Is Lifelong Therapy Necessary? CBT Has Other Ideas

If you’ve ever sought therapy, you might have wondered: Is this effective—and why does it seem to take so long?

For many individuals, therapy can extend over several years. While this can be essential in some cases, it may also indicate that the therapeutic approach lacks the necessary tools for genuine transformation.

Greg Lukianoff, a lawyer and advocate for free speech, faced a similar struggle. After battling clinical depression and experiencing a suicidal crisis in 2007, he turned to cognitive behavioral therapy (CBT) in 2008. Unlike traditional therapy, CBT focuses on actionable tools to identify and modify unhelpful thought patterns.

“Most individuals seek CBT for anxiety, depression, eating disorders, or ADHD [attention-deficit/hyperactivity disorder],” noted clinical psychologist Terri Bacow in an email to The Epoch Times. “Others aim to enhance relationships, bolster self-esteem, or navigate significant life transitions.”

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The initial step in CBT is to recognize the thinking patterns that influence our emotions and behaviors, explained clinical psychologist Lauren O’Flaherty. One individual might see a black cat and think, “Bad luck—I should stay inside.” Another might smile at the same cat, recalling a childhood pet.

Emotions follow the narratives we create. “Each individual will respond differently based on the story they tell themselves,” she added.

CBT aids individuals in identifying and altering common cognitive pitfalls—such as catastrophizing (focusing on worst-case scenarios), mind reading (believing others harbor negative thoughts about you), all-or-nothing thinking (viewing situations in extremes), overgeneralization (drawing broad conclusions from a single incident), and rigid internal rules that exacerbate guilt or frustration.

CBT therapists identify these irrational patterns—like “shoulds,” “musts,” and inflexible expectations, according to clinical psychologist Mike Abrams. “They help the client recognize that it’s not solely the situation causing distress—it’s their interpretation of it.”

Once you learn to identify these thinking traps, the next step is to gently challenge them and experiment with new, more balanced perspectives.

From Thought Patterns to Real-Life Changes

Consider a father who sought therapy due to his temper creating strain at home. When his children misbehaved, he didn’t just see spilled milk or toys on the floor—he perceived failure. “I’m a bad parent,” he told himself. Guilt morphed into frustration, leading to outbursts—and subsequent guilt.

In CBT, O’Flaherty guided him to pause and scrutinize those automatic thoughts. Were they accurate? Were they fair? Was he jumping to conclusions?

The father practiced disputing those reactions, and the cycle began to change. He stopped interpreting every tantrum as evidence of his failure as a dad and started responding with increased patience.

However, none of this can transpire without trust.

“Even in the most structured CBT sessions, everything hinges on the therapeutic alliance,” Abrams remarked. “You must convey that you’re listening. That you accept the individual—even if you don’t condone every behavior. This relationship is vital for the work to take place.”

Breaking Free From the Inner Critic

CBT can also help silence the inner critic—that voice insisting you’re not sufficient.

O’Flaherty recalls a young professional who fell into self-loathing each time she made a mistake at work: “I’m pointless. I should just quit,” she would think.

“When we’re depressed, we wear the opposite of rose-colored glasses, viewing most things negatively,” O’Flaherty said. Together, they labeled her cognitive pitfalls—generalization and jumping to conclusions—and began reframing them.

With practice, her thoughts evolved: “I made a mistake, but I am committed to doing well. I’m human—and I’m learning.” Her depression diminished, and her confidence returned.

This process may begin with a 10-minute walk, bringing movement, sunlight, and a feeling of accomplishment. One small action leads to another.

Anxiety typically follows a predictable cycle, explained Bacow, who authored the guided journal “Goodbye, Anxiety” after working with numerous anxious clients.

It often begins with a triggering thought: “What if I embarrass myself?” This incites a wave of emotions—panic, dread, tension. To cope, individuals tend to avoid the situation entirely or rely on “safety behaviors,” such as seeking constant reassurance or planning exit strategies.

The downside? Avoidance yields short-term relief but reinforces anxiety in the long run. “You don’t allow yourself the opportunity to disprove your concerns,” Bacow noted.

