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Experts debunk CBT myth

nickh

nickh

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Sometimes you don't know whether to laugh :D or cry :(

Reading the following was one such time....

http://www.mentalhealth.org.uk/information/news/?EntryId17=61838

I'll cut and paste it for convenience too....


>>The idea that cognitive behavioural therapy (CBT) is more effective than other types of talking treatment is a myth, experts said today.

Unlike some other talking therapies, CBT focuses on "here and now" problems and difficulties rather than delving into the past.

It also looks at changing how somebody thinks and their behaviour.

Today, researchers attending a conference at the University of East Anglia (UEA) said it was commonly believed that CBT was superior to other methods.

But this could be because there are more published studies on CBT than any other therapy, they argued.

CBT has not been proved to be better than other therapies and such perceptions could mislead the public and harm patient care.

In a joint statement, Professors Mick Cooper and Robert Elliott, from the University of Strathclyde, William B Stiles, from Miami University, and Art Bohart, from Saybrook Graduate School in San Francisco, said: "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. One, more academic researchers subscribe to a CBT approach than any other. Two, these researchers get more research grants and publish more studies on the effectiveness of CBT. Three, this greater number of studies is used to imply that CBT is more effective.

"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."

The experts said the belief has "direct negative consequences for other well-developed psychotherapies, such as person-centred and psychodynamic, which have smaller evidence bases than CBT".

They added: "These approaches are themselves supported by substantial, although smaller, bodies of research."

The scientists said a meta-analysis of more than 80 studies revealed that person-centred and psychodynamic therapies were just as effective as other forms, 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."

Prof Cooper said studies suggested that it was not the therapy chosen but the client's level of motivation, participation and ability that made a difference.

"After that, the key ingredient seems to be the quality of the therapeutic relationship, with warm, understanding, trustworthy therapists having the best results."

Prof Bohart added: "There is evidence that some clients prefer an approach to counselling where the focus is on helping you explore and understand yourself.

"In contrast, other clients prefer an approach where the therapist takes the lead in teaching you particular cognitive and behavioural skills, such as how to think. Since both work about equally well it is important that both be available to the public."

A spokesperson for the Department of Health said: "We are looking to improve our primary care preventions - that is why we launched a major new programme designed to help transform the lives of thousands of people with depression and anxiety disorders earlier this year. This will train an extra 3,600 Psychological Therapists and offer greater access to Cognitive Behaviour Therapies.

"It is also crucial that a range of options are available to best suit the patient. For many people, prescribing medication is a successful treatment but psychological therapies have proved to be as effective as drugs in tackling these common mental health problems and are often more effective in the longer term.

"The Improving Access to Psychological Therapies programme, which aims to improve individual's well-being, satisfaction and choice, has already captured the imagination of Primary Care Trusts up and down the country and is transforming the lives of thousands of people with depression and anxiety disorders in the areas that have been involved so far."<<

My own position has always been that the promotion of CBT as some kind of new wonder-cure was motivated above all by the fact that it is cheaper than other talking therapies and crudely interpreted it shifts the blame onto the patient. I certainly don't deny that for some people it is enormously helpful - just as medication, other talking therapies/analysis/counselling can be not to mention social issues. Chanting my mantra :) the fact is everyone needs to be treated as an individual and any one size fits all solution is not only wrong but can have appalling effects when applied to those whom it does not fit. But treating people as individuals is the most expensive option.

Nick.
 
honeyquince

honeyquince

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Fascinating! I always felt that CBT would be no good for me exactly because I have very low levels of motivation - I knew that the approach wouldn't succeed and that it would be my fault which I thought would just make me feel worse. It's nice to feel partially vindicated!

Thanks for posting Nick! (y)
 
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Dollit

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The first lot of CBT was good because I was strongly motivated and quite well. The last lot of CBT I did I was severely depressed and couldn't concentrate and the psychologist actually asked me why I thought that being depressed affected my concentration because it wasn't true. I didn't go back.
 
connect

connect

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I don't know where on when I read this, but I'm pretty sure there is research which shows that the actual method used (i.e the type of talking therapy) is less important than the therapist/counselor. In other words, if there's a good match and you have good rapport with your therapist, the outcome will be better regardless of the type of therapy. I also think that most good therapists would employ a number of methods and mix and match according to their clients' needs. CBT as a "course of treatment" seems to be on the increase though. In a sense, this can be seen as a step backwards and, as Nick has said, it's done for cost-cutting purposes.

Then again, if the cost-cutting approach means that more people have access to at least one type of talking therapy, it might not be all bad (well, better than nothing). I doubt though that CBT alone is very effective when there are underlying issues that need to be addressed. I do believe that CBT can be very effective, but hardly a cure-all when it's used to gloss over the real problems (wayyy to simplistic). The techniques learned through CBT are probably useful for most people, though (and for many people, they may totally resolve issues). But most of the time, I would think that they're just one more useful skill to learn when dealing with mental health issues.
 
nickh

nickh

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The first lot of CBT was good because I was strongly motivated and quite well. The last lot of CBT I did I was severely depressed and couldn't concentrate and the psychologist actually asked me why I thought that being depressed affected my concentration because it wasn't true. I didn't go back.
See that really is the kind of thing that makes me :mad::mad: (refraining from swearing!). It almost beggars belief that a medical professional could say that being depressed doesn't affect concentration and shows that the person has absolutely no understanding whatever of the condition.

Nick.
 
