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

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Videoconference delivered CBT for anxiety disorders: working alliance and intolerance of uncertainty

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Tyler Hughes blogs about a randomised controlled trial which explores therapeutic alliance in videoconference delivered CBT for anxiety.

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Psychological interventions for youth depression and anxiety can improve emotion regulation skills #ActiveIngredientsMH

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In her debut blog, Ariadna Albajara Saenz summarises a recent active ingredients review, which finds that psychological interventions for youth anxiety & depression can improve emotion regulation skills.

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Psychoeducation for perinatal depression and anxiety in young people #ActiveIngredientsMH

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In their debut blog, Wezi Mhango & Darya Gaysina explore psychoeducation as an active ingredient that might help young people who are affected by perinatal anxiety or depression.

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Behavioural therapies may reduce inattention symptoms in adults with ADHD

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Shubhangi Karmakar summarises a systematic review on the effects and feasibility of psychological interventions to reduce inattention symptoms in adults with ADHD, which highlights significant uncertainty in the field.

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In their debut blog, Zill-e-Huma & colleagues explore a systematic review finding family interventions beneficial for child anxiety and depression in low and middle income countries.

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Ally Canaway blogs a systematic review which finds evidence of internet-based psychological interventions being cost-effective for depression and anxiety.

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CBT for youth anxiety and depression: satisfaction guaranteed?

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Alice Potter explores a systematic review which finds that children and young people are often satisfied with the CBT (cognitive behavioural therapy) they receive for anxiety or depression.

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School-based mental health interventions: reducing depression, anxiety and aggressive behaviour

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In their debut blog, Rasanat Fatima Nawaz and Lauren Cross summarise a comprehensive review from the Early Intervention Foundation on school-based mental health interventions.

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Quality of life for people with multiple sclerosis: new systematic review looks at risk, protective factors and psychological interventions

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Elena Marcus summarises a recent systematic review on quality of life in adults with multiple sclerosis, which identified a range of promising psychological interventions for improving quality of life.

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