CBT

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Introduction

‘Don’t believe everything you think’. This essential mantra underpins much of what has become known as Cognitive Behavioural Therapy (CBT). Developed originally by Aaron T Beck and colleagues, who observed that people with depression were more prone to experience negative cognitive biases, or ‘automatic thoughts’ which he argued became central to maintaining their difficulties, CBT combines our understanding of cognitive theory and behavioural psychology as a psychological treatment for a range of mental health problems.

More recently, so called ‘third wave’ cognitive therapies have incorporated therapeutic elements of CBT to create new interventions targeting specific client groups or set of difficulties. These include dialectical behaviour therapy (DBT), commonly used with people with a diagnosis of personality disorder or complex trauma, and mindfulness-based cognitive therapy (MBCT) for the treatment of, well, near enough anything.

In England, the Improving Access to Psychological Therapies (IAPT) initiative provides countrywide access to free face-to-face and computerised CBT (cCBT) for common mental health difficulties, via NHS services. 

What we know already

In the world of psychological treatments, Cognitive Behavioural Therapy (CBT) is rather en vogue. According to NICE guidelines, CBT should be offered as first line treatment for common mental health difficulties, as well as be routinely offered where psychological difficulties such as depression exist alongside chronic physical health conditions such as heart failure, respiratory disease, or following stroke. We know that CBT works particularly well for anxiety-related difficulties and post-traumatic stress disorder (PTSD).

Areas of uncertainty

There is an element of controversy though. The recent proliferation of CBT in mainstream mental health services has come at the expense, some might say, of other treatments (such as psychodynamic therapy, which is typically of longer duration). The controversy arises partly from the fact that, in many studies, CBT has been shown to be no more effective than other treatments, with a few notable exceptions.

You’ll see many fine elves blogging about the ‘dodo bird verdict’, essentially that all psychological therapies are equal in their effectiveness. The debate concerns the fact that neither the quality nor quantity of evidence necessarily indicates effectiveness, and CBT has benefitted from being much more widely researched over the past two decades.

The debate into research bias and the quality of evidence for CBT remains ongoing, particularly in areas such as psychosis.

What’s in the pipeline?

The IAPT programme is continuing to expand the availability of CBT for children, people with long-term physical health conditions and serious mental health difficulties such as psychosis.

cCBT will no doubt adapt to new technologies in providing novel platforms for therapy.

CBT doesn’t work for everyone. Hopefully the debate surrounding CBT will drive further rigorous research, with a focus on those for whom CBT is unsuccessful. 

References

NICE (2009) Depression in adults with a chronic physical health problem: Treatment and management [CG91] [PDF]

NICE (2011) Common mental health disorders: Identification and pathways to care [CG123] [PDF]

Layard, R., & Clark, D. M. (2014). Thrive: The power of evidence-based psychological therapies. Penguin UK. [Publisher]

Acknowledgement

Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our CBT Blogs

One size does not fit all: divergent outcomes from CBT and antidepressants for depression

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Suzanne Dash explores a recent meta-analysis of CBT and antidepressants for depression, which looked at negative and positive responses to treatment and what predicted different outcomes.

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iCBT for depression: how does it work?

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Mark Smith presents the findings from a qualitative systematic review of iCBT for depression, which tries to unearth the mechanisms of change of internet-based or computerised cognitive behavioural therapy.

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Digital interventions for social anxiety disorder: new meta-analysis finds mixed results

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Carla McEnery reports on a recent meta-analysis of technology-assisted interventions for Social Anxiety Disorder, which finds positive results from Internet-delivered CBT and Virtual Reality Exposure Therapy.

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CBT for Autism Spectrum Disorders and comorbid mental illness

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Alix Dixon presents a recent systematic review on the effectiveness of CBT for autism spectrum disorders and comorbid anxiety or depression.

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iCBT may be an effective treatment for PTSD

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André Tomlin explores a recent systematic review and meta-analysis of the effectiveness of Internet-delivered cognitive behavioural therapy (iCBT) for post-traumatic stress disorder (PTSD).

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Specialist depression service may help people with persistent depression

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Ben Hannigan reports on a recent RCT of the efficacy and cost-effectiveness of a specialist depression service versus usual specialist mental health care to manage persistent depression.

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Antidepressants and psychotherapy for OCD in adults: network meta-analysis

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Alan Underwood summarises a recent network meta-analysis of medication and talking treatments for OCD (obsessive-compulsive disorder) in adults.

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Behavioural activation not inferior to CBT for depression: the COBRA RCT

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Ioana Cristea appraises the recently published COBRA randomised controlled trial, which concludes that behavioural activation is non-inferior to cognitive behavioural therapy for depression, and may offer significant cost savings.

This blog also features a podcast interview with the lead author: Professor David Richards from Exeter University.

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Worried sick: cCBT and bibliotherapy for somatic symptom disorder and illness anxiety disorder

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Suzanne Dash considers the findings of a recent RCT of exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder.

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