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Dollit

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But it comes as no surprise to know that for a first session she kept me there for 90 minutes and I was exhausted. She kept going on about how I'd been through CBT before and so I had to have remembered something. It was 5 years before and I did remember that the therapist then was kind and caring and didn't set the pace, he let me do that. I was also really in two completely different states. The latter experience was during a time of depression so bad and prolonged (14 months) that every day I couldn't get out of bed until I decided whether I was going to live or die that day.

I was unlucky the second time and my consultant raised my concerns with that person. But it was one of the few negative experiences I've had in this part of the world.

But yes, you can train them and give them PhDs but you can't make them sensitive and caring!
 
intelgal

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I am just stating out on CBT but have a had a watered down version of CBT before. I am more hopeful this time as I feel I have clicked with the person delivering it and I think that this is highly important !
 
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Dollit

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I think the chemistry is really important in any therapeutic setting. My problem with the last person I did CBT with is that I didn't like her.
 
yakuza

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The CBT worked well for me for the time that it lasted,I was very ill at the time and in a bad place,it gave me a direction and a new refreshing way at looking at how I coped with things.
I wish it had lasted longer,I would also be happier if the GP would let me try a refesher course but pointing patients in the direction of the internet seems more common these days.
 
Aahbut

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CBT was never going to work for me. I was indifferent to the psychologist, I just could not relate to anything she said. My concentration was poor, depression seems to do that, but that maybe our imagination :evil: I was taught how to breath and relax, I told her I practised meditation but she ignored that. The second time seemed to be about pointing out the bleeding obvious to me, how that was going to help was beyond me. The third session I cut short after about twenty minutes. By this time I had psychosis and a very insistent voice was being extremely loud about the 'silly woman'. I have declined the rest of the course. Let someone who may get something from it occupy the psychologists time.
 
j_lol

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By way of balance, I have found CBT had been working wonders for me. Its true that you do need to have a psychologist who you click with which I think is true for all treatments of any kind, even down to having your legs waxed!

CBT is hard work so you do need to be in a fairly good phase in order to get up the motivation to make some headway in it initially but once you are into it a good practitioner will tailor what they are asking you to do in accordance with any fluctuations in mood, motivation, energy, concentration etc.

I have no experience of CBT offered on the NHS as I felt I was unable to wait untill I came to the top of a very long waiting list so I am aware my experiences may be different to many others.
 
S

Starbright

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I agree about the therapist and the client having a match being the most important thing.

I was assessed for CBT and she said to me that since I'd done a computer course on it (just an introduction) that I had to read all of my notes every day. I said that I couldn't do that but I could read them once a week. There were TONS of notes and I can't cope with deadlines, they totally stress me out. She then asked why I wanted CBT to which I replied I didn't, I wanted psychotherapy but they'd refused me but I was totally willing to work at it. She denied me on the basis that I didn't want her therapy. How arrogant and prideful is that! I didn't choose her therapy first so she didn't want me...vindictive b**** excuse me I'm a church goer but I felt so rejected and somehow 'punished' for not choosing hers as my top choice.

Anyway when I'd calmed down I realised that if she was so judgemental and prickly then she would not have been any good for me anyway. Imagine telling someone who is totally slowed down with antipsychotics and recovering from serious mental illness that they have to read 40+ pages of notes every day! Stupid cow.:mad:
 
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Dollit

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CBT is reliant on a lot of "homework" - I had to do work everyday. I had to read things and assess myself on a daily basis. CBT is full of deadlines so it's not a good therapy for someone who can't do deadlines.

And to be quite honest you did say you didn't want to do CBT but also you didn't want to be told you couldn't do it. That doesn't add up. There are long queues for therapy and if you're not totally compliant it can waste time that the therapist could be spending with someone else.

Maybe there's another sort of therapy that you can do - one that suits your needs better?
 
S

Starbright

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Dollit, I don't know why you're being so hard on me. Have I annoyed you in some way? If so, please tell me how.

I said that it wasn't my first choice but I was totally willing to work very hard at it. How is that not compliant? I needed help, it didn't matter how it came. I have just recently been re-assessed for psychotherapy and accepted so I'm very happy about that. I'm also on different drugs so I am more awake (thank God). But because I was very honest with her and didn't pretend that hers had been the first choice meant that she rejected me. My point was that this didn't give me a chance to access any kind of help. She didn't know that I have a problem with deadlines because I didn't tell her that and she didn't ask, and I didn't know that it was necessary to have them, so I never knew that was relevant. She didn't reject me on that basis.

Although now that you've told me that, I can see that CBT would have been a bad choice for me. Perhaps the majority of my annoyance was with the psychotherapist who rejected me without giving a reason other than 'it is argued that psychotherapy is not useful for psychosis'. A very great deal later, maybe 2 years later, I found out that this is because you don't have insight when you're psychotic. So he had assumed off his own back that I was actually experiencing psychotic symptoms THEN, which wasn't true at all. I was out of the psychosis totally by that point.

So the fault appears to be a little on the CBT lady who was so prickly (her manner left a LOT to be desired) and the psychotherapist who jumped to conclusions about my state of mind.

The guy I was reassessed by was very different. He was very warm. I felt immediately that I could talk to him and so it was easy to spend the hour talking and answering questions. I was pleased that he accepted me, but I don't know why he did. I did make a point of saying that I'm not psychotic now, perhaps that helped. I don't know. But anyway, I hope I get him when my turn comes up (probably in another two years!!)
 
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Dollit

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I wasn't being hard on you I just made an observation. Debate is just a series of opinions and I don't know you well enough to make a personal comment and certainly wouldn't do so on public forum even if I did.
 
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