More threads by David Baxter PhD

David Baxter PhD

Late Founder
Is cognitive therapy the answer?
By Jane Dreaper, BBC News
2008/11/08

There was huge excitement last autumn when the health secretary, Alan Johnson, announced that ?170m would be spent on talking therapies in England.

The programme focuses on one specific branch of treatment - Cognitive Behavioural Therapy (CBT).

But a tide of doubt has begun to be expressed about whether CBT is getting too much prominence - and money.

However, the therapy's supporters say its attackers do not understand the latest versions that are being used for NHS treatment.

The London borough of Newham has been an important test bed for the idea of getting CBT to a wide number of people. It is the home of the 2012 Olympics, but also an ethnically diverse area with significant deprivation. Outside East Ham tube station, the nearby pub is appropriately called the Overdraft Tavern and it seems likely that there is plenty of unhappiness to treat in the area.

'I was angry'
Rita Edgar-Dimmack, 51, sought help from CBT after 20 years in an abusive marriage.

She said: "I left my husband with nothing. I was angry with myself because I'd stayed so long, and I got depressed. My GP, who'd known me for years, noticed my personality had changed. He handed me a leaflet on CBT. A few weeks later I rang, and then came in and saw a therapist. He started me with a booklist, and said he wanted me to do some reading. I started reading books on depression. Each week, he'd have me do something else - like keeping note of my moods. He also started me thinking about the times when I did incredible things, and wasn't stupid or inept. That's when I started to heal."

Practical skills

CBT looks at difficulties in the here and now. It includes homework and aims to build up practical skills.

Dr Ben Wright, the doctor in charge of the CBT programme in Newham, said: "I think this is a dream service. Patients can refer themselves and get access to quick treatment."

The service has a good record for getting unemployed people back to work, or at least moving in that direction through training or volunteering - thanks to ties with specialist charity workers.

Dr Wright added: "They will speak to people, and help them get vocational plans. Our focus is first and foremost on the person and what they want. Employment, however, is a very important pathway for social inclusion and most people find that's the way in which they want to get back on with their lives."

'Hoodwinked'
It seems compelling, and pilot schemes in Newham and Doncaster helped persuade the government to fund CBT on a massive scale.

But critics are nervous about therapy being linked with employment services and some say, in quite strong terms, that ministers have been hoodwinked.

Andrew Samuels is a psychotherapist and professor at Essex University.

He said: "What you're witnessing is a coup, a power play by a community that has suddenly found itself on the brink of corralling an enormous amount of money. The CBT community has managed to sell to the government and its agencies a notion of research that is allegedly scientific. Science isn't actually the appropriate perspective from which to look at emotional difficulties. This kind of pseudo-scientific shambles simply isn't the right way to do it. In CBT, the client is a recipient of instructions or suggestions. They're told their thinking is wrong. Everyone has been seduced by its apparent cheapness."

'No axe to grind'
His private practice is fully booked - and so he says he does not have an axe to grind in his attack against the promotion of CBT as a superior therapy.

Andrew Samuels insists he is not a lone voice, though he says colleagues who email supportive messages privately are reticent about speaking publicly.

Other psychoanalysts have recently written newspaper critiques of CBT.

But a professor at the Institute of Psychiatry, David Clark, says it is the critics who are guilty of misunderstanding. He said: "CBT is a rapidly evolving field. The versions we have now are very different from the ones we had 10 years ago, and in many cases quite a bit more effective. CBT researchers are always looking at what you can do to fine tune the treatment, and make it a little bit more effective and efficient. It's a serious misunderstanding to say that CBT tells patients how to think. Rather than saying any thoughts are wrong, we explore the evidence. I think the government chose this expansion because of the moral case - there's a large number of people with common mental health problems which are severely disabling. They haven't had treatment before and they should be offered it because we know there are effective treatments."

Common concern
Back in East London, at the headquarters of the leading mental health charity Mind, talking treatments are a common concern for people who ring their information service.

Policy director, Sophie Corlett, said: "The debate appears to have focussed on 'CBT good' or 'CBT bad' without any recognition that CBT is good for some people. I feel that some of the arguments seem to have almost disintegrated into arguments between the therapies. I think it's got to the point where it's become unhelpful within the professions. There is a case for saying that CBT has been promoted above its usefulness. It's extremely useful for large numbers of people. Some people have assumed therefore that the evidence base is superior - but for some, it may be of no use at all. There needs to be recognition of different approaches for different people."
 

