CBT Isn’t the Problem… But It’s Not Enough

Licensed trauma therapist Tabitha Westbrook takes an honest look at why Cognitive Behavioral Therapy (CBT) often gets a bad rap in trauma work—and where it still holds real value.

In this episode, she breaks down what CBT actually is, where it came from, and why its focus on identifying and shifting automatic thoughts can be helpful—but also deeply limited when used in a rigid, one-size-fits-all way. Tabitha explores how non–trauma-informed CBT can unintentionally minimize real harm, invalidate appropriate emotional responses, and overlook the critical roles of the nervous system, attachment wounds, dissociation, and the lived experience of the body.

She also highlights more integrative “third-wave” approaches like DBT and ACT, which better account for emotional regulation and embodied experience. Importantly, she names a truth many people feel but rarely hear: some thoughts aren’t distortions—they’re accurate reflections of real pain, loss, or ongoing realities (including chronic illness), and they cannot simply be reframed away.

Drawing from her work in EMDR and faith-informed identity healing, Tabitha offers a more nuanced path forward. This episode invites listeners to move beyond therapy “camps” and toward a flexible, compassionate, and effective trauma healing toolkit.

Links:

Transformational Topics Community - https://thejourneyandtheprocess.com/upcoming-events-groups/trauma-healing-support-online/.

The Beck Institute - https://beckinstitute.org/

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Transcript

Tabitha Westbrook: [00:00:00] Somewhere along the way, CBT or cognitive behavioral therapy became the one that everybody loves to hate on online when it comes to trauma work. I agree in large part, but today we're gonna talk about where it is super useful.

Welcome to Hey Tabi, the podcast where we talk about the hard things out loud with our actual lips. We'll cover all kinds of topics across the mental health spectrum, including how it intersects with the Christian faith. Nothing is off limits here, and we are not take two verses and call me in the morning.

I'm Tabitha Westbrook, and I'm a licensed trauma therapist, but I'm not your trauma therapist. I'm an expert in domestic abuse and coercive control and how complex trauma impacts our health and wellbeing. Our focus here is knowledge and healing. Trauma doesn't have to eat your lunch forever. There is hope.

Now, let's get going.

Tabitha Westbrook: So let's talk about cognitive behavioral therapy a bit more deeply. First of all, cognitive [00:01:00] behavioral therapy was developed in the '60s and '70s by a dude named Dr. Aaron Beck. There is a Beck Institute still out there, and they do a lot of good work. It is a really well-researched modality. You will often hear it called evidence-based, which means they've just done a lot of research, and in the clinical trials that they have run, they've shown that it's pretty effective.

Most insurances will pay for cognitive behavioral therapy or CBT in the work that people do, and that's always helpful, and it does have a place. Now, is it a first-line place for trauma? I don't think so. It isn't for me. I do think that we have to be more somatic and body-based and a little more nuanced in it.

But there is a place for CBT in good therapy. So I really wanted to highlight that today because it does get a ton of shade from a lot of trauma therapists. I have for sure given it some shade over time, um, because it can be misused. And I think that's the thing is like, how do you use it? When do you use [00:02:00] it?

When is it helpful? So at its core, cognitive behavioral therapy is a form of structured talk therapy, and the goal is for it to help individuals learn to recognize and change negative patterns of thinking and behavior so that they can better cope with challenging situations and overall improve their quality of life.

There are more than two thousand studies that have been done on this particular modality. That is a lot, right? And that comes directly from the Beck Institute and their information that is out there, which I will link in the show notes. They talk a lot about automatic thoughts, and there are some really good things to understand about automatic thoughts.

We, if we're not paying attention, have a ton of them. We can spiral like nobody's business, right? And I've written about this. I've talked about it before. We can go from zero to, "I am going to be homeless, living in a ditch," pretty fast in our minds. And that is because we [00:03:00] are trying to self-protect, or we've seen some really hard things, and we all have automatic thoughts.

What I really do like about CBT is that we get to really start to explore those automatic thoughts. We learn to notice them. We learn to engage with them and really stretch out what are nanoseconds into longer seconds so that we can decide what we want to do with an automatic thought. Do we want to keep it?

