Why is CBT inappropriate for trauma survivors?

CBT = Bad for Trauma

Cognitive Behavioral Therapy (CBT), the most common and widely promoted modality, can actually be deeply harmful to trauma survivors. Trauma physically changes the structure of the brain. It reduces access to the PFC because major resources are consumed by the limbic system, the fear brain, which is in charge. The fear-driven nervous system cannot focus well on learning; it is an unaffordable luxury. 

Talk therapy alone neglects the somatic, which is vital to trauma recovery. We experience trauma in the body. We store trauma in the body. We experience trauma symptoms in the body. But cognitive therapy virtually ignores the body.

When people are hypervigilant the limbic system (which directs the “fight-flight-freeze-fawn” reaction) is in charge. The prefrontal cortex (PFC), the “make better decisions” part of the brain, is of limited access. There is a physical disconnection in the brain. Cognitive therapies require significant access to the PFC. Without it, cognitive therapies are ineffective at best, and, very often harmful.

Many trauma experts say the somatic work must come first unless the nervous system is already calmed. We need therapies that help us reintegrate the brain, regulate the nervous system, and foster secure attachment. 

The primary goal of trauma therapy must be the recovery of a sense of safety in the body. That’s where the trauma exists, not in the thoughts, but in the body. Thinking better thoughts can certainly help, but only when the brain can actually make those connections. 

Sadly, CBT is too often used on trauma survivors by a system that overlooks that trauma is a neurophysiological condition. It doesn’t recognize that our brains cannot function like normal brains because they’ve been harmed so deeply. Far too many therapists reinforce the domination system of mainstream culture. Even fewer know anything about the neurophysiology of trauma, much less, how to help us recover. 

Psychiatrized medicine ignores the MASSIVE neurophysiological component of what it calls mental health, which is health. 

CBT is held up as the standard “because it’s been studied so much,” but the studies are deeply flawed. For instance, they were conducted on people who do not have PTSD! To push CBT at a brain on fire is to shame the suffering person for choosing not to to override a neurophysiological condition, something that is not a choice.

Talk therapy flies in the face of the neurobiology of trauma and recovery. Neuroscience shows that if we keep talking about our problems without the somatic element and the capacity to complete the trauma resolution process it actually strengthens the neural pathways for the traumatic experience, memories, flashbacks, and feelings. A cognitive-oriented therapist will have no clue they are actually making things harder for their client by encouraging them to talk about it again and again.

Most “mental health” (which is health) issues are rooted in trauma, particularly Developmental Trauma, the number one health crisis in the world and the number one health crisis ignored by the mainstream medicine – psychology- pharmaceutical complex. 

Trauma dysregulates the nervous system, putting it on red alert. The chronic production of stress hormones results in chronic disease like diabetes, arthritis, CRPS, PTSD, dysautonomia, and cancer, as well as recurrent “unexplained” pain. Hypervigilance causes the growth of nerve fibers that register pain. Reduce the hypervigilance and the pain fades.

Cognitive capacities come and go depending on activation level. So, stressful input from the environment will reduce cognitive abilities. The client won’t be physically able to make those decisions even if they know what they “should be doing.”

Most complex trauma occurs in relationship. Therefore, it must be resolved in relationships. According to the NARM Training Institute, to support the healing of their patients’ complex trauma, “therapists must be willing to explore their own unresolved trauma, and ‘do their own work.’ This requires a process of self-inquiry and self-reflection. Due to the deeply relational process of working with complex trauma, therapists can’t just learn skills and protocols, they must learn a deeper engagement necessary for relational healing.” 

CBT/DBT: Inherently Shaming, More Provider BurnoutMost therapists are trained in Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT, often described as “CBT plus mindfulness”). This modality is inherently shaming: it treats the individual like they are broken and the therapist can fix them. The therapist has the power and the individual must conform. This is the overarching premise of mainstream psychology as an institution. 

The shaming of CBT is greatly amplified when used on trauma survivors. It focuses on changing our supposedly unacceptable thoughts, feelings, and behaviors, which are normal responses to abnormal experiences. The intolerable internal state is the driver of our emotions, behaviors, and thoughts. Cognitive therapies cannot help us learn to regulate, titrate, and tolerate our internal state. The very thing driving our distress is not even in most therapists’ comprehension.

