Counselling Articles & News

In our press release on the 24^th of March, “Cognitive Behavioural Therapy on the Rise at Harley Therapy, London” showed how enquiries about Cognitive Behaviour Therapy (CBT) are increasing. Therapists practicing at Harley Therapy offer a wide variety of approaches, but they have seen a particular increase in interest in Cognitive Behaviour Therapy since 2006. As Clinical Director of Harley Therapy, Sheri Jacobson wrote about how the increase in popularity of Cognitive Behavioural Therapy may partly be due to the government’s endorsement within the IAPT (Improving Access to Psychological Therapies) initiative, which has generated publicity for the approach. Furthermore, individuals experiencing positive results when trying the therapy spread the word to their friends and family. The fact that CBT produces results a lot faster than other therapies also plays a part in its increasing popularity. The article stated how CBT is more easily quantifiable than other therapies, which makes it easier to prove its’ effectiveness, and looked at the process CBT uses to bring about positive change.  So why is Cognitive Behavioural Therapy becoming so popular with people seeking help on a variety of issues? What are the potential limitations of this form of therapy, and is it suitable for everyone?

Factors affecting the increase in popularity of Cognitive Behavioural Therapy

Accessibility

A major factor of the popularity of Cognitive Behavioural Therapy is its accessibility.

There has been a big increase in the number of CBT therapists available on the NHS – in 2007, the government earmarked £173m to train an extra 3,600 therapists in the approach by 2010 (figures from The Independent, link at the end of the article) Furthermore, following the trend there has been an increase in health insurance providers who cover talking therapy as part of their healthcare policies. Some therapists at Harley Therapy accept clients covered by their health insurance. These combined factors mean that CBT is more readily available to people seeking therapy. In addition to this, Cognitive Behavioural Therapy can produce relatively rapid results, which mean it may be more affordable than more traditional time-intensive therapies. In an easy to read book Brilliant Cognitive Behavioural Therapy, Dr Stephen Briers writes on how the underlying principles of CBT can be mastered relatively quickly, meaning courses of therapy following the CBT model can be time limited and equip people with skills with in a few months (full reference below). David Clarke, Professor of Psychology and Director of the Centre for Anxiety Disorders and Trauma at Maudsley Hospital, says depending on the issue being worked through, a course of Cognitive Behavioural Therapy could last between six and twenty sessions.

Secondly, to use a different meaning of the word accessibility, the principles of Cognitive Behavioural Therapy are more easily understood than more complex theories, and are therefore relatively easy to learn. This helps empower the client who is undertaking the therapy.

Skills-based approach

Linked to this idea of empowerment is the fact that CBT is skills-based and takes an educational approach. It consists of being introduced to techniques that can be used to tackle issues such as negative thinking, and practising using them, with the facilitation and assistance of the therapist. It may involve “home work” of exercises to do at home, such as making a log of feelings. The focus is on a client learning skills needed for them to tackle their own problems, and solve problems on their own. These techniques, once learnt, can be used in the future and are useful when other issues come up. This means the therapists’ role is to help equip clients with skills and help them practice these, rather than be an expert that “fixes” problem. Therefore some people will find this approach less threatening, and also reduces the risk of emotional dependence upon a therapist.

Research evidence

Another important factor is CBTs recent unprecedented track record of research indicating its effectiveness. In the last press release it was mentioned that the standardised measures used in CBT meant it was more quantifiable, and usefulness could be measured more easily. The National Service framework, used by the NHS, classifies the quality of evidence that is used in support of effectiveness. Research into Cognitive Behavioural therapy has been classified “level 1” evidence, which means at least one randomised controlled trial and one good systematic review has been undertaken with positive and significant findings (cited in an article by Jeremy Holmes, 2001, link below). However it is worth highlighting other therapeutic approaches also received honourable mentions.

