Subtitled “Common-sense techniques for improving your mind and mood“, this self-help manual aims to be a comprehensive introduction to the theory and application of CBT techniques that can make people’s lives better and fuller…without a therapist.
But CBT without a therapist is a very challenging task for any author, and in this book the attempt goes badly wrong.
Right from the start, this book deliberately obscures some important distinctions. And by “right from the start”, I mean the front cover. Claiming that this book is therapy, or that it is about therapy, stretches the meaning of the word therapy in a misleading way.
In the realm of psychology, therapy has a particular meaning. It means the special kind of helpful human interaction between a therapist and a patient. Stretching the word “therapy” to include self-help books means that there is no special word for that special kind of helpful human interaction, almost denying its existence or importance.
Even in the chapter Working with the Professionals, that special human interaction continues to be denied. There’s even a suggestion that most therapists use books as part of the treatment.
So this book is actually a little dangerous in the way it misleads. Some people with serious mental health problems can be helped by having real psychological therapy like CBT. But if they read this book first, they might think that CBT is nothing special, just some good advice that you get in books. They might fail to try the very thing that could help them, because they have been mislead about it.
Another important distinction that this book deliberately obscures is the distinction between everyday difficulties and illness. The list of complaints in Chapter 1 is really a list of medical diagnoses. These are serious conditions that can lead to long-term disability and, in some cases, death.
The book obscures the distinction, making it difficult for readers to decide whether their difficulties are illness or not. On the one hand, some of the difficulties covered are described as illness. On the other hand, the book implies that much of this illness does not need medical attention. Advice about seeking medical attention is hidden away at the ends of some chapters, and it’s not always as clearly spelled out as it could be.
The next trouble that the book runs into is the well-known kind of hypochondria that medical students get, sometimes called First clinical syndrome. The affected students begin to experience the symptoms of every disease they are studying.
Reading this book has the same effect. Most people probably read it because they have a particular difficulty that they want help with. A first step should be identifying the characteristics of the particular difficulty. So when Chapter 2 has the title Spotting Errors in Your Thinking, it looks very promising.
But the body of the chapter never mentions spotting errors. Instead, it gives the impression that everyone makes all twelve errors. So when you buy the book you have, maybe, one area of difficulty in your life. By the time you have read Chapter 2 you have twelve! Identifying the specific areas that you need to work on only gets a passing mention right at the end.
As subsequent chapters go into the practical details of what to do, this trouble persists. The various techniques are genuine examples of the kinds of thing CBT therapists sometimes ask their patients to do, and they are adequately described, but they are presented in a kind of blunderbuss way so that everyone gets to try some of everything.
There is little guidance to help an individual reader focus on what is appropriate. As a result, many readers will probably waste their time with irrelevant exercises, while failing to persist with the ones that might really help them.
A chapter on attention sums up the book’s general approach by presenting a half-baked version of the Buddhist notion of mindfulness.
Originally, mindfulness techniques were designed to promote integration of inner reality with the external world, “being one in the moment”, merging emotion and reason. Early training exercises in mindfulness can involve observing your own thoughts in a detached way, so as to make the eventual goal of integration more explicit.
But the half-baked approach in this book takes the early training exercise and stops right there. Instead of being one, you are expected to remain split in two — a detached observer who interacts with the world in an emotionless way, separated from your inner self, which is characterized as having “unhealthy” and “negative” thoughts:
Given that many of the negative thoughts you experience when you’re emotionally distressed are distorted and unhelpful, you’re much better off letting them pass you by…
This seems to be the book’s core belief — that you should live as a detached observer of yourself, making value judgements about your real self and finding ways to deflect and subvert the things that you judge to be “unhealthy” or “negative” about yourself.
Just don’t do it
The crunch comes when this book tries to suggest cures for common complaints — in each case, the cure is little more than denial and distraction. This is a sad caricature of CBT.
For example, Deconstructing and Demolishing Depression describes how to distract yourself from a few of the common side-effects of depression, like rumination, inactivity and disturbed sleep. A sign of how lost these authors are is this astounding tip:
Doing only what you feel like doing when you are depressed is likely to maintain or worsen your symptoms. Instead, try doing the opposite of what your depression directs you towards doing.
How close is that to: “Pull yourself together!”
Similar approaches are suggested for all your difficulties. Identify a side-effect, then…just don’t do it. The general rule seems to be that you ignore the actual condition and treat a few easier things by distracting yourself.
CBT without a therapist
CBT without a therapist was always going to be challenging for the authors of any book.
At its heart, CBT is a talking therapy based on human interaction, and in a book there’s obviously no human to talk with, but as books go, this one does not even try to be human. Instead of human stories that we can identify with, we get impersonal lecturing.
In its methodology, CBT gets straight to the heart of a patient’s problems, using a process known as guided discovery to distinguish between core issues and side-effects, but this book makes no attempt to provide any equivalent process. Indeed, its focus is the opposite — on the side-effects, because they are superficially easier to deal with.
CBT does use some of the same thinking exercises and behaviour exercises that we get in the book, but in CBT they are carefully targeted so as to address specific elements of your problem. In the book you get everything thrown at you, whether it’s relevant or not.
And CBT’s aim is to allow you to trust your thoughts and feelings completely, and live a fully emotional life. It does not necessarily aim at the complete oneness of emotion and reason that the mindfulness gurus teach, but it does aim to free you to be open to your emotions as well as to your thinking. The book, by contrast, seems to want you to detach from emotions and to distrust thoughts.
So this book is certainly not CBT. And it’s not very good. Indeed, if you have a serious mental illness and it puts you off having real CBT, it might be very, very bad.
Cognitive Behavioural Therapy for Dummies, by Rob Willson and Rhena Branch, was published by John Wiley & Sons Ltd in 2006, in Chichester, England