One of the most empirically tested forms of Christian therapy is Christian Cognitive Behavioral Therapy (C-CBT). Secular Cognitive Behavioral Therapy (S-CBT) was developed in the 1960s by Dr. Aaron T. Beck and centers around the belief that “distorted or dysfunctional thinking (which influences the patient’s mood and behavior) is common to all psychological disturbances.” S-CBT has been proven effective in reducing difficulties with anxiety, depression, schizophrenia, and other psychological symptoms. Like its secular parent, C-CBT has likewise been demonstrated through empirical research to help struggling Christians overcome depression.
Why then is C-CBT considered a rival approach to biblical counseling instead of an ally? After all, many Christians treated with C-CBT overcome emotional and psychological problems and live happier, freer lives. Doesn’t this demonstrate substantial arrogance on the part of biblical counselors to reject a system that has been empirically verified to positively impact Christian’s lives?
These good questions draw us back to our presuppositions about what constitutes “successful” counseling. Pragmatism cannot be our guiding light. “Does it work?” is a good question, but it isn’t the only (or even most important) question. Christians are to be most concerned about godliness through right worship. The relief of symptoms does not necessarily mean that real issues have been addressed. Even the C-CBT focus upon “core beliefs” often stops short of the worship disorders that govern the heart. As one biblical counselor writes, “A truly humble servant of God will be well adjusted . . . but [this this is a] byproduct of godliness, not a goal. . . Not just any change will do.”
Genuine Christian transformation begins with being conformed to the image of Christ through the power of the Holy Spirit. Any change that does not require the work of Christ is not authentically Christian change. Beyond disagreement about what constitutes “success” in a counseling setting, empirical studies of C-CBT cast doubt on how “Christian” the change it produces actually is.
David R. Hodge conducted a review of empirical studies that tested the effectiveness of spiritually-modified CBT. Researchers in Malaysia integrated CBT with Islamic principles and were able to significantly reduce the symptoms of anxiety and depression for Muslim patients. Taoists patients in China suffering from neurosis were treated with Taoist-modified CBT and experienced greater levels of cognitive and emotional normalcy. Levels of psychological distress among Mormon students struggling with perfectionistic tendencies plummeted after being treated with Mormon-modified CBT.
One leading practitioner and proponent of C-CBT rejoiced in 2007 that “There are now at least 10 outcome studies (six Christian and four Muslim) with varying levels of methodological rigor that provide some empirical support for the efficacy of religiously-oriented or spiritually-oriented CBT with religious clients…” But does it speak well of supposedly Christian therapy when Muslims are able to duplicate their results?
The trouble for C-CBT does not stop with other faiths claiming equal effectiveness through their own modified CBT. One well-respected 1992 study indicated that C-CBT was more effective when administered by an unbeliever rather than by a believer. Participants were broken up into four different subgroups, two of which received C-CBT. Half were given C-CBT by a Christian psychotherapist, the other half by a non-Christian practitioner. Contrary to all expectations, the non-Christian practitioners of C-CBT outperformed their Christian counterparts! This poses another significant question: How can self-identified unbelieving therapists be more effective at helping Christians be transformed into Christ’s image?
Three hundred and fifty years ago, Richard Baxter warned of the danger of the unregenerate being our hope for Christian growth:
Alas! It is the common danger and calamity of the Church, to have unregenerate and inexperienced pastors [who are to] . . . worship an unknown God, and to preach an unknown Christ, to pray through an unknown Spirit, to recommend a state of holiness and communion with God, and a glory and a happiness which are all unknown, and like to be unknown to them forever.
If the results of Christian CBT are indistinguishable from CBT practiced by those who follow Joseph Smith and claim Jesus was a created being, can it genuinely be said that the Spirit is the reason the Christian changed? If Christian CBT can be more effectively practiced by non-Christians than by Christians, is the resulting life change really transformation into the image of Christ? Any form of therapy that does not require a crucified, risen Christ and an indwelling, purifying Spirit is not genuine Christian counseling, for Christian counseling demands the necessity of the Christian message.
I’m thankful for the positive effects of CBT in our society. I’m thankful that many individuals have been moved from the depths of suicidal contemplation to brighter skies. I’m thankful for the wives that aren’t abused, the children taught to overcome compulsions, and the first responders who have been able to put their traumas in perspective. However, CBT is making the best of a bad situation. Those who do not know Christ will never achieve the righteousness of God (James 1:20). Why would we, as Christians, run to baptize that which is insufficient when we have available to us a distinctly Christian form of counseling that is able to equip us for every good work?
Questions for Reflection
What are your thoughts on Christian Cognitive Behavioral Therapy? How would you counsel someone who is considering pursuing C-CBT?
 Judith Beck, Cognitive Therapy: Basics & Beyond (New York, NY: Gulliford Press, 1995), 1.
 David R. Hodge, “Spiritually Modified Cognitive Therapy: A Review of the Literature.” Social Work, Vol. 51, no. 2 (April 2006): 157-166. Psychology and Behavioral Sciences Collection.
 Jim Berg, Changed Into His Image (Greenville, SC: Journeyforth, 1999), 2-4.
 Hodge, “Spiritually Modified Cognitive Therapy: A Review of the Literature.”
 Siang-Yang Tan, “Use of Prayer and Scripture in Cognitive-Behavioral Therapy.” Journal Of Psychology And Christianity, Vol. 26, no. 2 (2007): 101-111.
 L. Rebecca Propst, Richard Ostrom, Philip Watkins, Terri Dean, and David Mashburn, “The Efficacy of Religious and Nonreligious Cognitive-Behavioral Therapy for the Treatment of Clinical Depression in Religious Individuals.” Journal of Consulting and Clinical Psychology, Vol. 60, no. 4 (1992): 94-103. American Psychological Association.
 Richard Baxter, The Reformed Pastor (Carlisle, PA: Banner of Truth Trust, 1974), 56.
Nate Brooks serves as the Coordinator of the Christian Counseling Program at Reformed Theological Seminary – Charlotte and is a Ph.D. student in Biblical Counseling at Southwestern Baptist Theological Seminary. He counsels and teaches at Oakhurst Baptist Church in Charlotte, NC where he lives with his wife and sons.