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 psychological victory for the domestic violence and abuse sector: the PATH trial

Young adults who reported depressive and/or suicidality symptoms in adolescence were significantly more likely to have experienced relationship violence in their romantic relationships

Emma Yapp summarises two new studies out yesterday looking at the PATH intervention (Psychological Advocacy Towards Healing), a CBT-informed psychological intervention delivered by trained domestic violence and abuse (DVA) advocates in specialist services.

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Preventing psychosis: no one intervention is better than the rest

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A group of UCL Mental Health Masters students summarise a recent network meta-analysis that highlights a lack of evidence about specific interventions for preventing psychosis.

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Is third-wave CBT good value?

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Chris Sampson summarises a systematic review on the economic impact of third-wave cognitive behavioural therapies, such as mindfulness-based cognitive therapy, acceptance and commitment therapy, extended behavioural activation, dialectical behaviour therapy, and mindfulness-based stress reduction.

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Transdiagnostic and disorder-specific anxiety disorder treatments have equivalent treatment effects #TransDX2018

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Jill Newby and Peter Norton blog an RCT on the unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders.

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Preventive cognitive therapy when continuing or tapering off antidepressants

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Linda Gask is encouraged by the findings of a new high quality RCT (the DRD study), which compares preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in the prevention of depressive relapse or recurrence.

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Can eCBTi improve adolescents’ sleep?

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Jack Barton marvels at the paradox that the very digital devices that harm our sleep patterns so terribly, may also be a possible solution to insomnia and sleep problems in young people. A new systematic review on digitally-delivered cognitive-behavioural therapy (eCBTi) for youth insomnia shows a little promise.

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Just how effective are digital mental health workplace interventions?

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Chris O’Sullivan explores a systematic review and meta-analysis on the effectiveness of eHealth interventions for reducing mental health conditions in employees.

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Adverse effects of psychotherapy for depression: new meta-analysis looks at deterioration rates

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Edel Mc Glanaghy reacquaints us with the negative effects of psychotherapies for adult depression, through an impressive new meta-analysis of trials that measure deterioration rates in patients receiving psychotherapy compared with controls.

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Dental anxiety in paediatric patients: Is cognitive behavioural therapy effective?

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This review of cognitive behavioural therapy(CBT) for dental anxiety and dental phobia in children identified 6 RCTs suggesting it therapy produces better anxiety reduction than diverse behavioural management techniques. However the available evidence is of low quality.

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CBT for anxiety: new meta-analysis confirms significant improvements to target symptoms

CBT plus taper is effective at reducing benzodiazepine use in the short term (3 months) but this effect is not sustained at 6 months.

Inês Pote summarises a recent meta-analysis of randomised placebo-controlled trials of cognitive behavioural therapy for anxiety and related disorders.

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