Myths About Cognitive Behavioral Therapy for Medical Illness

Just because CBT works for medical illness does not mean it’s all in their head.

Reviewed by Michelle Quirk

Key points

• CBT can help improve quality of life for people with chronic medical conditions.
• Whether or not CBT helps improve quality of life does not mean a condition is psychosomatic.
• The notion of "psychosomatic" relies on a problematic mind-body dualism.

One of the most frustrating myths for me is about cognitive behavioral therapy or CBT for medical illness. A distressing part about these myths is that they are often perpetuated by people in authority like physicians and scientists. It’s important to note that while physicians and some scientists might have great knowledge and experience in their area of expertise, CBT and especially psychological and behavioral treatments are not within that expertise. Instead, psychologists who specialize in the treatment of people with medical conditions are the ones with that expertise.

The most damaging myth is that if CBT or another psychological treatment improves symptoms for a medical condition, that means the medical condition is psychosomatic. Psychosomatic means that physical symptoms and diseases are caused by psychological states like anxiety and depression. Sometimes this myth expands into behaviors, which are what people do. For example, one myth is that fatigue results from patients not being active when, in reality, patients are often less active and conserve energy due to fatigue.

Causal and Maintaining Factors

There are many problems with this myth. First, just because a treatment works for a condition does not mean the treatment’s target caused the physical illness. Most chronic illnesses have what are called causal and maintaining factors. Causal factors are what they sound like—they caused the disease, like smoking for lung cancer. Maintaining factors, as the name implies, keep the illness and symptoms going. Most psychological and behavioral factors targeted by CBT are maintaining factors. So CBT can help address psychological and behavioral changes to improve quality of life for people with medical illness but does not necessarily address the underlying causes.

Another problem with this myth is how much it damages patients. I’ve often heard healthcare providers say, “It’s stress” (psychological factor), “You are eating too much sugar” (behavioral factor), and “You are not listening and are not understanding my instructions” (behavioral factor). These statements are traumatic and invalidating for the patients who hear them and incorrectly blame themselves for their suffering. When healthcare providers believe the myth that CBT working for a condition means it is psychosomatic, it leaks out into their behavior through comments attributing the patient’s medical illness to poor stress management and behavioral choices.

Mind-Body Dualism

Another problem with this myth is that it is based on a flawed premise called mind-body dualism. Mind-body dualism is an old philosophy, originally from Ancient Greek philosophers and popularized by René Descartes, which says the mind and the body are two distinct substances, with the mind essentially hovering over the body. Subsequent research from neuroscience and psychology has shown this dualism to be false. Everything psychological is physiological and our physiological states have the ability to affect our psychological function. Brain scan research has shown that all psychological processes are just another, albeit very powerful, form of a physiological process. The idea that some illnesses are psychosomatic relies on mind-body dualism.

The result of this myth and healthcare providers believing it is that patients do not get a potentially helpful treatment and their quality of life suffers. Patients with medical conditions might resist CBT especially if their provider refuses to look for a physiological cause or treatment and instead just pushes CBT alone. It can also lead to patients erroneously believing they caused their illness through negative thoughts and unhealthy behaviors. These beliefs can lead to guilt and actually make their medical condition worse.

The correct belief about CBT for medical conditions like cancer and heart disease is that it is a powerful adjunct to traditional medical treatments. CBT can help a patient improve their sleep, diet, and exercise, thereby helping their physical health. It can also focus on better stress management so that stress doesn’t worsen their medical condition or interfere with sleep, diet, and exercise. When the myths about CBT for medical conditions is challenged and replaced with reality-based beliefs, patients will benefit.