to do?

Imagine you had a bacterial infection, a chest infection perhaps. You visit your GP and they prescribe you some antibiotics. You go home, take the medication and you feel better. There is no home study component to this. The medicine does the magic.

Of course, you could just not take the pills. Patient compliance is a major problem in other medicine as well. However, for the most part, you just take the pill and it does the work.

With CBT, it is not like this. The medicine the therapist dispenses needs to actually be taken. Really, they are giving you a blueprint to make the medicine: you still have to do the legwork to actually mix the stuff up.

You have to be ready

Finding the motivation to do this is tough. You need to be really willing to put the time in. More so than time, you need to be willing to feel uncomfortable. Because that is what it is. CBT techniques are about handling your anxiety, so in order to use them, you need to subject yourself to some anxiety.

For many people entering CBT, it may be the first time they have realised that it is anxiety that they are struggling with. It may be a recent diagnosis, even if they have been feeling that way for a long time.

Therefore, when your GP refers you for CBT, you may still be coming to terms with having anxiety. Sometimes it takes a while to really settle in, and if so, this gap in between may make finding the motivation extra difficult.

What can we do about it?

To an extent, some of the work lies with the therapist. In my book Technical Anxiety I wrote about how my therapist was surprised I had done the homework. If they know compliance is so low, maybe more of the sessions should be dedicated to the important of the homework and how to find the motivation.

Primarily, though, the responsibility has to lie with us as to how to get the most out of it. We are going to get CBT as it comes, so it makes sense to make the most of it. Here are some suggestions.

Go into it understanding that there is a homework component and that will take time and energy. If you do not think you can commit to that right now, CBT may not be the best option.
If CBT did not work for you the first time, understand that your own state of mind is an important factor in this. You may find that if you give CBT another go when you are feeling more motivated, you may get better results.

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Published 28 November 2016. Written by Chris Worfolk.