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CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science
Is CBT all it claims to be? The Cognitive Behavioural Managerialism, Politics, and the Corruptions of Science provides a powerful critique of CBT’s understanding of human suffering, as well as the apparent scientific basis underlying it. The book argues that CBT psychology has fetishized measurement to such a degree that it has come to believe that only the countable counts. It suggests that the so-called science of CBT is not just "bad science" but "corrupt science".
The rise of CBT has been fostered by neoliberalism and the phenomenon of New Public Management. The book not only critiques the science, psychology and philosophy of CBT, but also challenges the managerialist mentality and its hyper-rational understanding of "efficiency", both of which are commonplace in organizational life today. The book suggests that these are perverse forms of thought, which have been institutionalised by NICE and IAPT and used by them to generate narratives of CBT’s prowess. It claims that CBT is an exercise in symptom reduction which vastly exaggerates the degree to which symptoms are reduced, the durability of the improvement, as well as the numbers of people it helps.
Arguing that CBT is neither the cure nor the scientific treatment it claims to be, the book also serves as a broader cultural critique of the times we live in; a critique which draws on philosophy and politics, on economics and psychology, on sociology and history, and ultimately, on the idea of science itself. It will be of immense interest to psychotherapists, policymakers and those concerned about the excesses of managerialism.
The rise of CBT has been fostered by neoliberalism and the phenomenon of New Public Management. The book not only critiques the science, psychology and philosophy of CBT, but also challenges the managerialist mentality and its hyper-rational understanding of "efficiency", both of which are commonplace in organizational life today. The book suggests that these are perverse forms of thought, which have been institutionalised by NICE and IAPT and used by them to generate narratives of CBT’s prowess. It claims that CBT is an exercise in symptom reduction which vastly exaggerates the degree to which symptoms are reduced, the durability of the improvement, as well as the numbers of people it helps.
Arguing that CBT is neither the cure nor the scientific treatment it claims to be, the book also serves as a broader cultural critique of the times we live in; a critique which draws on philosophy and politics, on economics and psychology, on sociology and history, and ultimately, on the idea of science itself. It will be of immense interest to psychotherapists, policymakers and those concerned about the excesses of managerialism.
214 pages, Kindle Edition
Published September 25, 2018
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Displaying 1 - 7 of 7 reviews
June 27, 2019
Written by a physics graduate turned group analyst, this work which is a full onslaught on CBT and its claims deserves way more attention. The last couple of chapters on misrepresenting research and statistical spins (with solid examples) are very well written, worthy of inclusion in research textbooks. The history of CBT and its mechanisms are also easy to understand although one has to be cautious about taking the claims blindly. Otherwise, book spends too much time on the earlier chapter whining about managerialism, politics, and philosophy, which could have been skipped without detracting from the essence. It’s a short and smooth read otherwise, worth the time of every psychotherapist/counsellor.
Biggest downfall is that no alternatives or recommendations were offered aside from ‘be very very doubtful and skeptical of CBT research’.
Biggest downfall is that no alternatives or recommendations were offered aside from ‘be very very doubtful and skeptical of CBT research’.
December 8, 2020
Although interesting about the relationship between politics and psychological therapy, the books is overall a tendentious review of CBT. Opens with a few well-known caricatures of psychiatry (psychiatric diagnosis presumes a biological cause - not true - and all required for a diagnosis is ticking boxes on a checklist - not true, just read the DSM intro, come on) and CBT (changing cognitions to reflect "objective reality" will "cure" clients - not necessarily true, CBT is bedfellows with DSM and managerialists and rely on diagnostic categories - not true, more and more research on transdiagnostic categories and unpacking of active components). The section on IAPT and managerialism in psychological services is an interesting (and frightening) read. It highlights the influence of neoliberalist politics and managerialism and how bad their effects are. The review of psychological research makes some well-known points for those versed in the literature, but are important nonetheless. However, whether or not this is specific to CBT - I'm not so sure. It extends well beyond CBT research. The review of two studies of MBCT makes some important and good points - spin in abstracts is indeed way too common, the language used often implies more certainty than methodologies allow and too often researchers and journalists mix absolute and relative effects, but is also mired in biased language, and again, does not address whether this is specific to CBT. Beyond this the review was in my opinion interesting and in-depth, and added to my knowledge about the actual state of the evidence base. Too bad there was too little of this throughout the book.
