Cognitive Behaviour Therapy (CBT)

CBT is the therapy of choice for many psychological problems. It has in recent years become available in Hastings, and has also been rolled out nationally. HOT columnist Sean O’Shea interviews a local CBT Therapist and asks: What’s CBT?

Sean O’Shea (SOS): What’s the origin of Cognitive Behaviour Therapy?

Therapist (T): CBT has evolved from two main strands within psychology: firstly, behaviour therapy, developed during the 1950s and 1960s by Wolpe and others as a reaction to the tradition of Freudian psychoanalysis, focusing on behaviour and what was observable as opposed to unconscious processes and hidden motivation; secondly, cognitive therapy, developed by A.T. Beck during the 1960s, which endeavoured to overcome some of the limitations of a purely behavioural approach by taking into account mental processes such as thoughts, beliefs and interpretation of events.

SOS: Why did the government feel it necessary to provide therapy for people, and why was CBT the treatment of choice?

T: In 2006 the Labour government introduced a programme known as IAPT – Improving Access to Psychological Therapies – arising from a report by health economist Lord Layard, aka “the happiness guru”. The incentive for this was predominantly economic, the rationale being that providing therapy for people who were unfit to work due to depression and anxiety would achieve considerable savings in sick pay and sickness benefits. A moral argument was also put forward relating to long waiting lists and inconsistent treatment for those with mental health problems, with very little access to talking therapies. The programme, which proposed training 36,000 new staff, opted to use CBT as the predominant treatment modality. This was based on the National Institute of Clinical Evidence (NICE) guidelines which demonstrated that CBT could be as effective as drug therapies in the treatment of depression and anxiety. CBT has always prided itself in being evidence-based (drawing extensively on randomised control trials to demonstrate its efficacy), while other therapies have been slower to recognise the benefits of this.

SOS: What sort of problems is it helpful with?

T: Research presented by Roth and Fonagy (2005) in What works for whom? and by NICE demonstrates that CBT is effective in the treatment of depression, panic and agoraphobia, generalised anxiety disorder (GAD), specific phobias, social phobia, obsessive compulsive disorder (OCD), post-traumatic stress disorder, anorexia, bulimia, schizophrenia, bipolar disorder, and some personality disorders.

SOS: How does one get CBT? What’s the referral process?

T: Since the IAPT programme was instigated (2008 onwards), CBT has become widely available through the NHS and the most common route for referral is through your GP. Waiting lists vary according to area. Private practitioners can also be accessed through the website of the British Association of Behavioural and Cognitive Therapists (BABCP).

SOS: What is expected of the person receiving the therapy?

T: CBT is a structured approach with treatment goals which are agreed at the beginning of therapy. An agenda is set at the start of each session, and clients are usually expected to complete “homework” between sessions, which can involve recording thoughts or completing agreed tasks. For someone with an anxiety problem this may involve conducting a “behavioural experiment” – deliberately putting themselves in a feared situation which can help to demonstrate that they are over-estimating the danger and underestimating their ability to cope with it.

SOS: What is the role of the therapist?

T: Initially the therapist will help the client to understand their problem and what is keeping it going – sometimes referred to as a maintenance cycle. They are often given reading materials to help support this process. CBT is essentially a collaborative process, with both client and therapist participating equally and agreeing each step along the way. CBT uses a technique called guided discovery – based on principles developed by the Greek philosopher Socrates – to enable people to clarify their thoughts and beliefs and find for themselves a different and more helpful perspective. In some cases the therapist will work with the client in live situations outside the therapy room to provide extra assistance.

SOS: How long does it last?

T: CBT is a time-limited therapy and the number of sessions will depend on the problems experienced by the client. Local services are likely to offer up to twelve sessions, though for more complex or longer-term problems, e.g. OCD, more sessions may be indicated. In some cases (e.g. with a simple phobia) six sessions or even less can prove effective.

SOS: Could you give some case examples of how it works, anonymously of course?

T: People’s lives are often severely restricted by their anxiety about certain situations or their depressed mood. Someone with panic disorder may not be able to do simple things like shopping in their local supermarket. Someone with a phobia of needles may be putting their health at risk because they are unable to undergo blood tests or receive necessary injections. Someone with depression may be cutting themselves off from the very things that may enable them to feel good about themselves and the world.  Avoiding situations, seeking reassurance, trying to find ways to feel safe may appear to help, but usually prolong these difficulties. CBT helps to unravel this and find solutions, helping individuals to confront and overcome their fears, or to change unhelpful styles of thinking and see things from a more realistic perspective.

SOS: Are there problems for which it is not appropriate?

T: For those who want to spend time examining their childhood experiences or who want to resolve relationship problems or be supported after bereavement, other talking therapies, such as counselling, IPT (interpersonal therapy) or psychodynamic therapy may be more appropriate.

SOS: Do you enjoy being a CBT Therapist?

T: Although my work involves supporting people who are distressed, enabling individuals to find solutions to their difficulties and live their lives more fully is immensely rewarding.

SOS: Thank you for agreeing to be interviewed by Hastings Online Times.

Jan 2013

Note: The therapist requested that they remain anonymous for this interview

 

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