The Great CBT Experiment: How We Turned Mental Health Into a Production Line

Right, let's gut this sacred cow properly.

Here's what's actually happening in the therapy world that nobody wants to say out loud: CBT has become the McDonald's of mental health - efficient, standardised, and completely missing the point of why people are actually suffering.

The CBT Con Job

CBT sells itself as evidence-based, which is therapy-speak for "we can measure it, therefore it must work." It's brilliant marketing for a profession desperate to be taken seriously by people who think feelings are just faulty programming.

The whole model treats your mind like a broken computer that just needs better software. Negative thought? Replace it with a positive one. Catastrophising? Here's a worksheet to logic your way out of it. Having a panic attack? Just breathe differently, you silly goose.

CBT basically promises you can turn off depression like a light switch - just flip your thoughts from negative to positive and Bob's your uncle. It's therapy for people who want to feel better without actually having to feel anything.

The Inconvenient Numbers

Since 2008, the NHS has spent billions rolling out CBT through IAPT (Improving Access to Psychological Therapies, now called NHS Talking Therapies). The programme now treats over a million patients in the UK each year and has been hailed as a "world beating standard."

But here's the inconvenient truth that nobody wants to talk about: the prevalence of common mental health disorders has increased progressively among the UK population, from 17.6% in 2007, 18.9% in 2014, to 22.6% in 2023/4.

Read that again. Mental health has gotten progressively worse during the CBT revolution.

We're now treating more people than ever before with "evidence-based" therapy, yet in 2023, one in five children and young people aged eight to 25 had a probable mental health condition. This number has been rising since 2017. The prevalence of common mental disorders amongst adults aged 16-64 had risen from 17.6% in 2007 to 22.6% in 2023/4.

Meanwhile, waiting lists have become a joke - average waiting time for mental health treatment is 45 days with some people waiting over 18 months. 78,577 young people were waiting over a year for mental health treatment from the NHS in 2023/24, with 44% waiting over two years.

The CBT Success Story That Isn't

IAPT loves to trumpet its recovery rates - about 50% of people who complete treatment "recover." But let's look at what that actually means:

60% of all referrals in 2017–18 did not complete treatment. So before we even get to those recovery statistics, we've lost more than half the people who walked through the door.

Of those who do complete treatment, the "recovery" means their scores on depression and anxiety questionnaires drop below a certain threshold - just enough to be considered fit for work again. It doesn't mean they're thriving, it doesn't mean their problems are solved, it means they can tick boxes differently on a form and get back to work.

What CBT Actually Does

CBT doesn't heal trauma - it teaches you to manage symptoms. It's the emotional equivalent of taking paracetamol for a broken leg. Sure, the pain lessens, but you're still hobbling around wondering why nothing feels quite right.

The dirty secret? CBT works brilliantly for insurance companies and NHS commissioners because it's quick, cheap, and produces measurable outcomes. Six sessions, standardised protocols, tick-box recovery. Mental health efficiency at its finest.

But here's what they don't track: how many people leave CBT feeling like they've failed because they couldn't think their way out of their pain. How many learn to perform wellness whilst their actual emotional life remains completely untouched.

The Psychodynamic Truth

Psychodynamic therapy starts from a radically different premise: you're not broken, you're making perfect sense. Your symptoms aren't bugs to be fixed - they're features developed for very good reasons that you've probably forgotten.

Instead of replacing thoughts, we get curious about why your mind goes where it goes. Instead of changing behaviours, we explore what those behaviours are protecting you from feeling.

It's messy, unpredictable, and completely resistant to being measured in neat little boxes. You can't standardise the process of helping someone understand why they keep choosing partners who abandon them, or why they sabotage every good thing in their life.

The Real Question

If CBT is so bloody effective, why are we collectively more mentally unwell than before it took over the NHS?

The uncomfortable answer is that CBT treats symptoms, not causes. It's brilliant at teaching people to manage their anxiety and depression, but it does nothing to address why an entire generation is struggling in the first place.

The economic case for IAPT was literally sold as paying for itself through reduced welfare costs and increased tax revenues from people returning to work. As economist Richard Layard put it: "The cost of treating psychological therapy is, if you take all conditions from the mildest to the most severe, a one-off cost of £650. The cost to the treasury of having somebody on disability benefits because of mental illness is £650 every single month". The whole system was designed to get people off benefits and back to work.

What We're Actually Doing

CBT has become the mental health equivalent of teaching people to smile while their house burns down. Yes, they'll feel better in the short term. Yes, their questionnaire scores will improve. But their house is still on fire.

Psychodynamic therapy asks a different question entirely: why does your house keep catching fire? What keeps drawing you to combustible situations? What is it about fire that feels familiar?

The Real Difference

CBT asks: "How can we fix this problem?" Psychodynamic asks: "What is this problem trying to tell us?"

CBT treats symptoms. Psychodynamic treats people.

CBT wants you to feel better. Psychodynamic wants you to feel real.

The Inconvenient Truth

The real reason mental health services love CBT isn't because it works better - it's because it's cheaper, faster, and easier to measure. You can train someone to deliver CBT in a year. You can standardise the protocols. You can tick boxes and hit targets.

But you can't standardise the human condition. You can't protocol your way out of generational trauma. You can't worksheets your way through why you keep recreating the same relational disasters.

Here's the question nobody wants to ask: if CBT really works the way it claims, why don't CBT therapists seek CBT for their own therapy? They know all the techniques, all the cognitive distortions to spot, all the thought patterns to change. If changing your thinking was really the path to lasting psychological change, these people would be the most mentally healthy humans on the planet.

But somehow I doubt many CBT therapists are saying to their personal therapists: "Right, just give me 6 sessions of cognitive restructuring and I'll be sorted, thanks."

I know CBT therapists who, when their own lives fell apart, didn't book themselves in for 12 sessions of cognitive restructuring. They went looking for something deeper. Because when your own patterns are destroying your relationships or your own anxiety is keeping you awake at night, you don't want someone to hand you a thought record - you want to understand why this keeps happening to you.

The Bottom Line

We've built the most extensive mental health system in our history, treated more people than ever before with "evidence-based" therapy, and mental health has gotten steadily worse.

That's not a failure of implementation. That's the system working exactly as designed - keeping people functional enough to work, but not well enough to question why they keep ending up in the same patterns.

CBT teaches you to think differently about your problems. Psychodynamic therapy helps you understand why you keep creating the same problems in the first place.

One produces better questionnaire scores. The other produces people who actually know themselves.

The question isn't which therapy is better. The question is: do you want to learn to manage your life, or do you want to actually live it?