In a quiet and private room, somewhere in the northeast of England, an earnest debate was taking place.
“I do understand that the human mind is the stage for a complex interplay between thought and emotion, in which it can be nigh on impossible to determine which comes first,” opined the old man.
“Oh no!” objected the middle aged lady, as she looked up from her notes. “The thought always comes first. You feel the way you do only because of the thoughts you entertain.”
“Surely that can’t be the whole story,” persisted the old man. “For when I feel down, I can only entertain certain trains of thought.”
“Now, now, Mr Ridgway,” warned his counsellor, “I do hope you’re not going to prove difficult for me!”
Thus ended a rather brief and unproductive encounter between a jaundiced and disillusioned old sceptic and an enthusiastic exponent of Cognitive Behaviour Therapy – the psychological snake oil of our modern age. I had been referred for such treatment (in case you were wondering) by my GP in a rather optimistic attempt to cure me of a generalised anxiety disorder that I had been putting up with for a good fifty odd years whilst trying my best not to trouble the medical profession. To me, it was my personality – to the doctor it presented as a disease worthy of the NHS’s attention. I was supposed to see a CBT expert to cure me of being me, but the truth is I only went along for the
debate. As you can see, it didn’t end well.
For those who are not familiar with CBT1, it is the medical intervention of preference (as far as NICE is concerned) for a whole raft of psychological and emotional ailments embracing: depression, anxiety disorders, substance abuse, post-traumatic stress, eating disorders, dissociative identity disorder, chronic pain, insomnia, phobias, irritable bowel syndrome, chronic fatigue syndrome, obsessive compulsive disorder and a good deal more. You will even find it advocated for the treatment of psychotic conditions such as schizophrenia and bipolar disorders. Is there nothing that CBT cannot cure? Apparently not.
And the best thing about CBT is that it is an evidence based intervention. Everyone knows it works and anyone who doubts its legitimacy will have to answer before the full might of the medical hegemony. Doubting CBT is as anti-science as, say, denying the irrefutable evidence for Catastrophic Anthropogenic Global Warming. Indeed, not only do CBT and CAGW both enjoy the firm endorsement of a scientific community, they are both government sanctioned. No wonder that my counsellor could label me as a trouble-maker, simply for questioning the central premise of CBT. I was a CBT denier because I challenged the idea that thought always determines emotion (but never the other way round) and that the key to controlling unwanted emotions will always be to eradicate the pathological thinking strategies that are causing them.
Actually, that is a slight over-simplification. I don’t deny that there are circumstances where maladaptive thinking can lead to emotional distress, and even the staunchest of CBT proponents will concede that emotion feeds back into the thought process. However, the CBT expert insists that the emotion will only exist in the first place as a result of a thought – the thought always comes first. Hence the primary line of questioning upon which CBT counselling sessions are based:
“When you felt that way, what had you just been thinking?”
The idea that one might have been thinking nothing at all just doesn’t enter the frame; which is a problem for me. When I was first diagnosed with generalised anxiety disorder, they didn’t call it that. They called it ‘free floating anxiety’. The whole point of free floating anxiety is that it exists irrespective of the situation one is in, or what one might be thinking of one’s situation. Furthermore, acute episodes of anxiety will often be experienced as a purely reflexive response to a physical stimulus – there is just no time to think. This happens because the amygdalae and hippocampus collude to instigate a paralimbic reaction long before the pre-frontal cortex and any language centres of the brain have had chance to construct the inner dialogue associated with the experience.2
So when the experts tell me that CBT is ideal for curing my anxiety state, I can either bow down to their expert authority or I can reflect upon fifty years of introspection that contradicts them, together with the fact that CBT lacks a sound neurological underpinning. Except, it turns out that my extensive, direct experience doesn’t impress the experts one little bit. Take, for example, the following claim, extracted from one of the many expert proclamations made on the internet:
“It is common for clients to experience emotion prior to any conscious recognition of their preceding thought(s). This can make it difficult to ascertain the actual thought(s) that activated the emotional response.”