Cognitive therapies require that the therapist drive the therapy. Therapists often have an agenda for their client, which may be below their conscious awareness. Such practitioners engage in “therapist efforting,” which actually blocks the client’s process!

The Trauma Survivor’s Experience of CBT

As Dr. Stephen Porges asserts, “Safety is the therapy.” But CBT often brings further threats, as it greatly did for me. When I turned to mainstream psychology for help with Developmental Trauma in 2019, the psychologist tried to use CBT to teach me how I could make better choices. I told him I had become dysregulated due to bad encounters with my parents and had fallen back on the childhood coping tool of binge eating.

The provider seemed to truly believe he was doing right when he focused on telling me I needed to stop and think instead. He treated me as if a person could somehow magically think their way out of severe dysregulation, dissociation, triggers, flashbacks, and the resultant disconnect of the cognitive capacities. It was obvious he had no idea what was really going on. Which was true, and is too often the case with mainstream Western psychology. 

Of course, this focus bypassed what was actually happening and what I truly needed. It also shamed me for ostensibly choosing not to use my brain the right way. The psychologist and his one-trick pony, CBT, shamed me for my neurophysiological condition and my normal human response to highly exceptional lived experiences.The inappropriate use of CBT shamed me by its expectation that a human being has the capacity to “stop and think” when their brain is already hijacked by fear.

The psychologists’s shaming kept him in his position of power and kept me shamed and on the floor. He didn’t have to do any real work, like understand what was actually going on, connect with his patient, and respond appropriately as one human being with another. He didn’t even have that capacity. In part, it had been trained out of him by the psychology paradigm and driven out of his practice by corporate interests. He just did all the things he was trained to do. Check the right boxes, mouth the right words, and make inaccurate notes on my chart.

With his lack of Trauma-Informed Care training and focus on cognitive treatment, this psychologist didn’t have to look at my history of horiffic abuse, recognize the toxicity of our culture, the pandemic of insufficient psychosocial support, and the structure of a society that would allow rapists access to young victims, leave the children to figure out how to recover on their own, minimize the impact, and protect the abusers at the expense of their victims.

The uninformed psychologist simply tried to use cognitive means to shame me into believing he was right and my internal milieu was of no concern. He also ignored and dismissed my complaints about increasing suicidal ideations from the Lexapro, which landed me in the Cuckoo’s Nest 8 days and nights for an iatrogenic condition. That experience of abuse, neglect, and ignorance caused such deep harm I’m still trying to recover 5 years later. And my story is not unique; this is how mainstream medicine treats adults with Developmental Trauma. This is “mental health care” in America. It ain’t about health and it ain’t about care.

Blinkered Mainstream View
The biggest thing mainstream medicine- psychology – pharma gets wrong about mental health is that it’s an individual phenomenon. That the environment–especially the psychosocial environment of cruelty and contempt we are all subjected to– has nothing to do with the individual capacity to function, when it is the number one factor. 

Unresolved trauma is cumulative and compounded. Those who have experienced trauma are far more vulnerable to more traumatization. Especially in the medical and psychology realm. I shudder to think how many people have been and are harmed by providers who don’t understand the basic neurobiology of trauma. I’ve suffered enough at their hands myself. 

We need neuroscience-informed care, not the pseudoscience of psychology and psychiatry that chop us up into bits and tell us it’s our fault we can’t function.

Fortunately, the scientific field of Interpersonal Neurobiology shows us that we are designed to help ourselves and each other heal through safe connection. It is a biological imperative, to which the mainstream culture is opposed. We need an Interpersonal Neurobiology Revolution. This is why I started the #TraumaAwareAmerica initiative, to inform providers and empower survivors.

DISCLAIMER: This is not medical, psychological, pharmaceutical, or legal advice. The contents of this site represent Shay Seaborne, CPTSD’s lived experience and understanding of the neurobiology of trauma through study and experiences. For medical, psychological, pharmaceutical, or legal advice, consult a licensed practitioner.