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Cognitive Behavioral Therapy
Should Therapy Change What We Believe? Can It?
Cognitive therapies and the ethics of belief.
Posted August 17, 2021 Reviewed by Jessica Schrader
Key points
- A core idea of cognitive behavioral therapy is that beliefs are often the grounds of mental disorders, and one aim of therapy is to change them.
- CBT as traditionally practiced may seem to conflict with doxastic involuntarism, but there are multiple ways of responding to this conflict.
- Another goal of therapy may be to help a client make new beliefs possible, even when they are not quite justified.
Cognitive behavioral therapy (CBT) is perhaps the most widely adopted form of psychotherapy today, applied to depression, anxiety, psychosis, pain, sleep, and much else. I want to raise a question about its philosophical foundations, one that arises from reflecting on an old philosophical argument.
The argument, due to Pascal, goes like this. It is better to believe in God than not. If you believe and you're right, that will be very good for you (at least according to certain traditional doctrines). But if you believe and you're wrong, it doesn't much matter. On the other hand, if you disbelieve and you're wrong, that will be very bad for you (at least according to certain traditional doctrines). If you disbelieve and you're right, it doesn't much matter. So, on balance, you really ought to believe.
A common response to this argument is the following. This is an argument that it would be better for us to have certain beliefs, but we don’t get to choose our beliefs, even when those beliefs would be better for us. So the argument doesn’t—indeed, can’t—achieve what it aims to achieve. This position sometimes goes under the heading doxastic involuntarism, which is simply an elaborate name for the view that our beliefs aren’t under our voluntary control.
This concern about Pascal’s argument feels highly relevant to the practice of cognitive behavioral therapy. A core idea of CBT is that beliefs are often the grounds of mental disorders, and that one aim of therapy is to change or “restructure” these beliefs. For example, people who are depressed may be prone to believe that no one likes them. A goal of a CBT therapist, working with a depressed client, might be to help the client to change such beliefs.
But at first glance, CBT as traditionally practiced seems to conflict with doxastic involuntarism. If we cannot change our beliefs, then how can the goal of therapy be to get us to change them?
There are three ways of responding to this conflict, with each of them promising a clinical as well as a philosophical way forward.
First, the therapist might focus on the aspect of CBT that we might call evidential CBT. On this approach, the therapist adduces evidence against the client’s belief. For example, if a client believes that no one likes her, a therapist might point out people in her life that do like her. Alternatively, a therapist might point out that her belief is produced by a cognitive distortion—such as “all-or-nothing thinking”—and that it, therefore, may not be tracking the evidence.
Second, the therapist might focus on the behaviors in CBT—the ‘B’ in cognitive behavioral therapy. A common response to Pascal’s argument is that, even if it’s not a good argument for believing in God, it may be a good argument for going to church—after all, if you go to church, you’re more likely to end up believing. So the CBT therapist might focus on behaviors that tend to change beliefs. For example, someone who believes that no one likes her might be encouraged to ask for feedback from her friends and family—or even to list and reflect on the features that make her like herself.
Third, the therapist might turn to a version of CBT that does not depend so centrally on cognitive restructuring. Specifically, acceptance and commitment therapy (ACT) is a development of CBT that gives central attention to accepting maladaptive thoughts, rather than attempting to change them. ACT then does not face the conflict for CBT that arises from the fixity of belief.
There is also another response, which rejects the alleged conflict altogether. The advocate of CBT may simply deny the psychological necessity alleged by the doxastic involuntarist. Perhaps we can, to some degree, choose our beliefs after all. William James held, in "The Will to Believe," that this was the case with moral beliefs: “If your heart does not want a world of moral reality, your head will assuredly never make you believe in one.” So too, he held, for questions “concerning personal relations”:
“Do you like me or not?—for example. Whether you do or not depends, in countless instances, on whether I meet you half-way, am willing to assume that you must like me, and show you trust and expectation. The previous faith on my part in your liking's existence is in such cases what makes your liking come. ... Who gains promotions, boons, appointments, but the man in whose life they are seen to play the part of live hypotheses, who discounts them, sacrifices other things for their sake before they have come, and takes risks for them in advance? His faith acts on the powers above him as a claim, and creates its own verification.”
This is a bolder response to the doxastic involuntarist, and it is a picture on which something like Pascal’s argument might in fact move us, and on which we arrive at a different vision of CBT and its relationship to belief.
Perhaps the end of CBT is not only to correct cognitive distortions and to stubbornly stick to the evidence. Another end of CBT, and of therapy generally, is to make room for the client to outrun the evidence, to boldly believe something that she does not quite know, and so to find a way out of the cognitive traps that characterize so many mental disorders. If that is right, then one aim of therapy is not simply to restructure our beliefs, or to accept them, but to make altogether new beliefs possible, even when they are not quite justified.