Overall, the language is tendentious to the point of compromising the integrity of the book - categorically using the word "cognitivist(s)" about research, therapy and individuals, seemingly to imply ideology, is not really worthy of a serious academic book. I've rarely, if ever encountered the term anywhere else. The book contains several such cheap rhetorical devices (e.g., "the participants 'were put through' the MCBT programme"; "[the participants did not continue] - was this a rational choice … or were they simply disorganised, unmotivated, and therefore 'CBT-resistant'?"). Furthermore, despite lengthy reflections and claims about CBT, its politics and the corruptions of science, there is a dearth of references to actual research and meta-analyses, apart from claiming that it's all RCTs comparing CBT to wait-list and other passive controls (of course there is active control groups as well, there even is research appraising the amount of bias in the literature on both CBT and other modalities) and the two MCBT-studies. One paragraph in the conclusion is especially telling:
"If it is the case that these sorts of figures which we came across in the MBCT study, are representative of the CBT research base in general (that the efficacy is not 50 per cent but 25 per cent), then something much more worrying is going on. Then we would have to ask: is the whole CBT research base infected and corrupted by these kinds of statistical malpractices? The answer appears to be an unequivocal yes."
Come on - a brief search on EBSCO before writing up the last couple of paragraphs could've changed this passage from a cheap rhetorical device to an actual appraisal of the evidence, and even compared CBT to other modalities. I really looked forward to reading this book, as I was recommended it as part of a CBT training course. I find the themes of the book highly interesting and relevant to psychotherapy and politics (an integral part of psychotherapy) - the evidence base of the therapies promoted, the state of psychological science and its relationship to the political hegemony. Unfortunately, despite some glimpses of interesting facts and analyses, the book overall comes out as biased, full of hackneyed anti-psychiatry clichés and lacking of appraisal of the available evidence.
Overall, the language is tendentious to the point of compromising the integrity of the book - categorically using the word "cognitivist(s)" about research, therapy and individuals, seemingly to imply ideology, is not really worthy of a serious academic book. I've rarely, if ever encountered the term anywhere else. The book contains several such cheap rhetorical devices (e.g., "the participants 'were put through' the MCBT programme"; "[the participants did not continue] - was this a rational choice … or were they simply disorganised, unmotivated, and therefore 'CBT-resistant'?"). Furthermore, despite lengthy reflections and claims about CBT, its politics and the corruptions of science, there is a dearth of references to actual research and meta-analyses, apart from claiming that it's all RCTs comparing CBT to wait-list and other passive controls (of course there is active control groups as well, there even is research appraising the amount of bias in the literature on both CBT and other modalities) and the two MCBT-studies. One paragraph in the conclusion is especially telling:
"If it is the case that these sorts of figures which we came across in the MBCT study, are representative of the CBT research base in general (that the efficacy is not 50 per cent but 25 per cent), then something much more worrying is going on. Then we would have to ask: is the whole CBT research base infected and corrupted by these kinds of statistical malpractices? The answer appears to be an unequivocal yes."
Come on - a brief search on EBSCO before writing up the last couple of paragraphs could've changed this passage from a cheap rhetorical device to an actual appraisal of the evidence, and even compared CBT to other modalities. I really looked forward to reading this book, as I was recommended it as part of a CBT training course. I find the themes of the book highly interesting and relevant to psychotherapy and politics (an integral part of psychotherapy) - the evidence base of the therapies promoted, the state of psychological science and its relationship to the political hegemony. Unfortunately, despite some glimpses of interesting facts and analyses, the book overall comes out as biased, full of hackneyed anti-psychiatry clichés and lacking of appraisal of the available evidence.
