One aspect that I find less effective about this theory is that it seems like it will take a long time to be effective. Changing patterns of thinking and behavior takes a lot of effort, and it can be difficult to work with people with depression and other mental illnesses who are not motivated or willing to try to ask for help. I think, especially with people dealing with substance abuse, there is a lot of denial before they get help, so this therapy doesn't take into account how long the denial phase will last. CBT can also help people face their fears, which can be really hard and difficult for people, but even if it's hard for a while, it will pay off in the long run