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

Add on iCBT: weak evidence of modest benefits in depression and anxiety

iCBT can be effective in reducing symptoms of depression, anxiety, OCD and PTSD - could its accessibility help reach more people?

Liesbeth Tip and Antigone Lanitis reflect on a recent systematic review and meta-analysis that investigated internet-delivered psychological treatment as an add-on to treatment as usual in depression, anxiety, and PTSD.

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Computerised CBT for youth anxiety and depression: a growing evidence-base

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In her debut blog, Jemma Baker reports on a systematic review and meta-analysis investigating the effectiveness of computerised cognitive behavioural therapy (CBT) for depression and anxiety in adolescents.

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Improving access to CBT for people with anxiety: a review of solutions?

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In her debut blog, Elli Bouliou reflects on a scoping review exploring ways to improve access to Cognitive Behavioural Therapy for people with anxiety disorders.

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Equipping young adolescents with wellbeing skills: does a universal, classroom-based CBT intervention promote positive mental health?

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Emily Hards and Maria Loades summarise a cluster randomised controlled trial exploring the effectiveness of universal process-based CBT for positive mental health in early adolescence.

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Is cognitive behavioural therapy the best we’ve got for depression?

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Camilla Babbage and Maria Loades summarise the largest meta-analysis to date on the effectiveness of CBT for depression.

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Can therapeutic alliance help prevent suicide in people with psychosis?

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Melanie Lafanechere and Dafni Katsampa summarise a study on the therapeutic alliance and suicidal experiences in people with psychosis receiving Cognitive Behavioural Suicide Prevention Therapy.

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Blended CBT for depression: does it affect the working alliance?

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Destiny Kumari summarises a study on practitioners’ experience of the working alliance in a blended CBT intervention for depression.

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Youth trauma narratives: a thematic analysis of meaning-making during trauma-focused cognitive behavioural therapy (TF-CBT)

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In her debut blog, Georgina Thompson explores a qualitative study of how young people create meaning of their experiences during trauma narration, when receiving trauma-focused cognitive behavioural therapy.

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Can brain scans tell us how successful CBT for anxiety will be? Meta-analysis of task-based fMRI studies shows promise

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Millie Lowther, Isabel Luetkenherm, Carlos Mena and Alexandra Pike summarise a recent fMRI meta-analysis, which finds that activation in brain circuits related to salience, interoception and emotional processing were found to predict a positive response to CBT in anxiety disorders.

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CBT reduces depressive symptoms in mothers with perinatal depression, but many questions remain unanswered

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In her debut blog, Kyla Vaillancourt summarises an umbrella review, which suggests that CBT is the most effective treatment for reducing symptoms of perinatal depression. However, many questions remain about psychological support for mothers, infants and families during the perinatal period.

[read the full story...]