Is it accurate? What do we want to do with it? Dr. Beck really came to the conclusion that, our thoughts and our emotions are interconnected, and that's a true thing. Right? Now, sometimes our emotions start and our thoughts go after. Sometimes our thoughts, you know, happen first, and that triggers the emotions.

It can be a cycle. But it is really helpful understanding of how these things connect to each other. And when you have a bunch of negative thoughts or these automatic negative thoughts, it's gonna influence your emotions negatively. That's a true statement. Now, the thing where I believe that [00:04:00] CBT can get a little...

I'll say a little too rigid, is you can't fix everything by challenging your thoughts. Sometimes your negative thoughts are accurate. Right? When we are in a harmful situation or harmful relationship, we may have a lot of automatic thoughts, and they may be very accurate. So to feel fear or to feel sadness or things like that, we aren't going to necessarily change by changing our thinking.

Right? If I'm standing next to a bear and I'm like, "That bear really isn't dangerous," that's just an automatic negative thought, then that's ridiculous. And any therapist that is practicing CBT in that way is probably not very good. And it can be really tempting to minimize harm and really tempting to minimize perfectly natural responses to harm when we are just going, "Well, change your thinking, make it better, it'll fix everything," because that's not true.

Now, there are other things that have come out of CBT that I [00:05:00] think can be really helpful to understand. So there's a concept called third-wave CBT, and third-wave CBT are modalities like acceptance and commitment therapy, also known as ACT, and things like dialectical behavioral therapy, which is DBT. I'm a big fan of both of those.

I especially like DBT. I think it's very helpful for clients, and it brings more of the body-based awareness into it, which I think is vital. I think that when we are using these modalities, we want to be clear about what we hope to get from them. For example, I absolutely want to know what my clients think and believe.

What we believe really matters, and sometimes it's accurate, and sometimes it's inaccurate. So when our personhood has been harmed by a abusive individual, someone who is a coercive controller, then my perception of myself may not be accurate. In fact, it probably isn't accurate. And I need to take the time [00:06:00] to take a look at that and go, "Okay, if this is what I'm believing, how is it influencing how I walk in this world?"

And then I'm gonna bring in the somatics of that and go, "What do you notice in your body? What happens? What comes up in you when you think about this or you believe this to be true about you?" And those are really important things to lean into. So If I'm not looking at what I actually believe about a situation or my thoughts about a situation, then I am gonna end up coming up short.

And so while I would definitely not say that CBT is a first line for trauma, I, I really don't think it is. I think it's part of the treatment, but it's not my primary treatment for a client that comes to me who has been through a traumatic experience. But all that said, like it does have importance. So even in EMDR, we are looking at what your negative cognitions are or your negative beliefs about a situation.

So if your negative belief about a situation is, "I am worthless," [00:07:00] I'm gonna do some body-based somatic processing through the bilateral stimulation of EMDR, and we're going to try to reprocess that belief, and we're gonna use all of the body sensations that come up for you, all of the thoughts, all of the emotions, all of those things to work through it and work on the reprocessing of the traumatic incident and the belief that you hold.

Also, we're moving toward a positive cognition or a positive belief. And oftentimes in my practice, because I do a lot of faith-based work, that's going to be about what God says about you. What does God say your identity is? And not in a cheap, take two verses and call me in the morning sort of way. But, you know, if I am a daughter of a king, then I am not worthless, right?

And so if we are moving in that direction or we are moving to, "I am strong and I can survive and I have survived and I am, you know, surviving now," then that is very much cognitive, right? Like my brain has to get there [00:08:00] and my body has to go with it. And when we're looking at combining the cognitive and the somatic, which is your body, then we are looking at really doing that whole-person care.

So if you hear me talk about what we do here at The Journey and The Process, we are very much whole-person care. So we want to engage your mind, your body, and your spirit in all of these things. And if I'm not engaging your mind, I am leaving a piece out, right? And again, like I said, I-- CBT is not a first line for me.

It is part of the treatment for me with clients. And I think that's just a very important note. And I think when, you know, I talk to some clients and they're like, "Actually, CBT, like straight up CBT therapy was really helpful for me." And I think that's amazing. And different therapies are going to be more helpful for different people, right?