A thorough study into “What Works For Whom?” conducted by Roth & Fonagy, 2005, showed that there is a body of methodologically sound research studies that provide strong evidence Cognitive Behavioural therapy is helpful in treating major depressive disorders, social phobias, generalised anxiety disorders, panic disorders, post-traumatic stress disorder, bulimia, and some of the behavioural problems that autistic children may experience. There is also some evidence to suggest is can be useful in treating bipolar disorder, obsessive compulsive disorders, anorexia nervosa, cocaine abuse and sexual problems. (cited in Brilliant Cognitive Behavioural Therapy, Dr Stephen Briers, 2009)

Therapy has also be reported to be as effective as anti-depressants for many types of depression by the Royal College of Psychiatrists, which makes it an attractive choice for people who may not want to use conventional drug treatments (website address below). In the Independent, the National Institute for Health and Clinical Excellence (NICE) recommends CBT should be the first approach treatment for mild and moderate depression, followed by drug treatment only if it is unsuccessful in producing positive change .

Quantifying improvements

Cognitive Behavioural Therapy seeks to measure the gains clients benefit from in observable and concrete terms. For example, during CBT, clients may be asked to frequently rate the intensity and occurrences of negative thoughts. A person experiencing anxiety may be asked to gauge the intensity of the anxious feelings from 1 to 10, whilst thinking about a situation that makes them nervous. If, during or after a course of CBT, they repeat the exercise and rate their level of negative feelings lower, this is a reasonably quantifiable, albeit subjective, demonstration that the client feels they have undergone positive change. This means it is possible to look at improvements made through CBT in measurable and more scientific terms than it is in other forms of therapy.

The need for careful assessment of most suitable therapeutic approach

However Cognitive Behavioural Therapy will not suit everyone, and its’ increasing popularity may mean conventional therapies that may be more useful for a particular person are overlooked. Another type of talking therapy may be more helpful to an individual than CBT. For this reason, assessment therapists should be able to discuss which approach they feel would be most beneficial.

Limitations of CBT

Although CBT produces faster results than some conventional therapies, it is not a “quick fix” and requires effort and commitment. When an individual is feeling low, it may be harder than usual to summon the energy and concentration to work on the exercises. Furthermore, to overcome anxiety and negative thinking patterns, it is necessary to confront them and work through them. This may be very hard in the beginning if individuals have spent years trying to suppress or ignore these feelings. Confronting these feelings may create more anxiety in the short term.

Severe depression, CBT and medication

Furthermore, Cognitive Behavioural Therapy cannot take the place of medication, if it is necessary. Depression can have psychological, physical and social symptoms, and can interfere with everyday work, social and family life. Mild and moderate depression may make daily life seem hard to cope with and seem less worthwhile, and have a significant impact on your daily life.  However, if you have a lack of interest in doing anything at all which makes daily activities almost impossible, or physical symptoms such as excessive tiredness or loss of appetite, you may be suffering from severe depression. For people suffering severe depression, a medical diagnosis may be needed to determine whether medication is necessary. A visit to a GP could be a first step. Psychiatrists at Harley Therapy can offer diagnostic evaluations and treatment programmes if needed. There are different types of antidepressant treatments available and a psychiatrist can help determine which one may be most appropriate. All have side effects, so it’s important to get as much information possible about it to make sure to find the one that suits you best. (see BUPA fact sheet, link below) Cognitive Behavioural Therapy also cannot take the place of antidepressant medication, if it needed to help treat severe depression.  As Cognitive Behavioural Therapy involves effort and self discipline, it may need to be used alongside medication, because changing thinking patterns may seem impossibly difficult until antidepressants have started working to make you feel better.

Recurrence

Finally, BUPA state about half of people who have an episode of depression will have another episode (BUPA fact sheet). Over a period of 15 years, almost 90% of people that have suffered an acute depressive episode will face a recurrence of symptoms. (Nierenberg, Petersen & Alpert, 2003)

If stressful events arise in life, and feelings of anxiety, depression or other negative feelings return, the skills learnt through Cognitive Behavioural Therapy should help you tackle them and keep them under control. Some evidence on the Royal College of Psychiatrists website suggests CBT may be more effective than anti depressants in preventing depression from coming back. This demonstrates how a course of Cognitive Behavioural Therapy can have long reaching positive consequences.

