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

A PACE-gate or an editorial without perspectives?

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This commentary by Kjetil Gundro Brurberg, Signe Flottorp and Aase Aamland was written in response to an invitation from the Editor of the Journal of Health Psychology, who subsequently decided not to publish it. In the interest of science and open debate, we have decided to publish the commentary.

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Guided self help and cCBT for OCD: OCTET finds low adherence and uncertain fidelity

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Alan Underwood reports on the new OCTET trial published last week, which fails to find any support for the use of low-intensity guided self-help or computerised CBT for people with obsessive compulsive disorder (OCD).

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Digital interventions for PTSD: meta-analysis suggests they may reduce symptoms

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Jazz Croft publishes her debut elf blog on a recent systematic review and meta-analysis of digital interventions to treat the symptoms of post traumatic stress.

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Psychosocial interventions for negative symptoms in psychosis

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Rachel Upthegrove reviews a new systematic review and meta-analysis of psychological and psychosocial interventions for negative symptoms in psychosis.

This is the third in a new series of Mental Elf blogs produced in partnership with the British Journal of Psychiatry.

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Battle of the meta-analyses: is CBT becoming less effective over time?

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Suzanne Dash explores a recent meta-analysis that looks again at RCTs of cognitive behavioural therapy for depression, to ascertain whether or not the effects of CBT are systematically falling over time.

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CBT may help reduce anxiety and depression in people with diabetes, but standardised approach needed

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Ben Perry explores the findings of a recent systematic review looking at the effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes.

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Psychotherapies for borderline personality disorder: DBT and psychodynamic approaches do best

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Andrew Shepherd summarises a recent meta-analysis on the efficacy of psychotherapies for borderline personality disorder, which finds that dialectical behaviour therapy and psychodynamic approaches were effective versus control, but CBT and other talking treatments were not.

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Exercise and iCBT for depression: how do ‘alternative’ treatments compare to usual care?

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Bethan Davies publishes her debut blog on a recent Swedish RCT of exercise and internet-based cognitive-behavioural therapy for depression.

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CBTp changes the brain’s wiring? Extraordinary claims, ordinary evidence

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Keith Laws and Samei Huda are not impressed by a study on brain connectivity changes following CBT for psychosis, which received a significant amount of press coverage when it was published back in January.

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Targeting unhelpful repetitive negative thinking in young people to prevent anxiety and depression

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Michelle Moulds publishes her debut blog on a recent randomised controlled trial about the prevention of anxiety disorders and depression by targeting excessive worry, rumination and repetitive negative thinking in young adults.

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