Note: Usually, when I write about any remotely politically-charged topic, I make sure my arguments are very clear in my mind and supported by 9000 citations first. This isn’t the case with this topic, which I’m still forming ideas about. I’m posting this because I’d love to hear feedback/counterpoints from cognitive-behavioral therapy (CBT) and social justice perspectives: firstname.lastname@example.org.
I was recently on Jesse Singal’s podcast, and he asked thoughtful questions about the applications of CBT to campus culture war issues. Apparently, a side effect of asking me good questions on a podcast is that follow-up blog posts occur (well, it’s happened twice so far, anyway).
Here are my current, still-forming thoughts about whether CBT should be applied to college students making claims about politically-related offenses and psychological harm. My points are based on a variety of different arguments I’ve heard and are not directed at particular people/texts, though I believe this is the original article applying CBT in this way.
1. CBT is excellent and improves the lives of a lot (but not all) people struggling with mental health issues. I’d love for all college students to read David Burns’ self-help CBT book, Feeling Good: The New Mood Therapy (which is referenced in the original article on this topic). I read it in college, found it eye-opening, and then proceeded to recommend it and loan it to countless people since — including undergraduate students who I taught when I was a professor. Seriously, ask anyone who knows me — I have probably recommended that book to them. Not all students find it helpful (which is consistent with research on any treatment modality), but some really do. However, it’s important to recognize that CBT is designed and scientifically-tested as a treatment for people who are having mental illness-related distorted cognitions and thinking errors. It does not focus on societal stressors related to healthcare access, income inequality, rights, or prejudice, and it doesn’t offer solutions to those issues either. My concern is that placing thoughts related to these issues in a CBT framework reinforces some individuals’ default position that people talking about experiencing prejudice or feeling upset about political issues are exaggerating. Within a therapeutic context, these complexities can be addressed with nuance. Outside of that context, I worry that it bolsters notions that people can and should just think their way out of these types of stressors. This NYT article is about an illustrative real life example of how this kind of disbelief or minimizing default can lead to negative consequences.
2. Relatedly, I’m wary of using CBT as a method for ‘correcting’ other people’s thoughts and feelings about offense or harm unless I’m the person’s therapist (and even then I’m cautious) for the following reasons:
Humility & Accuracy: If you think someone is overreacting to a politically-related incident, you can just plainly state that as your appraisal of the situation instead of using CBT language (e.g., calling it catastrophizing or emotional reasoning). When you say someone’s thinking is distorted, the assumption is that you know for sure that they’re overreacting and also that you know why they are (and that is mindreading). I don’t see the incremental value of using CBT terms in situations where you don’t know much of the context, unless it’s to tone down the fact that you’re making a judgment about the accuracy of a person’s thought by framing it as a concern about their mental health.
Effectiveness: In the self-help version of CBT, a person learns tools for investigating their own distortions and thoughts. In therapy, it’s a collaborative process, where the therapist hears the person’s point of view and guides them through the steps of evaluating their thoughts in a compassionate, contextualized process. By design, CBT helps people arrive at reframed thoughts that ring true for them. It can be hard to get to that place in therapy — it seems much harder to get to that place through some of the other methods I’ve observed (articles/posts referring to students’ behavior as evidence of their fragility). To be clear, I’m not saying that thought errors don’t happen in certain college campus situations — I’m just saying I don’t see how motivated the average college student would be to evaluate thinking errors when presented with them as a sign of their fragility.
Ignoring Real Problems Where They Exist: As I wrote about before, I think that disproportionate focus on students’ purported lack of resilience ignores the valid reasons for their actions. If students get painted with too broad of a brush and are characterized as simply being unable to tolerate opinion differences, then it distracts from points of legitimate concern about the spread of ideas that perpetuate social inequities. When therapists disagree with their clients’ approaches to situations, they motivate change by looking for and validating the truth in what the client is saying and collaboratively generating ideas about adaptively achieving their objectives.
Furthermore, there’s a long history of people from marginalized groups being misdiagnosed and poorly treated within mental health fields (e.g., 1, 2). Broadly applying cognitive distortion framework in a public way doesn’t allow for a culturally appropriate framework that therapists are trained to use in treatment. Without that context and training, people might minimize or deny others’ valid experiences–which could be harmful to their health.
In conclusion, there are helpful elements in cognitive-behavioral therapy that apply to particular types of problems — especially when depression- or anxiety-related thinking errors are present. I have reasons to doubt it would generalize beyond what it’s been tested on and designed for, but could be convinced otherwise with empirical data.