Mari

MVP
There needs to be recognition of different approaches for different people."

I do not know anything about the money argument but I do agree with that last statement. :dimples: Mari
 

SueW

Member
The Layard Report (2006) recommended increasing access to psychological therapies, especially CBT (almost exclusively), in order to help alleviate the suffering of people with mental health problems. The reason for choosing CBT seems to be due to the larger body of research studies in CBT when compared to that from other approaches. The research studies simply imply that CBT is an effective therapy - they do not imply that it is more effective. There is substantial evidence which imply that other types of therapy are at least as equally effective as CBT.

The majority of evidence also suggests that no one therapy is better than another. Therefore it would seem more appropriate to give clients a choice and let them choose which therapy they want. If clients have no choice of therapy, then this may have serious implications, as not all clients (some of which will be extremely vulnerable) will necessarily be responsive to CBT. In fact there is some evidence that CBT is ineffective for some conditions such as Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). An ME charity (Invest in ME) has said that "there has been little evidence that CBT is a tool to support patients or to help them cope with the ravages of serious organic disease" (quote taken from the Invest in ME website). Furthermore there is some evidence that CBT might actually be harmful for this condition. Below are two examples of studies.

In a survey of 3074 ME/CFS patients conducted between 1998 – 2001, 55% of patients said that CBT had made no difference to their illness, whilst 22% said CBT had made their illness worse (Directly from the Horses’ Mouths, Doris M. Jones MSc, Reference Group Member, CMO’s Working Group. This survey was part of the Working Group on ME/CFS set up by the Chief Medical Officer Sir Kenneth Calman in 1998)

A survey by the 25% ME Group (for severe sufferers of ME) of 437 patients, 93% of those who had undergone Cognitive Behavioural Therapy had found it unhelpful (Analysis Report by 25% ME Group March 2004; the 25% M.E. Group Web Site is a UK registered charity dedicated to the needs of severe M.E. sufferers and their carers).

Below is a joint statement made at the World Conference for Person-centred and Experiential Psychotherapies during July 2008.

CBT Superiority is a Myth
The government, the public and even many health officials have been sold a version of the scientific evidence that is not based in fact, but is instead based on a logical error. This is how it works: 1) More academic researchers subscribe to a CBT approach than any other. 2) These researchers get more research grants and publish more studies on the effectiveness of CBT. 3) This greater number of studies is used to imply that CBT is more effective. This is a classic example of the logical fallacy known as ‘argument from ignorance’ i.e. the absence of evidence is taken as evidence of absence. Although CBT advocates rarely make this claim so boldly, their continual emphasis on the amount of evidence is misunderstood by the public, other health care workers, and government officials, a misunderstanding that they allow to stand without correction. The result is a widespread belief that no one takes responsibility for. In other words, a myth. This situation has direct negative consequences for other well-developed psychotherapies, such as person-centred and psychodynamic, which have smaller evidence bases than CBT. These approaches are themselves supported by substantial, although smaller, bodies of research. The accumulated scientific evidence clearly points to three facts: 1) People show large changes over the course of psychotherapy, changes that are generally maintained after the end of therapy. 2) People who get therapy show substantially more change than people who don’t get therapy, regardless of the type of therapy they get. 3) When established therapies are compared to one another in scientifically valid studies, the most common result is that both therapies are equally effective. A case in point is person-centred and related therapies (PCTs): In a meta-analysis of more than 80 studies to be presented by Robert Elliott and Beth Freire at the Norwich conference, PCTs were shown to be as effective as other forms of psychotherapy, including CBT. In view of these and other data, it is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of ?173m to train CBT therapists throughout England. Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment. We urge our CBT colleagues and government officials to refrain from acting on this harmful myth and to broaden the scope of the Improving Access to Psychological Treatments (IAPT) project to include other effective forms of psychotherapy and counselling.'

7 July 2008, PCE Conference, University of East Anglia
Joint Statement Issued by Professors Mick Cooper and Robert Elliott (both University of Strathclyde), William B Stiles (Miami University) and Art Bohart (Saybrook Graduate School)
To also add, please be aware that in spite of what I have written above, I am not in any way trying to discredit CBT in anyway. I realise CBT can be an effective therapy and know many CBT therapists. My point is that Lord Layard and the government should have looked more widely but they did not and that CBT is clearly not for everyone.
 
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SueW

Member
The Layard Report was 2006, not 2004. David, please could you re-edit the above. The links are brilliant by the way.
Sue
 
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