Short answer: No.

Longer answer to follow. But why am I even asking the question?

In my friend Bob Kellemen’s thoughtful and largely helpful response to my post about going to the doctor to discuss depression meds, he said that his most serious disagreement with me was about my recommendation of Cognitive Behavior Therapy (CBT).

If that surprised me, then I was even more surprised that Bob read my piece as recommending CBT as a comprehensive therapy to the exclusion of other means. A fair reading of what I wrote would recognize that I was clearly recommending CBT as only one part of a holistic approach that included the body, the mind, the soul, Christian friendship, pastoral counsel, Bible reading, prayer, and worship and fellowship in a local church.

However, it looks like Bob would object even to that – using CBT as any part of a package of comprehensive compassionate care. He sees it as non-Christian at best, anti-Christian at worst, and therefore to be shunned.

Are we talking about the same thing?
I must admit, this really baffles me and makes me wonder if we’re talking about the same thing. CBT’s basic point is that what we think affects what we feel and do. Therefore if we can change what we think, we can change how we feel and what we do.

It’s not exactly revolutionary. It’s actually one of the ways way the Bible describes and portrays how we work as well (Psalm 42; 73, 77; Proverbs 23:7; Romans 12:12; Philippians 4:8-9). If CBT is guilty of anything, it’s of unwittingly plagiarizing the Bible’s insights! But I’m just thankful that God has allowed and enabled even unbelievers to discover some insights into how He made us, and to devise ways of re-training our thoughts so that we are re-made into His image. They misuse it badly at times, of course, but I just wish more Christians would be as thoughtful and skillful in using these insights as unbelievers often are.

Firing and wiring
The behind-the-scenes science of it is that we create electrical and chemical pathways in our brains with our thoughts. As we think our way down these pathways, we strengthen the brain connections. As somebody put it, “cells that fire together, wire together.” The more we travel these mental paths, the faster and easier these paths become, so that eventually our thoughts and resultant action feels automatic. Think of learning to ride your bike.

But what happens if we think the wrong thoughts often enough? That’s right, we end up creating bad pathways that become our default thinking patterns, damaging the way we feel and our daily behavior. Not good! And not easy to get out of these deep and repetitive ruts.

If our thoughts are fixated on spiritual matters like God, sin, and guilt, paralyzing and debilitating us, then usually scriptural truth can transform us over time by renewing our minds.

But what if our thought habits are on everyday matters like being obsessed with cleaning door handles, or irrational fears about our health, or phobias about open spaces? What if we’ve got into any number of negative thought patterns about our children, our ability to cope, our work situation, etc? That’s where CBT can be so helpful. (Yes, with Scripture, prayer, fellowship, etc. too).

Stop it!
Any number of people can tell you, “Stop thinking that!” You can order yourself, “Stop thinking that!” You can try to memorize Scripture even. But the thought pattern is so deep, so habitual that you need extra help (e.g. CBT) to challenge it and change it.

Few people can eradicate irrational anxiety by reading Romans. Instead, we need help to figure out, “Why am I thinking, feeling, and acting like this?” And then we need the tools to challenge the lies and imbalance in these thoughts until we change the way we think, feel, and do.

There’s nothing spooky or even complicated about it. I’ve seen many depressed and anxious people crack deeply ingrained and damaging thought patterns just using this CBT book, I’m not supposed to feel like this (written by three Christians). Where I know there is a motivated Christian friend in the depressed person’s life, I usually recommend that they sit down every day or so with this book and work their way through the exercises. It’s usually not long before they start seeing a change in their thinking, and then their feeling and acting too.

Tomorrow, I’ll give an example of how CBT works in an individual case, and in the meantime have a look at this video.

Is CBT of the devil? The devil can misuse it, for sure. But I view CBT as a gift of God to suffering humanity. If more Christians would open their minds to learn from it and practice it skillfully, there would be far less depressed Christians running to ungodly counsel, and there would be far less depressed Christians continuing in their suffering.

  • http://bibchr.blogspot.com Dan Phillips

    Interesting. I agree; the methodology of CBT is eminently usable by Biblically faithful Christians. The verse I’d've cited would be (no surprise) from Proverbs: 4:23. What God says TO do there, CBT provides tools for accomplishing.

    However, like all approaches not mined directly from the Bible, it’s fatally limited. It turns me to myself and my thoughts, and helps me objectify and analyze them. But it doesn’t provide me with an objective and sure standard by which to do so. Only the Bible does that.

    Even more, the whole matter of turning inward to help myself has to be a first and temporary help. The real help comes from turning outward, in love of God and man. The future isn’t a rational inward bent; but often it’s the troubled thinking that’s making the right orientation hard. CBT can help there. But it’s not the cure.

    Agree, disagree?

