Cognitive Behaviour Therapy (CBT) is one of the most recognised and popular therapeutic approaches. The fact that it is well-researched and evidenced-based, makes it an effective approach for dealing with mental health concerns such as anxiety disorders, depression, and many other conditions as well. However, CBT has its limitations as well, particularly when it comes to dealing with complex childhood traumas or conditions such as Post- Traumatic Stress Disorder (PTSD). In this article, we will explore why CBT might not be the most effective approach to dealing with trauma.
Trauma is a complex emotional response to a distressing event such as an accident, a natural disaster, or abuse. However, a person may experience trauma as a response to any event that is physically or emotionally threatening. Trauma can lead to immediate responses such as shock or denial and even long-term responses such as flashbacks, nightmares, and unpredictable emotions. Most people tend to experience an event in their lives that could be considered traumatic, but the impact of trauma differs for every individual.
Trauma not only impacts people psychologically, but it can also impact the brain and the body. Research suggests that experiencing trauma can impair or reduce the brain’s ability to differentiate between threatening and non-threatening situations, leading a person to feel unsafe or anxious most of the time.
When someone feels anxious, the brain’s prefrontal cortex, which is responsible for logical thinking or regulating thoughts and emotions, functions in a limited capacity, leading the individual to feel emotionally and physically overwhelmed or dysregulated.
Cognitive Behaviour Therapy (CBT) assumes that people experience emotions as a result of their thoughts, and thus, CBT focuses on helping people challenge their negative thoughts and replace them with healthier patterns of thinking to experience changes in behaviour. CBT therapists use a range of exercises and techniques, such as cognitive restructuring and behaviour modification to help people make the desired changes. Due to its focus on changing thoughts and working with issues in the present, CBT might not be an effective approach for everyone.
CBT and Trauma
As discussed earlier, trauma is a complex emotional response that impacts an individual physically and psychologically. Trauma is frequently stored in the body as emotions and physical sensations; therefore, addressing physical symptoms is just as important as dealing with psychological symptoms to facilitate recovery. While CBT can help address the negative thoughts related to the traumatic event, it may completely ignore the trauma’s bodily symptoms.
Many trauma therapists believe that bodily symptoms of trauma need to be addressed first before moving on to the thoughts related to it, as primary trauma exists within the body and not only in thoughts. Thus, CBT might not work with trauma because it relies heavily on an individual’s thinking, whereas trauma causes physical and emotional dysregulation, which limits an individual’s capacity for logical thinking. Also, many times, trauma can cause negative thinking and unhealthy behaviours. In such cases, addressing negative thinking solves only a surface-level issue, but the root cause of trauma may remain unaddressed.
Addressing Trauma Beyond CBT
While CBT may not be the most effective approach for addressing trauma, other approaches such as Eye Movement Desensitization and Reprocessing (EMDR), somatic therapy and Narrative Therapy can help address the root causes of trauma and thus facilitate holistic healing.
While CBT has demonstrated efficacy in treating various mental health conditions, its effectiveness is limited when it comes to trauma. The physical and psychological nature of trauma often requires a more comprehensive and specialized approach. Specialized trauma-focused therapies, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), and various somatic approaches, have been specifically developed to address the unique challenges of trauma.
- Camilleri, J. (2021, November 20). Why CBT Doesn’t Work for Trauma & PTSD? Tips By A Therapist. Therapy Hunter. https://therapyhunter.com/why-cbt-doesnt-work-for-trauma
- How Does PTSD Affect the Brain? The Physical Effects of Trauma. (2015, September 16). Psych Central. https://psychcentral.com/ptsd/the-science-behind-ptsd-symptoms-how-trauma-changes-the-brain
- Kaushal, S. (2023, November 26). Why CBT Isn’t Always an Effective Approach For Trauma And PTSD. Calm Sage – Your Guide to Mental and Emotional Well-Being. https://www.calmsage.com/why-cbt-doesnt-work-for-trauma/
- What is trauma? (n.d.). Retrieved January 2, 2024, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/trauma/about-trauma/
- Why is CBT inappropriate for trauma survivors? (n.d.). Trauma Aware America. Retrieved January 2, 2024, from https://traumaawareamerica.org/is-cbt-appropriate-for-trauma-survivors/