Challenges in Cognitive-Behavioral Therapy: Overcoming Barriers to Effective Treatment

Authors of the two most widely used texts on cognitive-behavioral therapy (CBT) hosted an interactive session on methods for difficult-to-treat patients today. With a focus on treatment-resistant depression and personality disorders, Jesse Wright, M.D., and Judith Beck, Ph.D., described how to address common problems that can undermine the therapy process and derail progress. Session attendees helped generate a list of treatment challenges that can vex clinicians and interacted with session leaders as they illustrated CBT strategies for managing these problems.

Some of the challenges that were discussed included core beliefs that interfere with engaging in treatment, such as “It won’t do any good, so why should I try?” and “Therapy is too hard for me.” Chronic behavioral problems of patients include procrastination, lack of stimulating and pleasurable daily activities, isolation from others, failure to complete “homework,” persistent anhedonia, and entrenched self-defeating behavior.

CBT has been shown to be effective for treatment-resistant depression and personality disorders, but clinicians may need to develop skills beyond basic CBT methods for maximum benefit in patients with these conditions, Wright said.

Jesse H. Wright, M.D., Ph.D., is the primary author of learning cognitive-behavior therapy: an illustrated guide and cognitive-behavior therapy for severe mental illness: an illustrated guide from American Psychiatric Publishing. APA members may purchase the books at a discount.