    • http://headhearthand.org/blog/ David Murray

      Agree, CBT is limited. Agree, we need God’s blessing and help for CBT or any intervention to work. Agree, CBT is a help but not a full cure. I believe the methodology is biblical along the lines of Psalm 42, 73, 77.

  • Al

    This dialogue is good. When I read Bob’s article I thought about therapy for any other part of our body. No one would object to a non-Christian physiotherapist after a broken leg or non-Christian speech therapist for a child who was having troubles forming words…why then can we not use any “secular” therapy for the mind. The book, recommended here a while ago, “The Brain that Changes Itself” was so fascinating! I get leery of the testimonies a-la “I tried medicine, but when I finally confessed my sins I got better.” That casts a LARGE shadow, and is partly responsible for the shame culture related to troubles with anxiety/depression etc in the Christian community.

    • http://rpmministries.org Bob Kellemen

      Al,

      Thanks for interacting with both our posts. Here’s my brief response to your question that compares a broken leg and seeing a non-Christian MD and a broken heart/mind/soul and seeing a non-Christian CBT (that was the context of my original post).

      I believe it is totally different. My broken arm does not have a heart, mind, soul, will, affections, longings, mood states, purposes, mindsets, etc. A person struggling with depression, just like every person, does have a heart, mind, soul, will, affections, longings, mood states, purposes, and mindsets. If the goal of cognitive-behavioral therapy is to help us to change our worldview, our mindsets, and if at the core we are worshiping beings with either foolish or wise mindsets, then I do not want to send my depressed Christian friend is to a non-Christ, non-Jesus, non-gospel, non-grace, unregenerate therapist. That was what I stated in my response to David’s recommendation that a depressed Christian go to a non-Christian cognitive-behavioral therapist.

      And, even with a Christian CBT, I believe that comprehensive biblical counseling offers so much more than CBT, so, why go to a counselor who offers a piece of what is needed, when you could go to a counselor who can deal not only with behavior and cognition, but also with emotions, volition, mindsets, affections, our spiritual dimension, our social relationships, etc. And, if one says, “The CBT would do that,” then I would say, “then they are not practicing CBT, but something that is much more comprehensive than CBT.

      Bob

  • http://rpmministries.org Bob Kellemen

    David,

    I would encourage your readers to read my post where I interacted with your recommendation of a non-Christian cognitive-behavioral therapist. In that post, I expressed two concerns:

    1.) That a Christian practicing CBT would not be practicing comprehensive counseling. Rather, I recommended a more comprehensive biblical counseling approach that includes behaviors and beliefs, but does so much more: it explores biblically matters of the soul, of the heart, of our relationship to Christ, of our emotions, of our social situation, etc.. I went to great lengths to note that your overall approach was toward comprehensive care, but that I thought your recommendation of CBT was an approach that was far less comprehensive than a biblical counseling approach.

    2.) More importantly, I said that CBT practiced by a non-Christian, by definition, would be a worldview conflict. I noted your fine book, Jesus on Every Page, and then noted that a non-Christian therapist could not, by definition, offer a Jesus-focused worldview to Christians struggling with depression.

    You wonder out loud in this post if concerns about non-Christian cognitive-behavioral counseling is akin to saying you don’t take your car to a non-Christian mechanic. I believe it is totally different. My car does not have a heart, mind, soul, will, affections, longings, mood states, purposes, mindsets, etc. A person struggling with depression, just like every person, does have a heart, mind, soul, will, affections, longings, mood states, purposes, and mindsets. If the goal of cognitive-behavioral therapy is to help us to change our worldview, our mindsets, and if at the core we are worshiping beings with either foolish or wise mindsets, then I do not want to send my depressed Christian friend is to a non-Christ, non-Jesus, non-gospel, non-grace, unregenerate therapist. That was what I clearly stated in my response to your recommendation that a depressed Christian go to a non-Christian cognitive-behavioral therapist.

    In Christ’s Grace,

    Bob

    • http://veritaemedicinae.blogspot.com/2014/01/depressed-about-taking-antidepressants.html Chris

      Bob,

      I think David is arguing that CBT is a tool not a worldview. The therapist prods thinking and motivates change in behavior according to the client’s goals.

      Chris

      • http://rpmministries.org Bob Kellemen

        Chris, Thanks. I believe that CBT, in particular as practiced by a non-regenerate counselor, is much more than a tool. When trying to help someone “re-wire” (renew) their mindsets, worldview about what is foolish thinking and what is wise thinking must come into play. There really is no such thing, in my thinking, as counseling that is only tool-oriented or technique-oriented. Counseling is soul-to-soul, and worldview-to-worldview connecting. Note that my emphasis, as in my original post, is on the unregenerate practice of CBT. Bob

        • http://veritaemedicinae.blogspot.com/2014/01/depressed-about-taking-antidepressants.html Chris

          Thanks Bob.

