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  • Dr. Sarah Davies

When CBT Therapy doesn't work...

Updated: Mar 11, 2019

Most people have heard of CBT therapy. It is a talking therapy approach that is more often than not the go-to recommendation for mild-moderate issues of depression or anxiety. Most GPs or healthcare professional readily suggest CBT therapy for anxiety, depression, issues with self-esteem, eating disorders or even addictions. There is good reason for that too. Lots of clinical research supports its effectiveness in the treatment of a range of mental health issues and so it is recommended in the NICE guidelines.


CBT therapy helps you to understand the links between what you think (cognitions), how you feel and subsequently what you do (behaviour). Issues are understood then as being to do with our thinking. Our thoughts are subjective. Thoughts are opinions and thoughts are not facts. Our thinking can be off sometimes.



We can learn how to change our thinking. We can find ways to modify any unhelpful thoughts to ones that are arguably more accurate and certainly more helpful. As often how we feel is influenced by what we think, we can help ourselves to feel better by:

a) identifying our negative or unhelpful thinking.

b) challenge any unhelpful thoughts.

c) change them to more helpful or accurate ideas.


For example, if you notice you have negative thoughts along the lines of "I'm useless", "I'm a bad mum", "I can't do things as well as other people", "Nothing I do is good enough", "I should be over this by now", "Other people seem to cope much better than I do..."you can imagine how these thoughts will likely leave you feeling. These are all negative, unhelpful thoughts to have. They are judgemental and include comparisons - which are rarely helpful. You can see if we have these kinds of thoughts it wouldn't leave us feeling particularly positive, optimistic or happy. Most likely it would leave us feeling down, useless and would impact negatively on our self-esteem. As a result of feeling down we may find that we don't want to do the things we usually enjoy or that are good for us. We may isolate or even find ourselves drinking or eating more or some other unhelpful or destructive behaviours or habits.


Working with a CBT therapist can help you identify negative thinking pattens and find some practical tools to challenge and change your thoughts in order to help you feel better, alongside modifying any unhelpful behaviours. For example, by thinking more along the lines of; "I'm doing my best", "I can do things well sometimes, "I am good enough", "I am doing fine", etc. will likely help us to feel a bit better and more hopeful. We then feel more like doing enjoyable things.


CBT therapy is what is a called a 'top-down' approach. It is cognitive. It is helpful for many people, a lot of the time. However, sadly, sometimes I hear from people who have already tried talking therapies or CBT therapy and it hasn't actually helped as much as they would have hoped. Worse still, the lack of relief or any positive change has only then reinforced their core beliefs of "it's my fault" or "there's something wrong with me" or "things will never change or get better".


This is such a shame and absolutely not an indicator that it's your fault or that there's something wrong with you, or indeed that things cannot get better. Therapists are the ones best placed to identify and recommend what may be a more suitable or appropriate therapy approach for you. Often when I meet clients who have previously tried CBT therapy they tend to say; "It's been helpful... but it hasn't quite got to what it is..." Whatever that 'is', is. That's usually though because 'what it is' is sitting at a level that simply cannot easily be reached through cognitive, analytical or 'top-down' approaches. It is therefore not a case of willpower or of not having tried hard enough. It just using the wrong tool for the job. If this resonates with you, you may find a more body-based or 'bottom-up' processing approach be more effective.


If we have experienced any kinds of anxiety-provoking situations, any sudden or shocking or unpleasant experiences in the past - regardless of how significant it may or may not seem, then CBT may not always be the most helpful therapy to have. That is because sometimes sudden or unpleasant experiences can be too much for the brain to be able to process in the moment that it happens. What that often feels like, is as if something is held or stuck on a deeper level or perhaps even in our bodies. Perhaps we are left with a deeper held belief that is not helpful or accurate but it seems difficult to shift.


In these instances, it can feel like even though you have understood the theory and logic of a CBT approach and can even apply the techniques, it still doesn't seem to quite reach what is held on a deeper level. A CBT or analytical approach generally won't.


If we have deeply held beliefs or memories that feel stuck or weighing it may be that EMDR therapy could be helpful. EMDR (eye movement desensitisation and reprocessing) is a psychotherapeutic technique that can be used to process trauma or difficult memories, beliefs or feelings. It can help to shift deeper held beliefs we may have absorbed from earlier experiences that 'top-down' approaches can't quite reach. EMDR therapy is overall, usually a gentle process that doesn't require talking about or analysing in-depth past events. Many people report relief from EMDR in just a few sessions.


To find out more about CBT or EMDR therapy in Central London please feel free to get in touch at: www.drsarahdavies.com


When CBT doesn't work | CBT Therapy | EMDR Therapy | Harley St. | Central London

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