Like the way that I work with somebody isn't for everyone, right? I'm not everybody's therapist. I am a really great fit for my [00:09:00] clients. I'm not a really great fit for your clients or other people's clients, and I might not be a great fit for you. But it's really important to know that you have like a whole toolkit around you that you can lean into and do work with and all those kinds of things.

So let's talk about some of the ways that I use- Use CBT in my practice a little bit more. Let's go a little deeper here. So I definitely tend to move in the third wave space, so like the DBT, ACT, all of that kind of stuff. And I will say I have a deep and abiding love for dialectical behavioral therapy.

I use it constantly. I wrote a faith-based class on it, um, that has literally all four modules of DBT skills. I teach it to my clients constantly because it is helpful. In fact, at a retreat that I recently presented at, I did an entire session on interpersonal effectiveness, which is how to work and play well with others.

So if you're interested in that information, that'll also be in the show notes, and I can, uh, access that [00:10:00] with you. But when I'm using it with a client, I am very much thinking about: What do you believe? What do you believe about your body, about your soul, about the situation? Are these beliefs accurate? So we're gonna do fact-checking, which is very much part of DBT, and looking at those things.

And so those are some of the ways that I enter in, in that space with my clients. So we're gonna do the somatic work with it, though. So when that thought comes up for you and you say, "I am worthless," what do you notice in your body? Who first said that to you? Right? So we're still engaging the body and the cognition together, and I think that is where, like, the third wave CBT stuff is really helpful because it does take a more, you know, deep and introspective look that includes the somatic, which we desperately need in our lives.

Other ways that I might use CBT are to have people take a look at their automatic thoughts. Um, Dr. [00:11:00] Daniel Amen calls them ANTs, automatic negative thoughts, and I like that 'cause we sometimes need to be ANT killers. I, I wanna make sure that that thought, um, is not factual. Like, if it's factual, then we may need to change some things situationally, uh, and physically before we can have a different thought, honestly, so that's just something to consider.

But I might have my clients track their automatic negative thoughts or do some ANT detection, if you will. And that can really help folks figure out, like, what is going on. A lot of times we are just super unaware of what's happening in our heads, and I often have my clients work through their TUBES, so their thoughts, urges, behaviors, emotions, and sensations.

And I wanna know what you're thinking. So before you took that drink, or acted out in this way, or leaned into maybe an addictive pattern or an unhealthy pattern, I wanna know what was happening. So what were your circumstances? What was happening around you? But also, [00:12:00] and mostly, what was happening in you?

What thoughts came up prior to you taking this action? What did you notice? And what then triggered emotionally and somatically for you? And I wanna know these things so that I can help you walk through them. So it's not uncommon for me to give a client the homework assignment of, "I want you to just write down what you notice."

You know, either throw it in a note on your phone or write it down in a journal or in some way kinda keep track of it. Um, I have clients that text themselves. There's, like, all kinds of ways to do this. And then I wanna talk about it in our next session. What did you notice? And it's a very grace-filled way of doing it, right?

Like, I don't expect people to give me every thought they've ever had. Like, that's unreasonable. But I do, especially when there's distress, I want them to lean in and try to figure out what's going on a little bit. So yeah, like, when this thing happened, I absolutely thought, "This is terrible. I'm not gonna make it.

It's the worst thing ever. I'm gonna fall apart." [00:13:00] And then I felt really depressed and, and, and, right? So when we are tracking those things, we start to get clarity, and we're like, oh my gosh, I literally was spiraling. Uh, I- there is a meme in one of our blogs that I created for us that said, "I'm not spiraling.

I am just following a suspiciously curved path," which is, I think, funny because we all do it from time to time, right? Everybody I have ever met at some point is gonna spiral a little bit and sometimes a lot of it. Depends on the stimulation, right? What's happening around you. So I want to know where are our spirals?

What can we maybe interrupt or change or shift or evaluate together, um, or reprocess that is helping you go in that direction? My friend Matt Wenger says it this way: "The water will flow where the ditch is dug," and he means from a neurological perspective. When we have neural pathways that have gone in a particular direction for a long period of time, it's a ditch, [00:14:00] right?

Things are used to flowing that way. So we have to backfill that ditch with, uh, some new dirt and then dig a new one going in the direction that we want, and that takes time and effort. Dr. Diane Langberg at the same conference that I presented at, presented that there are three things that we need for trauma therapy: uh, talking, tears, and time.