To tackle anxiety, Bacow employs a gradual strategy called a fear ladder—starting with low-stakes exposure and escalating from there.

Take for example a woman grappling with social anxiety—she’s skipping parties, dodging phone calls, and dreading work events. Instead of plunging into high-stakes scenarios, Bacow encourages starting small.

The initial step could be greeting a coworker. Then, she might call a friend instead of texting. Ultimately, she could present at work.

At each step, the CBT method addresses the beliefs underpinning the fear: “No one likes me. I’ll say something foolish.” Over time, she replaces these with more realistic perspectives: “Some people appreciate me. Everyone makes awkward comments sometimes.”

With practice, her anxiety’s grip loosens—not just in social contexts, but in her self-perception.

From Panic to Peace: When Fear Feels Physical

Not all anxiety manifests socially. Sometimes, it emerges as panic attacks—unpredictable surges of intense fear.

This can occur with someone who begins experiencing panic post-exercise—or seemingly without reason. Their heart races, their chest tightens, and they feel dizzy, triggering catastrophic thoughts: “What if I’m dying? What if I faint?”

Treatment commences with educating the individual about panic—how the brain misinterprets normal physical sensations as threats.

Once the individual acknowledges the connection between physical feelings, catastrophic thoughts, and escalating anxiety, they can begin altering their response. Instead of perceiving something as drastically wrong, they learn to reassure themselves: “This is anxiety—and it cannot harm me.”

Subsequent exposure involves reintroducing the activities that incited fear. If the fear relates to exercise, it may start with a light jog, followed by a more challenging hike. Gradually, each success consolidates the evidence: “I’m safe. I can manage this.”

Over eight to twelve sessions, panic attacks may diminish. More crucially, the fear of fear starts to dissipate. Because the objective isn’t to eradicate anxiety, but to alter one’s relationship with it.

When CBT Isn’t Enough

CBT is not designed to create dependency on a therapist. Its essence lies in fostering autonomy—equipping individuals with tools they can utilize independently after therapy.

“In my experience, significant results are often visible in just three sessions,” O’Flaherty remarked.

“In every other healthcare field, there are standards and metrics. Psychology and psychotherapy remain unique in that area,” Abrams pointed out. “However, we possess evidence for what works. If an individual isn’t improving, we ought to modify the approach.”

Nevertheless, not every case fits neatly into that paradigm. “Some individuals require longer-term support,” Abrams stated, citing conditions such as schizophrenia, severe autism spectrum disorders, or entrenched personality disorders. In such instances, ongoing assistance may be essential alongside specific therapeutic methods or life coaching.

The Balanced View

Some derive benefits from a blended approach. For those navigating intricate conditions—like bipolar disorder or entrenched personality patterns—CBT may form just a part of a broader toolkit, incorporated with medication, lifestyle adjustments, or prolonged relational therapy.

“I frequently embed CBT principles into therapy irrespective of the client’s concerns,” Bacow remarked.

Even regarding more common issues such as anxiety or depression, context is vital. An individual dealing with chronic trauma, grief, or burnout might need a gentler pace, additional flexibility, or more emotional space than traditional CBT’s structure usually accommodates.

‌CBT is grounded in more than technique; it’s woven into a philosophy that has persisted for ages. As Abrams noted, those foundational principles resonate with much older philosophical ideas: stoicism. Ancient philosophers like Epictetus and Marcus Aurelius posited that suffering arises not from events themselves, but from our interpretations of them—a notion that continues to inform CBT’s framework for emotional resilience today.

Try It Yourself

Engaging in CBT doesn’t require a therapist’s office. One of its core strategies, cognitive restructuring, can be practiced anywhere—with a journal, just a few minutes, and the willingness to engage in self-reflection. Numerous digital tools and applications also guide you through the fundamentals—helping track moods, identify unhelpful thoughts, and shift perspectives in real-time.

“Amid life’s inevitable challenges lies the potential for meaning, contribution, and impact—not just for oneself, but for others,” Abrams concluded, highlighting a profound aspect of CBT—one that transcends mere symptom relief.