Cognitive Behavioral Therapy Is Not Just Positive Thinking

I have been a cognitive behavioral therapist for 14 years and have found this approach to be a powerful tool to address anxiety and depression. However, there are many myths or misconceptions about cognitive behavioral therapy, including among mental health professionals. One of the most common and understandable misconceptions is that cognitive behavioral therapy is just positive thinking.

First, let’s break down the term cognitive behavioral therapy. This approach is actually two extensive types of therapy. The cognitive side addresses thoughts, perceptions, beliefs, and attitudes. The behavioral side focuses on actions or what people do. So, the myth about cognitive behavioral therapy focusing only on positive thinking is about the cognitive therapy side, not the behavioral part.

So, what is cognitive therapy, if not positive thinking? I usually explain that cognitive therapy is about more realistic thinking, not positive thinking. Our thoughts, beliefs, and attitudes are not simple two-category perceptions of the world. They are not either positive or negative but rather fall on a spectrum. I could have an extremely negative thought, such as ‘nothing is ever going to work out for me.’ I could have an overly positive thought such as ‘I am a fantastic person and will never fail.’ Or I could think something in the middle such as ‘I am good at some things, but not others or ‘I fail a lot, but that’s expected, and I learn something each time.’ So the goal of cognitive therapy is not to go from the overly negative to overly positive but rather to land somewhere in the middle, wherever is most reasonable or realistic given the situation.

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The tendency to stay away from positive thinking might seem counterintuitive. But there are several reasons for this. Perfectionism, thinking that everything has to be perfect, is associated with increased depression and anxiety and is not dissimilar from overly positive thinking or overly negative thinking. Trying to have an overly positive view of the world could actually make someone feel worse. Overly positive thinking is also effortless to refute. It does not take much time or trying before it becomes evident that having an excessively positive belief is unrealistic.

The goal with cognitive therapy is to make sure someone has an accurate assessment of the situation. Some situations are genuinely awful, and a negative belief about them makes sense. Some situations are truly good, so a positive thought is accurate. But if a situation is negative, it’s helpful to have an accurate assessment to address the problem. And if a situation is actually positive, it can be helpful to recognize that and enjoy the moment.