References/ Further reading

Cognitive Behavioural Therapy London (CBT) London

All you need is cognitive behaviour therapy? Jeremy Holmes, 2001

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122202/

Cognitive-Behavioral Therapy for Generalized Anxiety Disorder – What CBT is and Why it Works William Meek, 2001  http://gad.about.com/od/treatment/a/cbt.htm

Royal College of Psychiatrists website, clear online leaflet http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx

Depression, online factsheet published by Bupa’s health information team, April 2008.

http://hcd2.bupa.co.uk/fact_sheets/html/depression.html

Q and A with David Clark , professor of psychology at King’s College London and director of the Centre for Anxiety Disorders and Trauma at Maudsley Hospital. http://www.nhs.uk/Conditions/Cognitive-behavioural-therapy/Pages/Questionstoaskpage.aspx

The Big Question: Does cognitive therapy work – and should the NHS provide more of it for depression? Jeremy Laurence Health Editor, The Independent

http://www.independent.co.uk/life-style/health-and-families/health-news/the-big-question-does-cognitive-therapy-work-ndash-and-should-the-nhs-provide-more-of-it-for-depression-1925439.html

Nierenberg, A. A. Petersen ,T.J. Alpert, J. E. (2003) Prevention of Relapse and Recurrence in Depression: The Role of Long-Term Pharmacotherapy and Psychotherapy, The Journal of Clinical Psychiatry Vol 64, 15 At http://www.psychiatrist.com/pcc/pccpdf/v05s09/v64s15.pdf

Briers, S. (2009) Brilliant Cognitive Behavioural Therapy, Harlow: Pearson Education Limited

Author: Emma Bender

Harley Therapy: Cognitive Behavioural Therapists London

PressRelease: London, 24 March 2010. Enquiries have continued to grow for cognitive behavioural therapy (CBT) since Harley Therapy, a therapy service in Central London, first observed a growing trend in 2006. More established talking therapies, such as psychodynamic, gestalt, existential, person-centred or psychoanalytic therapy now appear to have been overtaken by CBT.

45% of enquiries for adult individual therapy (not including couples therapy, or child & adolescent counselling)) over the past 3 months have been for Cognitive Behavioural Therapy rather than any other therapeutic approaches on offer.

Clinical Director, Dr Sheri Jacobson believes that the popularity of CBT stems partly from the government’s roll out of CBT programs incorporated in the IAPT initiative (Improving Access to Psychological Therapies). IAPT was set up to support NHS Primary Care Trusts in implementing NICE (National Institute for Health and Clinical Excellence) guidelines for individuals suffering with depression and anxiety. It offers a stepped level of care starting with assessment and guided self-help and moving on to delivery of CBT in the cases of most mental health issues. CBT will be offered for panic disorder, social phobia, generalised anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and depression*. See NICE guidelines for full details guidance.nice.org.uk

“There has been a lot of publicity related to CBT programs within IAPT which is helping to inform the public about CBT and the types of issues it can help with.“ says Dr Jacobson. She finds that word of mouth is also spreading; “individuals with positive experiences of CBT have been recommending it to others. We are getting more enquiries from individuals saying that their friends/colleagues have had a course of CBT and suggest they give it a try.” Many of Harley Therapy’s referrals come from local private GPs and psychiatrists. These health practitioners will be aware of the range of approaches to therapeutic treatment, and yet the majority of their referrals are now for CBT. “In part this is due to the fact that CBT can bring symptom relief quicker than with other therapies, and thus client’s feedback of CBT therapists tends to be more positive. As more health practitioners are recommending CBT, more of the public is alerted to its existence and its advantages. Internet users are openly discussing the benefits of CBT for conditions such as OCD, panic and anxiety on website forums such as stuckinadoorway.org”

Additionally, the economic downturn seems to be impacting the private therapy sector. However, rather than falling referral rates, the administration team at Harley Therapy have observed a shift in the types of referrals. Cognitive Therapy may be viewed as more economical – it is designed to be a short-term therapy, spanning over 6 to 20 sessions. Much depends on the complexity of the presenting issues, how long-standing the issues are and the extent of the client’s goals. However, on average, CBT therapy is much shorter-term than conventional therapies (psychodynamic, humanistic, existential, gestalt, interpersonal) and can help with cost-saving.

