Benefits and limitations of treatment with cognitive behavioral therapy (2023)

The NICE (2009) guidelines are followed by the NHS. It provides clinicians with the following guidelines for treating depression:

For people with mild to moderate depression What is depression?

"Although depression has been recognized as a clinical syndrome for over 2,000 years, a fully satisfactory explanation of its enigmatic and paradoxical features has yet to be found. Important unresolved questions remain about its nature, classification and etiology." (Beck and Alford, 2009, p. 3)

However, the importance of depression is recognized by everyone in the field of mental health. According to Kline, "More human suffering can be attributed to depression than to any other disease that afflicts mankind" (Kline, 1964).

Hammen (Hammen, 1997, p. 3) states that “the term depression is used in everyday language to describe a variety of experiences ranging from a mildly noticeable and transient drop in mood to a profoundly debilitating and even potentially fatal disorder. ".

“The severity of depression is generally defined in terms of the number of symptoms present, the severity of the symptoms, and the severity of associated functional impairment or distress” (Whisman, 2008, p. 66).

This is done by healthcare professionals using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a publication in which each mood disorder is characterized by a unique set of symptoms or diagnostic criteria, divided into 4 areas:

Affective

To behave

Cognitive

Somatic

The cost of depression

Government adviser Lord Layard was already working on a 2004 report describing mental illness as "the biggest social problem facing Britain today". (Layard, 2004)

The report cited the Psychiatric Morbidity Survey, which indicated that one in six Britons would be diagnosed with depression or anxiety at some point in their lifetime. However, only one in four people with emotional disorders receive adequate treatment.

“It has a high cost for the economy (around 2% of GDP) and for the Treasury (again, around 2% of GDP). Currently, there are more people with mental illnesses receiving disability benefits than unemployed people receiving unemployment benefits.

Mental illness matters because it causes massive suffering to patients and their families, prevents them from contributing fully to society, and imposes a high cost on taxpayers” (Layard, 2004).

A British strategy was needed to support people living with depression. The vehicle for this was through the NHS.

In September 2007, “the UK government launched the largest publicly funded mental health initiative ever. According to Health Secretary Alan Johnson, £170 million has been pledged to create "an innovative therapy service in the UK". The service is expected to include an additional 3,500 CBT-trained psychotherapists to be identified and trained by 2011” (Evans, 2007).

What is TCC?

CBT (cognitive behavioral therapy) is the NHS treatment of choice for depression.

According to the Royal College of Psychiatrists (2010); CBT is a form of psychotherapy that involves:

How do you think about yourself, the world and other people

How what you do affects your thoughts and feelings

CBT was developed in the early 1960s by Dr. Beck, a psychiatrist at the University of Pennsylvania. dr. Beck had previously studied and practiced psychoanalysis.

“He designed and conducted a series of experiments to test psychoanalytic concepts of depression. Expecting research to confirm these fundamental principles, he was surprised to find otherwise." Beck Institute website (1999-2009)

"This research led him to look for other ways to conceptualize depression. Working with depressed patients, he found that they experienced negative thought streams that seemed to arise spontaneously.

He called these cognitions "automatic thoughts" and found that their content fell into three categories: negative ideas about oneself, the world, and the future. He began helping patients identify and evaluate these thoughts and found that, as a result, patients were able to think more realistically, which led to them feeling better emotionally and behaving more functionally." ( Beck Institute 1999 - 2009).

According to the NHS Choice website (2010), "Cognitive behavioral therapy differs from most other types of psychotherapy because:

Pragmatic

structured highlighting

Focused on current issues.

collaborative

"Cognitive-behavioral treatments are designed with specific cognitive content in mind because they are disorder-specific" (Scott, 2009, p. 2).

Depression:

Cognitive therapy

"For people with persistent underlying depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, depending on individual preference:

Individual self-help guided according to the principles of Cognitive Behavioral Therapy (CBT)

Computer Assisted Cognitive Behavioral Therapy (CCBT)

A structured exercise program for groups.

medicine

Do not routinely use antidepressants to treat persistent underlying depressive symptoms or mild depression because the risk-benefit balance is poor, but consider them for people with:

a history of moderate or severe depression

initial onset of underlying depressive symptoms that have persisted for an extended period (usually at least 2 years), or

underlying depressive symptoms or mild depression that persist after other interventions.

For people with moderate or severe depression:

For people with moderate or severe depression, clinicians are advised to "provide a combination of antidepressants and high-intensity psychological intervention (CBT or IPT)". (NICE Guidelines 2009)

The Royal College of Psychiatrists (2010) highlights that medicines used in the NHS to treat depression include:

tricycline

MAO inhibitor

SSRIs

IRSN

A TRAP

While medications can help lift a patient's mood, they do not address any underlying issues the patient may have. There are also several known side effects of the drug, including abdominal pain, nausea, headaches, suicidal thoughts, constipation, blurred vision, just to name a few. People react differently to different medications, so until you try them, there's no way to know if you'll be adversely affected.

