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

What’s BESST for young people? Efficacy of CBT-informed workshops for stress management in older adolescents

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Matthias Schwannauer explores the BESST cluster randomised controlled trial, which is out today in The Lancet Psychiatry. BESST stands for Brief Educational Workshops in Secondary Schools Trial.

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Watch yourself! Investigating the efficacy of remotely delivered video feedback in Cognitive Therapy for Social Anxiety Disorder (CT-SAD)

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KCL Masters student Katherine Jolly considers a study on internet-delivered compared to face-to-face video feedback to update negative self-perceptions in iCBT for social anxiety disorder.

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Exposing how exposure works: expectancy change is crucial for successful exposure treatment

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In her debut blog, Rena Gatzounis summarises a study that investigated the mechanisms of threat expectancy, occurrence, and change in relation to exposure therapy for anxiety disorders.

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What psychotherapies are currently available for people with ARFID?

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In her debut blog, Ellie Davis takes a look at a recent scoping review on psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID).

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SMS CBT TLC CYP? 🤔 Does delivering cognitive behavioural therapy via text messages help improve depression in young people?

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Becky Appleton summarises a randomised controlled trial investigating the effectiveness and acceptability of text-based Cognitive Behavioural Therapy for improving depression in young adults.

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Guided self-help for anxiety: the importance of choice

Only 7% of the participants accepted being randomised, while 93% chose their treatment, showing a preference for CAT-GSH; however, CAT-GSH and CBT-GSH were found to result in similar anxiety outcomes at the follow-up assessments.

In her latest blog, Francesca Zecchinato summarises findings from a recent pragmatic, partially randomised, patient preference trial on two forms of guided self-help for anxiety.

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Menopause in the workplace: A blog to celebrate World Menopause Day 2023

If you go down to the woods today, you’ll find us discussing the last of our World Menopause Day 2023 papers

Today, 18th October 2023, is World Menopause Day. It’s the now annual discussion on the impact that menopause has for the individual in the workplace, in the family and in our communities.

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Step-by-Step: promising digital app for Syrian refugees with depression

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Dafni Katsampa critiques a recent randomised controlled trial evaluating the effectiveness of Step-by-Step, a WHO-guided digital intervention for Syrian refugees with depression in Lebanon.

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Add on iCBT: weak evidence of modest benefits in depression and anxiety

iCBT can be effective in reducing symptoms of depression, anxiety, OCD and PTSD - could its accessibility help reach more people?

Liesbeth Tip and Antigone Lanitis reflect on a recent systematic review and meta-analysis that investigated internet-delivered psychological treatment as an add-on to treatment as usual in depression, anxiety, and PTSD.

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Computerised CBT for youth anxiety and depression: a growing evidence-base

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In her debut blog, Jemma Baker reports on a systematic review and meta-analysis investigating the effectiveness of computerised cognitive behavioural therapy (CBT) for depression and anxiety in adolescents.

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