May 31, 2019
I agree with some of the criticism of CBT in this book, but the book is filled with hackneyed and poorly-reasoned antipsychiatry cliches.
September 9, 2025
Wenngleich der Autor eine (vermutlich) sehr präzise Kritik am Gesundheitssystem in UK und der dort angebotenen Psychotherapie formuliert, ist seine grundlegende Kritik an der Verhaltenstherapie zu undifferenziert.
Bspw. kritisiert er die Psychoedukation in der Verhaltstherapie fälschlicherweise als eine Ausübung von Zwang. Später kritisiert er eine Studie zur achtsamkeitsbasierten Verhaltenstherapie dafür, dass die Autoren der Studie solche Studienteilnehmer nicht in ihren Ergebnissen berücksichtigt hätten, die die Behandlung am Anfang, also während der Psychoedukation, abgebrochen haben. Hier meint Dalal, dass es falsch sei, zu sagen, die Patient*innen hätten es nicht geschafft, die Behandlung fortzusetzen. Denn dies würde ein Versagen der Behandelten implizieren. Vielmehr könne es genauso gut sein, dass die Patienten die behavioristische Erklärung ihrer Probleme abgelehnt und sich daher gegen die Verhaltenstherapie entschieden hätten. Fakt ist, dass wir nur wissen, dass die Patient*innen die Behandlung nicht fortgesetzt haben, Dalal beginnt hier jedoch ohne Not über die möglichen Gründe zu spekulieren.
Solche tendenziösen Schnitzer und Vereinfachungen ziehen sich leider durch große Teile des Buches und trüben den Gesamteindruck sehr. Selbst an Stellen, an denen der Autor die Erfolge der Verhaltenstherapie lobt, zum Beispiel für ihre Erfolge bei der Behandlung von Angst- und Zwangsstörungen, spielt er diese Erfolge sogleich wieder runter und meint, andere humanistische wie psychodynamische Therapien hätten dies schon längst genauso gut getan. Dass bspw die deutschen Leitlinien zur Therapie von Angst- und Zwangsstörungen geradezu einhellig die Verhaltenstherapie als Mittel der ersten Wahl empfehlen (in UK vermutlich auch), kann der Autor nicht mit zutreffenden, aber hier nicht weiterführenden Hinweisen auf die Replikationskrise und den Publikationsbias in der akademischen Psychologie wegwischen.
Und am ärgerlichsten ist die Tatsache, dass einzelne Vertreter der Verhaltenstherapie als vermeintlich stellvertretend für ihr ganze Disziplin kritisiert werden, obwohl manche der stärksten Kritiker des biomedizinischen Krankheitsmodells und Befürworter transdiagnostischer Verfahren mehr mit dem psychologischen Autor gemeinsam haben, als dieser wahrhaben will. Allein die einleitenden Kapitel im Grundlagenwerk zur Akzeptanz- und Commitmenttherapie von Hayes, Wilson und Strosahl sind in dieser Hinsicht sehr erhellend.
Abschließend lässt sich sagen, dass der Autor mit seinen historischen Ausführungen zur Erkenntnistheorie in der Psychologie, ihren Verflechtungen mit den Wirtschaftswissenschaften und seiner Kritik an der Ökonomisierung der Psychotherapie glänzt, aber mit seiner Fundamentalkritik an der Verhaltenstherapie ein Zerrbild dieses Verfahrens, oder besser gesagt dieser Gruppe an Verfahren abliefert. Auch im Jahre 2015 hätte man diesen ermüdenden Schulenstreit hinter sich lassen und stattdessen eine Streitschrift für Methodenvielfalt und integrative Therapie verfassen können, schade.
