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

How important is understanding perfectionism for reducing depression and anxiety? #BABCP2022

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Alice Potter considers a meta-synthesis of qualitative studies on the link between anxiety, depression, and perfectionism in young people, and the implications for treatment.

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Technology-based CBT for youth anxiety: moderate short-term benefits but uncertainty remains #CAMHScampfire

Young people with anxiety disorders may benefit from t-CBT in the short term.

Douglas Badenoch takes a look at a recent systematic review on technology-delivered CBT for anxiety disorders in children below 18 years of age.

Join us around the #CAMHScampfire on Tuesday 24th May to discuss this paper with the author and a group of experts.

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Complex PTSD: 3 recent reviews yield clues about what helps #BIGSPD22

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Kirsten Barnicot summarises three recent systematic reviews exploring the most helpful interventions for people with complex PTSD.

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Let’s group them together! Transdiagnostic group therapy for anxiety and depression

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Melissa Black blogs an RCT which finds that transdiagnostic group therapy is not inferior to diagnosis specific CBT for anxiety and depression.

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CBT for eating disorders: which approach works best for whom?

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Alice Potter reviews a trial of CBT for eating disorders, which finds that motivational work may be important for patients with initially low motivation and resistance to therapy.

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Interpersonal psychotherapy for eating disorders: a viable alternative to CBT?

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Georgie Parker summarises a systematic review which suggests that interpersonal psychotherapy may be as effective as CBT for eating disorders, particularly in certain groups.

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On the dangers of protocolising telephone psychotherapy

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In his debut blog, Richard Byng summarises a study which finds that protocolising psychological therapy could be detrimental for telemental health.

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Videoconference delivered CBT for anxiety disorders: working alliance and intolerance of uncertainty

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Tyler Hughes blogs about a randomised controlled trial which explores therapeutic alliance in videoconference delivered CBT for anxiety.

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Psychological interventions for youth depression and anxiety can improve emotion regulation skills #ActiveIngredientsMH

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In her debut blog, Ariadna Albajara Saenz summarises a recent active ingredients review, which finds that psychological interventions for youth anxiety & depression can improve emotion regulation skills.

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Psychoeducation for perinatal depression and anxiety in young people #ActiveIngredientsMH

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In their debut blog, Wezi Mhango & Darya Gaysina explore psychoeducation as an active ingredient that might help young people who are affected by perinatal anxiety or depression.

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