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

Parental involvement in CBT for anxiety disorders: a help or a hindrance?

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Lucy Purnell summarises a recent systematic review which finds little support for parental involvement in cognitive behavioural therapy for adolescent anxiety disorders.

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Problem solving therapy: is it an effective ingredient for treating depression? #ActiveIngredientsMH

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Karolin Krause summarises a systematic review relating to her own Wellcome Trust funded research on problem solving training for young people with depression.

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Antidepressants and psychotherapy for adolescent depression: can they be compared? #ActiveIngredientsMH

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Catherine Harmer summarises a recent network meta-analysis relating to her own Wellcome Trust funded research into antidepressants for young people with anxiety or depression.

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Psychotherapy for depression across different age groups

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David Hallford summarises a recent systematic review and meta-analysis on the effectiveness of psychotherapy for depression across the lifespan.

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CBT delivery formats for adult depression: group, telephone & guided self-help all as effective as individual therapy?

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Kinga Antal reviews a network meta-analysis which finds that individual, group, telephone and guided self-help CBT are all equally effective for treating depression in adults.

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Enhanced CBT for eating disorders: new review suggests it’s no more effective than other treatments, but it may act faster

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Georgie Parker summarises a recent systematic review which finds that enhanced CBT is an effective treatment for eating disorders, but no more effective than other treatments. However, some research suggests that CBT-E may act quicker and therefore be most cost effective than other treatments.

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CBT for health anxiety: should it be delivered in person or online?

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Francesca Bentivegna explores a timely RCT concluding that delivering internet-based (email) CBT for health anxiety is non-inferior to face to face CBT in the short-term. The study also concludes that iCBT is more cost-effective.

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Antipsychotics versus CBT in first episode psychosis: some answers, more questions

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Joe Pierre summarises two recently published and widely reported RCTs, which suggest that antipsychotic medication might not offer an advantage over psychotherapy in broadly-defined first episode psychosis.

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Targeted school-based interventions for adolescents with depression and anxiety

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Rachel Symons summarises a practitioner review looking at the effectiveness of indicated school‐based interventions for adolescents, which finds a positive impact on both depression and anxiety, but little evidence of long-term benefit.

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Can enhanced CBT help people with eating disorders during COVID-19?

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Helen Bould summarises a guide for clinicians on how to deliver enhanced cognitive behavioural therapy (CBT-E) for people with eating disorders during COVID-19.

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