"Psychological therapies can help patients identify what may have contributed to their depression in the first place and what keeps them depressed." (Depression Alliance UK, 2010)

CBT can be done individually or with a group of people. It can also be done from a self-help book or a computer program.

Unfortunately, there are long waiting lists for CBT in many parts of the country, and people sometimes seek out private therapists rather than wait for an NHS-appointed therapist.

The benefits of CBT in the treatment of depression

The Royal College of Psychiatrists (2009) states: “CBT is one of the most effective treatments for conditions where anxiety or depression is the main problem. It can help patients break the cycle of changing thinking, feeling and behavior. It is the most effective psychological treatment for moderate and severe depression. It's as effective as antidepressants for many types of depression."

This is also supported by Townend, Grant, Mulhern, and Short (2009, p. 254), who state that "CBT remains the psychological therapy with the widest and broadest evidence base."

This is also supported by (Gabbard, Beck, & Holmes, 2007, p. 115): “CBT has evolved in the large number of studies since the original by Rush et al. (1977) demonstrated to be an effective treatment for depression. ”

They go on to say that "CBT produces greater improvement in symptoms than no treatment or waiting-list controls (Dobson 1989) and is equivalent in efficacy to pharmacotherapy for depression."

This is also supported by (Freeman and Power, 2007, p. 30) who state: “There have been numerous supportive RCTs (for a review, see Clark, Beck, and Alford 1999; De Rubeis and Crits-Christophe 1998; Dobson 1999; Robinson, Berman and Neimeyer 1990)” (Freeman and Power, 2007, p. 30).

According to (Ingram, 2009, p. 174) “In the acute phase of treatment, combination therapy consisting of medication and CBT has been shown to be superior in patients with more severe, recurrent, or chronic forms of depression, either as medication or as a TCC. just".

(Gabbard, Beck & Holmes, 2007, p. 115) state that "one of the most important potential benefits of CBT for depression is that it reduces relapse/recurrence to a greater extent than antidepressants".

“Today, CBT remains the gold standard for treating depression with psychotherapy” (Wasmer-Andrews, 2009, p3).

The limitations of CBT in the treatment of depression

While highly acclaimed, CBT has its limitations and, indeed, its detractors.

As for the limitations, they are listed below:

To benefit from CBT, the patient must be committed to the process. A therapist can help and advise, but cannot solve a person's problems without the patient's cooperation (NHS Choices, 2010). Therefore, the patient must be open to CBT and do their part in their recovery, including participating fully in any therapy and doing their "homework" to recover from depression.

This is also highlighted by the Royal College of Psychiatrists (2009) who state that “CBT is not a quick fix. A therapist is like a personal trainer who advises and encourages but cannot "do it" for a patient.

When a patient is feeling depressed, it can be difficult for them to focus and be motivated. (Royal College of Psychiatrists, 2009)

Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties. (National Health Service Decisions, 2010)

This is supported by (Wasmer-Andrews, 2009, p. 3) who states that "CBT has limitations in treating certain groups, including those with treatment-resistant depression and those with depression and personality disorder."

Critics of CBT argue that because the therapy only addresses current issues and focuses on very specific problems, it fails to address possible underlying causes of mental illness such as mental illness. B. an unhappy childhood. (NHS Decisions, 2010). This can be done with a diagnostic examination under hypnosis, when hypnopsychotherapy can be used.

CBT focuses on the individual's ability to change themselves (their thoughts, feelings and behaviors) and does not address broader issues in systems or families that often have a significant impact on an individual's health and well-being. (National Health Service Decisions, 2010)

The Royal College of Psychiatrists (2009) states: “In major depression, CBT should be used in conjunction with antidepressants. If a patient is in very bad shape, it can be difficult for him to change his thinking until the antidepressants start to make him feel better."

Critics of CBT in treating depression

As with all clinical theories, criticisms of CBT vary according to the mind of the analyst.

Townend, Grant, Mulhern and Short (2009, p. 254) point to many of these discussions. “Specific questions have been raised about, for example, the need for challenging thinking in CBT (Longmore & Worrell, 2007); and cognitive interventions for major depression (Dimidjian et al., 2006).

Furthermore, there is still debate (eg Gilbert and Leahy, 2007) about the nature and effects of the therapeutic alliance as causes of the observed changes in CBT”.

Weiner, Freedheim, and Stricker (2003) note that “Although the reach and effectiveness of CBT is impressive, much work remains to be done. In particular, future efforts by CBT clinicians should demonstrate the effectiveness of treatments outside of research settings and pay more attention to disorders that CBT misses (eg, personality disorders).

Kotler and Shepard (2008) emphasize that “people are multifaceted, with feelings and thoughts. It has been suggested that CBT overemphasizes thought processes to exclude many legitimate feelings, thus contributing to the suppression and denial of feelings.

