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

Can social recovery therapy improve social functioning in psychosis?

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Lisa Wood publishes her debut blog about a recent RCT of social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis: the SUPEREDEN3 trial.

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Can gamified cCBT prevent depression in secondary school students?

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Lisa Burscheidt summarises a school-based RCT of an online gamified cCBT intervention (SPARX-R) for preventing depression in final year secondary school students in Australia.

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Guided cCBT for depression: optimising therapist support and maximising efficiency

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Monisha Nahar writes her debut blog on a recent RCT that explores how we can improve the efficiency of psychotherapy for depression. The trial compares web-based guided CBT with face-to-face CBT for people with depression who are not taking medication.

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Digital guided self-help for binge eating disorder: a paper worth getting INTERBED with?

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Sarah McDonald summarises the INTERBED RCT, which explores the effect of Internet-based guided self-help versus individual face-to-face CBT on full or subsyndromal binge eating disorder in overweight or obese patients.

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#UnderstandingPsychosis?

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Sameer Jauhar and Paul Morrison consider the revised Understanding Psychosis and Schizophrenia report from the British Psychological Society Division of Clinical Psychology, which includes updated sections on definitions, aetiology and treatment.

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Are digital tools the answer to improving employee wellbeing and effectiveness? #WorldMentalHealthDay

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It’s #WorldMentalHealthDay today and the theme this year is promoting awareness of mental health in the workplace.

We’re getting in on the act with Chris O’Sullivan looking in detail at a recent systematic review of web-based psychological interventions delivered in the workplace, to improve employee wellbeing and effectiveness.

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Insomnia, paranoia and hallucinations: Sleepio CBTi at the OASIS

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Jack Barton publishes his debut elf blog on the huge OASIS randomised controlled trial, which explores the effects that improved sleep can have on our mental health.

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cCBT for people with learning disabilities: Pesky gNATs #MHNR2017

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Leen Vereenooghe presents the results of an RCT of computerised cognitive behavioural therapy for people with learning disabilities, featuring the computer game “Pesky gNATs: The Feel Good Island”.

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Brief, intensive and concentrated CBT for anxiety disorders in children

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Simon Brett summarises a recent systematic review of brief, intensive and concentrated cognitive behavioural therapy for anxiety disorders in children, which finds some promising results for this more focused approach to care.

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CBT for eating disorders: what impact on quality of life?

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Sarah McDonald explores a recent meta-analysis that summarises the effects of cognitive behavioural therapy for eating disorders on quality of life in adults.

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