And I agree completely. Even more than just talking, right? We need those somatic things. We need the somatic experiencing and, you know, EMDR, brainspotting, all of those things that help us from the body-based perspective. But there is something so special about being able to say, "This is the way that I spiral," and your therapist going, "Let's untangle that for you.

Let's maybe dig a new ditch and backfill this one." But if we don't know what we're doing, we can't change it. When I do perpetrator intervention work, so batterer intervention work, work with people who are destructive in their relationships, [00:15:00] the very first thing that we teach them is how to see it. Right?

See it, own it, turn from it. And when we don't see it, we can't change it. So if I can help you see your automatic negative thoughts, and we can go on a little ant safari together, then I can help you see these things, and you might not even know they're there. And you might go, "Huh, who knew?" Right? And so then we can lean in and dig in and try to figure it out together in a little bit of a different way and look at things differently together.

We can also see thought shift. So it's not uncommon for me to have a client do this over a period of time. So we identify the original negative thoughts. We start to evaluate them, work through them, figure out where they came from, all of those kinds of things. And then what we do from there is we look at them over time.

Now, where this would break down is if you were not sensitive to trauma, and there are certain things that you're having a perfectly normal reaction to [00:16:00] an abnormal situation. Additionally, you cannot think yourself out of chronic illness. Like, there's no amount of changing thoughts that are going to make a chronic illness go away.

It just doesn't work that way. So we need to learn how to maybe deal with that illness. We need to learn how to reorder our world a little bit, maybe grieve the things that we've lost or learn how to celebrate wins differently. So all of those things are a more nuanced approach. And so I would never say to any client, you know, "We're just gonna ignore your pain.

Think differently. You'll be fine." That is utterly ridiculous and will not work for anybody. So I wanna be really clear in this that we are not minimizing real harm when you're working with negative thoughts or any thoughts for that matter, or when you're entering into any part of cognitive behavioral therapy.

We are, when we are well-versed in trauma, using it as a tool in our toolbox when it is appropriate for our client. And I think that's a really important thing because [00:17:00] really truly, I have had clients come to me, and they have been told, "Well, if you just thought differently, then all of this would resolve."

And that's just not something that can be said of these things, right? Like y-you can't, again, think your way out of certain harm. You, you just can't. And if your body has ongoing struggle or if your life has ongoing struggle because of some of the things that have gone on that you've experienced, that you are experiencing, then we need to honor that and treat it a little differently and, um, not just say, "Well, if you thought differently, then you'd be in a different place."

Again, that just is ridiculous, and it, it does not work. But being aware of what you're thinking is really helpful Because again, we can evaluate it, and then we can use it to shift our behavior to a degree as well. So when I'm talking about shifting our behavior to a degree, I mean that we can, once we are aware of it, make behavioral changes.

So what you can do in that space [00:18:00] is go, "Okay, now that I know this thing about my automatic negative thoughts, I am going to start noticing them a little bit earlier." Like instead of going zero to living in a ditch, I'm gonna go to maybe five and say, "Oh, I'm noticing I'm doing that thing. What do I wanna do with this thing that I'm doing?

Do I need to give my body some tenderness and care? Do I need to reach out to a friend and get some support? Do I need to use another skill that maybe I've learned in therapy or coaching or something like that to help me make a shift here?" And that can give you a lot of empowerment, right? If we just think that we're a slave to it and it happens, and there's nothing we can do about it, then that isn't super helpful at all for anybody, frankly.

And I would be a terrible therapist. I don't think I would do this job if I didn't think people could heal. Like, that would be really ridiculous. But there are things that we can do that can keep us from going down the negative spiral that we sometimes, you know, will engage in. So I can say, "You know what?

I'm noticing that I'm pushing past my body's limits, [00:19:00] and I'm doing that because I believe that I'm not worth much if I can't fill in the blank," right? And that happens for a lot of people, especially a lot of high-functioning people who suddenly find themselves struggling with illness or something to that effect.

I am dealing with a h- a hurt thumb here, so it... Surprising how much you need th- both of your thumbs. Amazing. And so that's been a little bit of a struggle, but if my worth and value were tied up into whether or not my thumb was working, I would be struggling right now. I really would, more than just with the pain and the discomfort and the inconvenience.