They highlight another criticism of CBT as follows: "CBT is less effective with some types of clients: those who have problems with excessive intellectualization, or those who lack the ability to reason logically, or clients with minimal intelligence. (for example, young children, the elderly, schizophrenics, and people with other personality disorders).

Many CBT therapists complain of boredom and exhaustion from constantly repeating the same arguments and processes with every client.

CBT is difficult for some people and some professionals to practice unless they are outgoing, confident, and disinclined to engage in vigorous debate and confrontation.

Because the therapist's role is so verbal, active, and direct, the client may feel overwhelmed, dominated, and not responsible for the outcome. (Kotler and Shepard, 2008)

o debate

There is much debate about CBT as a treatment for depression on the NHS.

Oliver James' article (James, 2006) summarizes much of this debate. He notes that “depression and anxiety cost the (British) economy £17 billion a year. Because CBT is cheap, quick (15 to 20 sessions) and easy, it appeals to the government.”

In fact, in June 2006, Professor Richard Layard, dubbed the government's 'lucky czar', claimed that CBT can lift at least half of those affected out of their chronic depression or anxiety (James, 2006).

Another appeal to the government is that "CBT aims to get you to a point where you can do it all yourself and work through problems without the help of a therapist." (NHS Decisions, 2010). It is argued that the use of CBT could reduce future treatment costs for current users.

There is also now computer-assisted CBT, which has been approved by the NHS (Beating the Blues) to treat depression. (NHS Decisions, 2010).

Again, this is an inexpensive treatment for some people who would rather use a computer than talk to a therapist about their private feelings. (National Health Service Decisions, 2010)

In a follow-up article in March 2009 (James, 2009), he reignited the debate when he reported that "CBT is not a real cure, just a form of personal perversion".

Furthermore, he argued that the work of "the eminent American psychologist, Professor Drew Weston, found that after two years, two-thirds of those who received CBT for depression either relapsed or sought further help".

It is important that patients continue to practice their CBT skills even when they feel better. Some research suggests that CBT may be better than antidepressants at preventing depression from recurring. (Royal College of Psychiatrists, 2009)

James (2009) further argued: “Without treatment, most people with depression will drift in and out of it. After 18 months, those who receive CBT do not have better mental health than those who do not receive treatment.

On the other hand, in the same article by James (2009), Derek Draper, CBT practitioner and author, explains that CBT “is based on the obvious truth that our feelings are inseparable from the way we think and behave”. It's not remotely scary and very simple, and it works. CBT has helped many of my patients.”

new search

According to the website of the Royal College of Psychiatrists (2009), “Cognitive behavioral therapy (CBT) is most effective in patients who have had four or more episodes of depression, according to new research from the Netherlands.

The study, published in the December issue of the British Journal of Psychiatry, suggests that GPs could use the number of previous episodes to determine which patients are likely to benefit most from therapy and prescribe treatment accordingly.

In another recent study, a comparison of a CBT website with an informational depression website found that, after 6 months, only the CBT website was significantly effective in reducing symptoms. After 1 year, both interventions were significantly better than neither intervention (control condition).

Research has shown that brief CBT transmitted over the Internet can be effective in reducing depression, but it is unclear whether these benefits are sustained over time.

The aim of this Australian study, published in the February 2008 issue of the British Journal of Psychiatry, was to see whether the benefits of Internet-delivered brief psychoeducation and CBT were still present 6 and 12 months later, compared to a control condition. Participants were asked about their lifestyle.

Summary

In summary, CBT is the NHS treatment of choice for moderate to severe depression and, after reviewing all the benefits and limitations and reading critics and advocates, the author feels that there is still much to be learned and evaluated in the treatment of depression.

Although the results so far seem to show that CBT is very effective in treating moderate to severe depression, there are large groups of people who will not benefit from this treatment, for example young children, people with personality disorders, those suffering from depression in old age.

The author points out that there is no universally acceptable treatment for everyone - that some treatments work for some people with some therapists and other treatments work for others with a different therapist - the client's willingness to seek help plays a role in their recovery along with The chosen therapy sometimes helps some people. But what about the long term? Is that a band-aid on a cut? CBT can help in the here and now, but relapses can be at the root of the problem when they are in the past and are often not discussed in a present-focused CBT session.

Whilst the cost of depression to individuals, families and businesses is enormous, the author believes that the government has taken very positive steps through the NHS to try to help people with depression by encouraging the use of 'illness therapies'.

If more studies are commissioned in the future, new information will be obtained and new decisions will be made based on it. For now, the adoption of "talking therapies" is a very good step in the right direction, and it is hoped that other therapies will continue to be evaluated so that patients of the future will be able to choose between "talking therapies", including CBT. , but also others like Life Coaching, NLP and Hypno-Psychotherapy.

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