The 6 Limitations of Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) has been increasingly popular over the last few decades.

It’s an effective treatment for a wide variety of conditions like PTSD, insomnia, panic disorders, anxiety disorders, and more.

However, CBT is not a miracle treatment, and there are certainly limitations to it. It’s important to understand them to know when an alternative or complementary treatment should be considered instead.

CBT Doesn’t Fully Fix All Problems

Many studies investigating the use of CBT don’t use well-constructed control groups. When they do, the effectiveness is still usually good, but not as impressive.

For example, in a study on using CBT for panic the treatment group findings were impressive (1):

85% of patients are panic-free at posttreatment and improvements are maintained at follow-up

However, this study did have a good control group of waiting list subjects, which found that 26% of the control group also improved to an acceptable degree.

Therefore, while CBT was certainly effective, it wasn’t exactly 85% effective.

In addition, other studies have shown that CBT often fixes the worst symptoms, but not all of them. In a study on CBT for insomnia, many subjects who improved did not become “good” sleepers (2). It was certainly a worthwhile treatment, but clearly CBT alone in this context was not enough alone to fully cure a patient.

Finally, there are some studies that show that CBT may not be more effective than alternative treatments. For a condition like depression, alternatives like interpersonal therapy or clinical management plus antidepressants may be more effective (3).

CBT Doesn’t Work for All Psychiatric Conditions

CBT is often prescribed for insomnia, but little research has been done on exactly how effective it is on different types of insomnia.

In other words, CBT is typically studied for chronic insomnia, not not acute cases. In addition, insomnia can be caused by a wide variety of comorbidities, which are unlikely to respond equally well to CBT.

The same can be said for any other condition treated by CBT. Different types of PTSD or depression may need tailored intervention.

CBT is More Time Consuming Than Alternative Treatments

A typical CBT regiment initially consists of 5-8 weekly sessions.

While that’s not a terrible time frame, there are a few obvious limitations with it compared to other treatments like medication:

• Results don’t occur immediately (typically anywhere from a few weeks to months to see significant improvements)
• The sessions themselves take 30-60 minutes, plus travel time

This is a significant time and resource commitment for a patient. And while CBT can be done at the same time as many other treatments, they aren’t always prescribed together in order to determine which treatment is actually working.

CBT Relies on Patients to Be Effective

With most medications, a patient is simply asked to take a pill on a regular basis, and getting compliance for that can still be difficult.

For CBT, patients not only need to spend more time on the treatment itself, but they also have to be willing to put in the effort. They need to open with their therapist, and need to do any “homework” that’s needed on top of the sessions.

When you’re dealing with patients that have depression, you can’t always expect to get that level of commitment.

CBT is Not Always Easily Available

You’re unlikely to find therapists that specialize in CBT in most small towns. In addition, the cost of CBT can often be another obstacle. 

Luckily, treatment is often covered by insurance, and there are more budget-friendly options for CBT (e.g. online or group therapy) that have been proven to be almost as effective in most cases.

However, these alternatives also have limitations of their own, and not every patient will be okay with them.

The Effectiveness of CBT Depends on The Therapist

Like any counseling, the results will at least partly depend on the therapist.

There’s always going to be variable in therapist quality, with some being great, and others being poor.

This variable is removed with many other treatment options (i.e. medication is the same for everyone as long as quality standards are met).

Summary: The Limitations of CBT

CBT is an absolutely great treatment method for a wide variety of conditions.

However, the limitations we’ve discussed show that:

• CBT is often enough by itself for a full cure
• There are multiple accessibility concerns
• Other treatment methods may be just as effective, or even more effective than CBT

References

1. Cognitive-Behavioral Therapy for Panic: Effectiveness and Limitations
2. Contributions of cognitive-behavioral approaches to the clinical management of insomnia
3. All you need is cognitive behaviour therapy?