So it's really important as we look at this to go like, "Okay, I need to give myself a little more care and kindness. I'm holding myself to a standard that God does not hold me to. Maybe an abuser did, but I don't have to listen to them." And so I'm gonna critically evaluate that, and I'm gonna make a shift on that.

So if I'm saying, "I really need a little more care and kindness with this," then I'm gonna lean into that care and kindness a bit more deeply. [00:20:00] And I think that's a, an aspect of CBT that can really help. And when you have a therapist that's like, and their version of CBT is just think positively, that's not actually CBT Just so you know, it, it's again, very minimizing and it's not accurate.

We do need to engage our prefrontal cortex, which is our thinky thinky parts in trauma healing. We definitely need to engage the feely feely parts, so our amygdala, limbic system, all of the fear centers that are in the back of the brain. But we do need our prefrontal cortex and our thinky thinky parts, and one of the ways that we make sense of the world is language.

And CBT is great for giving us some language. It's really great to get Broca's area and Wernicke's area and our whole prefrontal cortex involved with the process. And we do need that. Again, whole body therapy is vital. It's so important. So we are not engaging here in toxic [00:21:00] positivity. So CBT with a healthy perspective and a third wave perspective and a trauma-informed and trauma-specialized perspective is not pretending that trauma didn't happen.

It's not toxic positivity, and it's not just thinking happy thoughts, right? It helps us notice patterns. It helps us identify beliefs that are definitely not helpful and not accurate, right? Our negative cognitions that are not what God says about us at all. It helps us become more aware. Again, we cannot change what we do not see, and that's really important.

It can help us figure out how we make meaning of things. I think it was Albert Ellis, who's a psychotherapist from way, way, way back in the day, who talked about examining how we make meaning out of things. And so if we make negative meaning out of a thought or a situation, then our emotions are naturally going to follow suit, right?

Because again, we are trying to protect ourselves, which is how we're created. But I can examine that, and I can decide whether [00:22:00] or not that is where I want to be and whether or not that's helpful or accurate, right? And also learning about how our thoughts, emotions, and behaviors all interact if we really kind of lean into our tubes and add those sensations and all of our urges and all the things that we feel inside, we're gonna have a much clearer and whole perspective on things.

So we know that trauma actually does impact what we believe pretty significantly, right? Abusers speak all kinds of stuff over us, and literally none of it is helpful. So we know that trauma reshapes our beliefs about safety, trust, worth, power, control, intimacy, God, everything, our identity, right?

It, it changes everything for us. And when we have those experiences, we often have negative beliefs, and some of them are accurate, like I'm unsafe can be very accurate. And we might go, "I'm unsafe," and that is a factual statement, and I need to figure out how to get to [00:23:00] safety. I need to lean into safety. But things like everything is my fault, my needs are too much, I can't trust anyone, my body betrayed me, I feel something bad is gonna happen if I just rest.

Like, those things are often a response for trauma, and they're also not accurate. And so we do wanna know that they're there, and we wanna be able to begin to evaluate them. Also, knowing our thoughts helps us find shame, and shame can be a real problem for trauma survivors. And everybody who's a trauma survivor just said, "Amen.

Sure can. Sure can." And so we want to be able to deal with shame and to lean into really looking at it and examining it and disconnecting from it where we can. And again, there's body-based things that we're gonna bring to play in that, so it works really well. We also wanna be aware of catastrophizing and dichotomous or black and white thinking.

Things are one way or another way. There's no in between, and we know life is a [00:24:00] whole bunch of in-betweens, all kinds of in-betweens. And we can also build coping skills. And CBT can be really helpful in evaluating, like, what coping skill is gonna work for me right now. And then sometimes none of them work, and you have to try something altogether new.

It's the way that it is, right? But CBT can help us with grounding skills, emotion regulation, behavior activation, panic management. And again, it's not gonna be perfect because sometimes the stimulus outweighs our skills, and that happens. We've talked about that on this podcast before. But it can be really helpful.

And we can use some of those things, again, in that third wave CBT variety to help us lean in and learn some more things

So let's talk about some critiques of cognitive behavioral therapy and why it honestly can get a bad rap. We've talked a little bit about it, but sometimes CBT, when it's done from a not trauma-informed, not body-informed perspective, [00:25:00] can feel overly intellectual. It can feel too focused on symptoms. It can completely dismiss body experiences.

