One of the most publicized and researched forms of therapy, especially for depression, is cognitive therapy (sometimes branded as cognitive behavioral therapy, or CBT).
The central idea of cognitive therapy is that our emotional states are primarily responsive to our thoughts and beliefs.
Cognitive therapists believe that painful emotional experiences, like depression, prolonged grief, maladaptive anger, or post traumatic stress symptoms, are often caused by “distorted” thinking— thinking hat is “catastrophized,” “overgeneralized,” or which otherwise doesn’t conform to reality.
Cognitive therapists work with their patients to change how they think about themselves, the world, and the future (the “cognitive triad”)— and, the theory goes, as patients begin to think more “realistic” thoughts, they begin to feel better and stand a better chance at responding effectively to life.
A type of cognitive therapy called Rational Emotive Therapy takes this framework a step further— RET proposes that people “disturb themselves” by buying into distorted beliefs (the founder of Rational Emotive therapy, Albert Ellis, used this language over and over again— people “disturb themselves” with their beliefs).
Cognitive therapy has a lot of fans in the mental health world, because it is an often-researched form of psychotherapy, and seems to work— with some people, for some problems, some of the time.
(There have been questions raised about how meaningful much of the research “proving” cognitive therapy’s effectiveness actually is, but that’s a different blog.)
There are ideas in cognitive therapy I like. I’ve found some cognitive therapy concepts useful in my own recovery, particularly in its emphasis on taking action and disputing distorted thoughts and beliefs about myself.
But cognitive therapy has real limitations when it comes to its usefulness in working with trauma survivors.
On of the main tenets of cognitive therapy is that people can feel better by thinking differently or revising their beliefs— but, as survivors of trauma can attest, changing how we think and what we believe is rarely as simple as deciding to think or believe differently.
Trauma conditions us. It conditions what we find believable or plausible. It shapes or ideas about what is and isn’t true or real.
We can’t just do away with trauma CONDITIONING with a “decision” to “think differently.”
Cognitive therapy also has a heavy emphasis on determining how “realistic” a thought is or how “likely” a feared scenario is to occur.
The problem with this is, MANY complex trauma survivors really HAVE experienced things that MANY people consider “unrealistic” or “unlikely.”
Cognitive therapy frequently warns against the “cognitive distortion” of “catastrophizing”— i.e., making a mountain out of a molehill (Albert Ellis calls this “awfulizing” in RET). The idea being, if you’re unduly upset about something, it’s probably because you’re making too big a deal out of it.
The problem with this is, trauma survivors are ROUTINELY told they are “making too big a deal” out of what has happened to them or their experiences in the aftermath— and this doesn’t seem to heal their traumatic stress reactions.
It is my experience that we can’t meaningfully heal post traumatic stress unless we get realistic about how big a deal what happened to us actually WAS.
Contrary to the default attitude of cognitive therapy, most trauma survivors AREN’T “catastrophizing”— they almost always MINIMIZE the impact of what happened to them, and blame themselves for “making too big a deal of it.”
I do think cognitive therapy can be useful in helping us talk to ourselves, ABOUT ourselves, more fairly and accurately.
But if cognitive therapy isn’t used in a meaningfully trauma informed way, it can VERY quickly side into a form of gaslighting or victim blaming of the type trauma survivors know all too well.
The truth is, thoughts AREN’T the only, or even the main, factor in how we feel, especially if we’ve been through trauma. In fact our thoughts are often kind of a byproduct of the train wreck that’s happening in our nervous system when we’re having trauma reactions.
Cognitive therapy is like many tools offered by the mental health field— it can have its uses, but used carelessly or arrogantly, it can be enormously destructive.
And, as many trauma survivors can attest, the mental health field is really good at handling its tools carelessly and arrogantly.
Use Your Damn Skills 