Cognitive Functional Therapy training now for sale

As cynically feared by some, and eagerly anticipated by others, training in “Cognitive Functional Therapy” (CFT) is now available for purchase. A timeline …

May 2023 — The RESTORE trial of CFT for low back pain is published, and it sure looks good, a seemingly strong scientific vote of confidence for “an individualized approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability.” For a while, I want to believe.

December 2023 — I write an extensive critique, reporting on RESTORE’s significant flaws and the concerns of many experts and professionals. One of the biggest? That the trial would be exploited to commercialize and promote CFT training and certification, with all the usual corrupting effects of profit and reputation.

May 2025 — The “Cognitive Functional Therapy tiered training program” launches. It took two years, but the boost from the putatively positive results of RESTORE have now officially been “monetized.” And it looks like the kind of thing that many of us cynically predicted.

It might be less of a problem that we feared. Founder Peter O’Sullivan says it’s non-profit:

EvolvePainCare.academy is a social enterprise. All profits support the mission. We have self funded this to provide free resources. 100’s of hours of work. People in middle income countries pay 50% fee. People in low income countries pay 10%. We need to cover costs. That’s all.

That is genuinely nice to know, and those idealistic values are partly why I was reluctant to doubt the results of RESTORE initially. “Profit” is not the sole source of concern, however.

What’s the big deal? What could possibly go wrong?

From my article:

Fair or not, CFT is going to face resistance from clinicians who feel that they were already doing something a lot like CFT — and they are very wary of its commercialization. … The branding and standardization of therapy methods is nearly impossible to do without “selling out,” thanks both to perverse incentives and overwhelming social pressures in the wrong directions. Most professionals and patients easily succumb to the allure of a branded methods and the assumption that “there must be something to it”… and are largely oblivious to their corrupting power and long-term consequences. Even the best of them seem doomed to turn into dumbed-down dogma, and to produce at least one or two generations of therapists still clinging to it — because of their literal investment in it — long after science has pointed out that their emperor has no clothes.

A method of therapy can truly be a good idea, founded by people who are smart and wise … and still become a simplistic parody of itself when it goes mainstream. That’s the danger. Even if CFT is actually great. Which is far from guaranteed.

There is a serious risk that CFT will become just another “modality empire,” prioritizing reputation and revenue over good clinical science. That is what could possibly go wrong.