It can be really invalidating. We've already talked about the spiritual bypassing and feeling missed in all of it. And it really does sometimes, when it's not done well, give the vibe of, let's just fix your thoughts and everything else will be fine. And we know that trauma is not a thinking problem, right?

If that was all it took, then I wouldn't have a job and you probably wouldn't be here. Let's just be real. But we know that it lives in the nervous system and trauma really impacts the body, our attachment, our implicit and explicit memory, and the way that we choose to survive. I think what it's really important to notice in this episode is that not all CBT is the same.

Not all CBT is crappy CBT and not all of it is misused. So again, it does have a place in trauma therapy that can be really helpful for us and it can be really done [00:26:00] poorly. I would say that I see it take place in ways that aren't helpful when it is the only methodology used in a trauma case and to help someone overcome their trauma and heal from it.

I would say that a high level of rigidity when the therapist themselves struggles with dichotomous thinking or a black and white perspective or is like wanting to just slap a label or a tool on something instead of really evaluating it. I think it can really go sideways when there is no nervous system and understanding of trauma, right?

If we don't have an understanding of the nervous system and a real good understanding of trauma, then CBT, no matter what skill you use, it's just not going to be effective. It's not going to work. If you don't have the understanding of attachment either, then I think that it can go really sideways. CBT is really easy to teach in grad school because it does have good structure around it.

It is evidence-based, and a lot of times grad school is preparing you [00:27:00] just to work for, someone that takes insurance or doing a certain thing, and it's not really trauma-informed. I do see grad schools getting better at that, but it is still the primary modality that most grad schools choose to teach, which isn't a bad thing.

It is in the field workplace, like when you do your internship, that we get to refine that, and we really help our interns change from being maybe a CBT base to a trauma base with CBT as a tool in their trauma toolkit, and that is something that is really important. And we know that when someone is just in that survival mode, until we can help them get a little more felt safety, logic isn't gonna land.

We cannot start with the prefrontal cortex. We have to start with the limbic system and felt safety when we are helping people heal. That's just the way it works. And if all you do is give people worksheets, it doesn't feel so great. I've had more than a few clients come to me and say, "My therapist just kept giving me worksheets, and, like, we never did anything," or, "My [00:28:00] therapist was just a blank slate, and they never reacted to anything that I said."

And that can be really, really, really hard on a survivor. We need some level of like, "Are you hearing me?" Like, "Do you get it? What is happening?" And so CBT, when it is in the wrong space, can be really damaging and harmful. So as we end this, I just wanna say CBT by itself is not bad. It's how it's used, and that's really true of any good therapy.

Healthy trauma-informed cognitive behavioral therapy looks like this. It moves slowly. It validates survival responses. It's not the only tool in the toolkit. It stays really curious. It incorporates the somatic. It's part of the whole mind, body, spirit, right? It understands dissociation. It honors and helps with attachment.

We talk about attachment wounds, and we work through them. We don't just ignore them. And we really can lean [00:29:00] in in a more somatic and refined way, and I think that's really where, like, the third wave CBT models are really, really helpful. Trauma healing isn't about choosing between the mind and the body.

Frankly, we need both, and we need mind, body, spirit, right? I've said that a few times in this episode. We need all of these things, and these things are really important. If this is something that you would like to know more about and explore more about, we would love to come alongside you. Our contact information for The Journey and The Process will be in the show notes.

If you are a therapist listening and you're like, "I'd like to know how to do this better and incorporate my trauma toolkit in a different way," reach out. We do consultation, and we would love to help you. I hope you enjoyed this week's episode of Hey Tabi. I hope you found it helpful and maybe taking a deeper dive on cognitive behavioral therapy and where it can be useful and where it can be not useful.

We look forward to seeing you again next time. Be sure if this is benefiting you to like and subscribe. Please share it [00:30:00] with a friend that might find it helpful, and we'll see you again next time.

Thanks for joining me for today's episode of Hey Tabi. If you're looking for a resource that I mentioned in the show and you wanna check out the show notes, head on over to tabithawestbrook.com/heytabi. That's H-E-Y-T-A-B-I, and you can grab it there. I look forward to seeing you next time.