It seems that, rather than admit that CBT’s central premise is refuted by patient testimony, the CBT proponents posit a mysterious delay in conscious recognition of thought. Which, of course, calls into question just exactly what is meant by a ‘thought’. Already, my bullshit detector is flashing frantically. For the purposes of a counsellor’s enquiry, a thought is a consciously experienced internal narrative, but, for the purposes of shoring up dodgy theory, it becomes any subconscious mental activity that suits the purpose. I’ve even seen it suggested that these ‘subconscious thoughts’ also include the activities of the emotional centres of the brain! Which, of course, makes a mockery of the whole thing.
Well there you have it. CBT is based upon a neurological model that was discredited many years ago but nobody on the CBT bandwagon seems to have noticed. Day after day, the therapists encounter ‘clients’ that tell them that they have emotions that are not directed by conscious thought, but their testimony is dismissed as that of the confused, even though this explanation results in CBT descending into gibberish: CBT exponents are adamant that thought precedes emotion, and yet, when put on the spot, they can’t even make a clear distinction between the two.
Notwithstanding all of the above, we are told that CBT is evidence based. Studies have shown, blah blah blah. Oh really?
As with CAGW, when one chooses to look beyond the headline hype, it turns out that not everyone with the requisite expertise is convinced by such studies. There is dissent within the ranks but one just doesn’t hear that much about it. Back in 2009, Dr Oliver James (as seen on TV) accused government ministers of being “downright dishonest” when they claimed that new NHS CBT-trained therapists will cure half of 900,000 people of their depression and anxiety. “There is not a single scientific study which supports that claim,” he said. “Being cheap, quick and simplistic, CBT naturally appeals to the government. Yet the fact is, it doesn’t work,” he added.
At the time, CBT proponents dismissed such ideas as “out of date”. And yet, by 2015, articles such as “Why CBT is Falling out of Favour” were starting to voice puzzlement over why CBT no longer seems to be working as well as it did. All sorts of theories have been proposed3, but the obvious one is overlooked. Many pharmaceutical drugs have suffered the same fate; they seemed effective in trials but lost their potency over time. It turns out that the initial studies proclaiming their effectiveness were subject to p-hacking, and it was only the emerging body of evidence, following widespread use, that finally exposed the subterfuge. Accordingly, the CBT experiment had simply failed the most fundamental of scientific tests – it wasn’t reproducible.4
Not that any of this matters. The world’s intellectual, political and financial investment in CBT is now so huge that there is no amount of counter-evidence that will impress its stakeholders. I can’t say for sure, but I wouldn’t be surprised if the medical consensus in favour of CBT currently runs at about 97%. Is that enough to accept the dogma unquestioningly? Not for this old curmudgeon. Rather than swoon when confronted by the experts’ CVs, I tend to reflect upon the nonsense that lies behind the ‘science’ they spout, and I wonder how such orthodoxy could have established itself in the first place. The answer, of course, lies in the sociology of science. Where there is plausibility, there will always be plenty of motivation to jump upon the bandwagon and, as long as there are no laboratory experiments available to prick the bubble, the sphere of influence can be blown up to any diameter that suits the zeitgeist. Such is the situation in the world of psychotherapy – and such is the situation in the world of climatology.
There are times when I feel that even the suggestion that the climate science canon could be bogus must be ridiculous, because scientific communities are just too self-critical to allow this to happen. Then I remember about CBT, and in an instant I’m cured of the thought. If CBT is any example, then scientific naivety is not that rare after all. And, contrary to what the CBT expert will tell you, sometimes it isn’t the thought that comes first – it’s the sentiment.
 My apologies in advance, but this essay is not going to tell you everything you might want to know about CBT. For those who are interested, I recommend that you start with the Wikipedia entry and then take it from there. Believe me, you will not find the internet short of things to say on the subject!
 Actually, your brain will sometimes create the illusion that its mental narrative is setting the mood, perhaps because such self-deception reassures us of the essential rationality of the human condition. In ‘The Decisive Moment’ (ISBN-10: 1847673139) Jonah Lehrer explains how our decisions are predetermined subconsciously by the brain’s emotional centres, but its higher executive functions trick us into thinking we arrived at a rational and dispassionate decision.
 For example, CBT’s waning efficacy has been ‘explained’ by suggesting that all the easy cases have now been dealt with and we are only left with the difficult nuts to crack – like me, presumably.
 Or maybe it is just experiencing a hiatus, and CBT efficacy will return once the short-term effects of a natural variability have passed.