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

Clinician-supported computerised CBT effective in US primary care, but what about digital exclusion?

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In her debut blog, Sue Brown explores an RCT from the US, which finds that computerised CBT was effective at treating depression in primary care patients, and was also beneficial to those with lower educational attainment, reading proficiency and incomes.

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iCBT for depression and anxiety: putting theory into practice

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In her debut blog, Bethany Williamson summarises a systematic review and meta-analysis on the effects of Internet-based Cognitive Behavioural Therapy (iCBT) in routine care for adults in treatment for depression and anxiety.

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Do therapist factors have an impact on PTSD outcomes in children and adolescents?

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In his debut blog, Sam Thompson explores a paper that looks into the associations between therapist factors and treatment efficacy in randomised controlled trials of trauma‐focused CBT for children and youth with PTSD.

[read the full story...]

Youth mental health interventions: umbrella review presents efficacy and acceptability data

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In his debut blog, Nick Meader tackles a huge umbrella review of youth mental health interventions, which presents the efficacy and acceptability of 72 different approaches to help children and young people.

[read the full story...]

Digital youth mental health interventions: will the evidence ever catch up?

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Robbie Fraser summarises an overview of systematic reviews, which finds that computerised CBT for anxiety and depression remains the best evidenced digital mental health intervention for young people.

[read the full story...]

Adult dental anxiety – management strategies

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This review of current management strategies for adult patients with dental anxiety in the dental clinic included 54 studies. Most of the psychotherapeutic behavioural strategies provided some benefits but there was limited supporting evidence for some approaches. Pharmocological approaches were not included.

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Treating PTSD in adults: EMDR and trauma-focused CBT still lead the way

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Nada Abou Seif summarises a network meta-analysis which finds that EMDR and trauma-focused CBT remain the most effective ways to treat adult PTSD.

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Trauma-focused CBT for PTSD in patients experiencing an ongoing threat of trauma

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In her debut blog, Tanya Garg summarises a systematic review that suggests trauma-focused CBT may be helpful for people with PTSD symptoms who are also experiencing an ongoing threat of trauma.

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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.

[read the full story...]