Bspw. kritisiert er die Psychoedukation in der Verhaltstherapie fälschlicherweise als eine Ausübung von Zwang. Später kritisiert er eine Studie zur achtsamkeitsbasierten Verhaltenstherapie dafür, dass die Autoren der Studie solche Studienteilnehmer nicht in ihren Ergebnissen berücksichtigt hätten, die die Behandlung am Anfang, also während der Psychoedukation, abgebrochen haben. Hier meint Dalal, dass es falsch sei, zu sagen, die Patient*innen hätten es nicht geschafft, die Behandlung fortzusetzen. Denn dies würde ein Versagen der Behandelten implizieren. Vielmehr könne es genauso gut sein, dass die Patienten die behavioristische Erklärung ihrer Probleme abgelehnt und sich daher gegen die Verhaltenstherapie entschieden hätten. Fakt ist, dass wir nur wissen, dass die Patient*innen die Behandlung nicht fortgesetzt haben, Dalal beginnt hier jedoch ohne Not über die möglichen Gründe zu spekulieren.
Solche tendenziösen Schnitzer und Vereinfachungen ziehen sich leider durch große Teile des Buches und trüben den Gesamteindruck sehr. Selbst an Stellen, an denen der Autor die Erfolge der Verhaltenstherapie lobt, zum Beispiel für ihre Erfolge bei der Behandlung von Angst- und Zwangsstörungen, spielt er diese Erfolge sogleich wieder runter und meint, andere humanistische wie psychodynamische Therapien hätten dies schon längst genauso gut getan. Dass bspw die deutschen Leitlinien zur Therapie von Angst- und Zwangsstörungen geradezu einhellig die Verhaltenstherapie als Mittel der ersten Wahl empfehlen (in UK vermutlich auch), kann der Autor nicht mit zutreffenden, aber hier nicht weiterführenden Hinweisen auf die Replikationskrise und den Publikationsbias in der akademischen Psychologie wegwischen.
Und am ärgerlichsten ist die Tatsache, dass einzelne Vertreter der Verhaltenstherapie als vermeintlich stellvertretend für ihr ganze Disziplin kritisiert werden, obwohl manche der stärksten Kritiker des biomedizinischen Krankheitsmodells und Befürworter transdiagnostischer Verfahren mehr mit dem psychologischen Autor gemeinsam haben, als dieser wahrhaben will. Allein die einleitenden Kapitel im Grundlagenwerk zur Akzeptanz- und Commitmenttherapie von Hayes, Wilson und Strosahl sind in dieser Hinsicht sehr erhellend.
Abschließend lässt sich sagen, dass der Autor mit seinen historischen Ausführungen zur Erkenntnistheorie in der Psychologie, ihren Verflechtungen mit den Wirtschaftswissenschaften und seiner Kritik an der Ökonomisierung der Psychotherapie glänzt, aber mit seiner Fundamentalkritik an der Verhaltenstherapie ein Zerrbild dieses Verfahrens, oder besser gesagt dieser Gruppe an Verfahren abliefert. Auch im Jahre 2015 hätte man diesen ermüdenden Schulenstreit hinter sich lassen und stattdessen eine Streitschrift für Methodenvielfalt und integrative Therapie verfassen können, schade.
March 18, 2020
It speaks a lot about political involvement in propagation of CBT in UK. Although, it doesn't offer a solution regarding evidence-based therapies monopoly of the psychotherapy market. CBT is limited, but it's empirically proven in some way. So, I think the government couldn't sustain other type of psychotherapy with no proof that it works, but this doesn't impede the patients to look out on their own for whatever therapy they like. Maybe the solution would be for the social security to provide more alternatives to CBT if it doesn't work.
September 2, 2023
The author, in a very fluid way, demonstrates the dangers of generalizing treatments for all cases, the impact of political and economic interests in the world of mental health, as well as the impact of these interests on the health and well-being of workers in the field, the flaws of psychoanalysis, as well as CBT, not forgetting the (often) sneaky ways in which research data and its interpretation are distorted.
September 26, 2021
Entertaining read to say that it was quiet deep in places, funny and easy to read as it explained the concepts in plain English.
Displaying 1 - 7 of 7 reviews