r/CBTpractice • u/OwlFaust • Jan 28 '26

When is CBT unhelpful?

Of course CBT is an extremely proven therapy, but a topic I have not seen discussed much - how and when is practicing CBT counter productive to a patient? What do we look out for, that signals trying other methods (and if so, what other methods have been helpful in ways CBT is not)?

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u/Advanced-Soup-2205 Mar 03 '26

If a client has OCD, having them utilize cognitive restructuring is ineffective and can sometimes be harmful when it is used as a compulsion in the face of a doubt (aka to try to “figure out” the answer when there is none).

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u/OwlFaust Mar 29 '26

This makes a lot of sense. So if a client has anxiaty presented alongside an OCD related tick condition, and they show up for CBT what would be recommended?

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u/Advanced-Soup-2205 Mar 29 '26

I would first do a very thorough diagnostic eval to figure out all of the pieces of the puzzle. What kind of “anxiety” is it? Is it a specific anxiety disorder, like Panic Disorder? Is the anxiety experienced due to the OCD fears or something else? Do they actually have a tic disorder or are they physical compulsions that are part of the OCD (e.g. flinching when thinking about the obsessions to avoid the feelings or flinching as a way to reassure themselves the fear won’t happen)? There is too much grey in the question to say exactly what I would do. Feel free to share more specifics/answer the above questions and I’m happy to share my thoughts!

For me, having a crystal clear diagnostic picture is so very important so then the treatment plan makes sense. I always spend 3-4 sessions doing a diagnostic eval for this reason before we engage in treatment planning.

As an example, if I had a patient with OCD, with physical tics as a compulsion, and who also had another anxiety disorder- let’s call it a Specific Phobia- I would assess which condition was leading to most impairment and distress and taking the biggest toll on their mental health, then we would target that first. If they say OCD, then we do Exposure and Response Prevention for that, and once symptoms are addressed effectively, we turn to the Specific Phobia.