          I know where you are coming from, but I do believe it is possible to peel away what is good and leave what is bad.

          While I am not a certified counselor, one of my responsibilities as a clinician caring for people at end of life was to help them work through thoughts, moods, feelings, and emotions associated with death and dying. To this end, the agency taught me how to use CBT because it is objective (that is it removes the counselor from imposing his or her beliefs) and it has proven empirical effectiveness. Here were some of the things I was taught: how to teach people to talk to themselves or journal, relaxation techniques such as deep breathing, how to listen to one’s body, rational thinking skills to analyze thinking, and goal setting. The other part was encouraging them to apply the positive thoughts they came up as adaptive behaviors. CBT makes it very hard to impose beliefs on people because you are not telling them what to believe; rather, one is guiding them according to their own “positive” beliefs (a disastrous recipe for non-Christians but an excellent therapeutic model of Christians). Restructuring thinking has to do with addressing maladaptive thinking, which has more to do with underlying motivations and not worldview.

          Freud does a better job than most of the theologians I know at describing the utter self-serving motivations that drive people (i.e., human depravity), but he builds his understanding on survival of the fittest, an evolutionary worldview. Nevertheless, his work on underlying motivations is still excellent; there is a lot for Christians to learn from him in his area, while throwing away all the other garbage he taught. I do not think many Christians truly appreciate how utterly depraved they really are—what is really pulling our heartstrings? Freud has a convicting answer.

          Brother this is a much overdue dialogue, thank you for the opportunity.

          Chris

    • Corey

      I agree Bob, that CBT without Christ Being Truth (ha, see what I did there) is actually dangerous. With no grounding in what our cognitions are or should be, we trade one lie for another. CBT also often focuses only on “positive” or happy truths. Many of the truths we need to face as Christians are not so happy, such as our sinfulness. To embrace the full Gospel, we need to understand the bad and the good.
      I do think that most counselors (even all counselors) practice a variety of approaches. Someone who is only CBT but ignores the client’s physical condition would certainly fail in the long run if the client had a disease contributing to the problems. I don’t think any Christian counselor would ever be 100% CBT either. So while it’s valid to say a Christian doing only CBT would be incomplete, I am not sure there are too many of those out there.
      Great thoughts though, I have enjoyed reading this discussion.

      • http://veritaemedicinae.blogspot.com/2014/01/depressed-about-taking-antidepressants.html Chris

        You wrote:
        “Someone who is only CBT but ignores the client’s physical condition would certainly fail in the long run if the client had a disease contributing to the problems.”

        Corey,

        You are right, but you are also making an assumption that challenges the biblical view of body-soul unity. While it is true that some bodily diseases will contribute to psychological problems, it is equally true that psychological problems may be purely psychological (see Psa. 42:1). I wish things were more clear cut, but we the reality is we really do not know the exact etiology of most the psychological problems. For a psychiatrist, neurologist, or medical doctor treating the body empirically it matters, but for biblical counselors not really. Our goal is to apply the means of grace wisely with discernment and prayer regardless of etiology.

        Chris

  • http://veritaemedicinae.blogspot.com/2014/01/depressed-about-taking-antidepressants.html Chris

    Love the title!

    CBT is simply another way of saying, put off the old man (behavior), renew the mind (cognition), and put on the new man (behavior)(Eph. 4:22-24). The theological term for this type of “therapy” is sanctification for the Christian. For the unbeliever, moral or virtuous improvement. See my article: http://veritaemedicinae.blogspot.com/2014/01/psychology-friend-or-foe.html

    This pitting of psychology against the Bible is misguided. People who do so would benefit from an overview course on the history of psychology (like this one: http://www.thegreatcourses.com/tgc/courses/course_detail.aspx?cid=660).

    While I agree with your analysis of CBT, as Christians we need to be careful not be become reductive materialists (i.e., assume all psychopathology is reducible to neurological processes) or adopt a radical functional psychology (i.e., make rigid distinctions between heart, mind, spirit, emotions, etc.). I don’t see you as doing this, but in a desire to find etiology we can make presumptions that may not be accurate and end up hurting the people we care for.

  • marika
  • Pingback: Can an Unregenerate Cognitive-Behavioral Therapist Be Christ-Centered?

  • http://www.theexpatcounsellors.com/ cognitive behavioral therapy for depression

    Hi,
    cognitive behavioral therapy for depression is help full to renew the mind of person and also change the behavior of person so it is good sign for old person. http://www.theexpatcounsellors.com/.

    thanks

  • Pingback: Today in Blogworld 01.29.14 - Borrowed Light