Another interesting shift observed at Harley Therapy is that individuals are turning to their private health insurance to cover the cost of the sessions. “Since the start of the year, we have witnessed a significant increase in requests for appointments with therapists who are registered with the major health insurance groups such as BUPA, AXA PPP, Cigna and Pruhealth. Providing that certain criteria are met, policy-holders can receive private therapy free of charge. More and more prospective clients would rather claim on their insurance rather than pay from their own pockets” says Jacobson.

But is CBT really that effective? CBT has been subject to numerous trials, and compared to other interventions. In the majority of studies, it comes out on top.

One reason why CBT is believed to be more effective than other studies, is due to the fact the other therapies are not always quantifiable. An integral part of CBT is the use of standardised measures, which means that progress can be quantified. The same cannot be said of the more traditional therapies, which may focus less on measures and inventories. However, this still cannot explain the positive feedback that clients usually give after a series of CBT sessions, and why they go on to recommend it to others.

CBT has a unique set of features which may explain its effectiveness. Once a client’s main problems are formulated and goals are set, the therapist and counsellor work to revise negative thought patterns and unhelpful behaviours. CBT makes use of tailor-made exercises – clients may test their negative predictions and try new ways of acting. It is these cognitive and behavioural shifts which can bring about new discoveries and associated improvements in mood.

The biggest danger of the rise in popularity of CBT is the misperception that it can help everyone, and indeed rid individuals of their problems. Whist many CBT clients will notice improvements, no permanent ‘cure’ is offered. Any improvements are achieved by acquiring a set of tools, and clients are encouraged to practice these skills and become their own guide. After initial improvements are made, ongoing commitment and hard-work are required to maintain these.

CBT does not suit everyone, and not all CBT therapists are the same. Some individuals have undergone CBT only to find they progress further with another therapist or a different approach. Many psychological issues that are deep-rooted and complex may do better under a psychodynamic or existential perspective. Other issues such as bereavement may do better with a humanistic counsellor.

There is a danger that conventional talking therapies are overlooked. It is useful for the public to learn about the different therapeutic approaches so they can make informed choices. Harley Therapy produces a number of theses: http://www.harleytherapy.co.uk/counselling/ If individuals are seeking therapy in the private sector, it can helpful to be assessed by a counselling psychologist trained in a variety of approaches.

There is no doubt that CBT is on the rise, and this is a trend that looks set to continue.

* Counselling, couples therapy or interpersonal therapy may additionally be offered for depression, and EMDR (eye-movement desensitisation and reprocessing) may be offered for Post-traumatic-stress disorder.

Harley Therapy offers a full range of talking therapies at Harley Street offices including Cognitive Behavioural Therapy CBT London, Psychodynamic, Existential, Person-Centred and Gestalt Therapy.

1-7 Harley Street, London, W1G 9QD
0845 474 1724

CBT London.

Cognitive therapy London, CBT Counselling London, cognitive therapist, cbt Psychologist, cognitive counsellor, cognitive behavioural therapy, cognitive Psychiatrists, central London, city london

Cognitive Behavioural Therapy is premised on the idea that thoughts, moods, behaviours and physical sensations are interconnected. Changes in our thoughts and behaviours can have an impact upon our mood. The essence of cognitive work is to examine underlying thoughts and beliefs behind the emotional disturbances and to generate alternative, more balanced thoughts. This in turn will generate more positive feelings. Cognitive therapists aim to examine and challenge your thoughts and your behaviour to help improve how you feel. To this effect, they are trained to use a number of tools including Daily Thought Records and Behavioural Experiments.

CBT is  an evidence-based therapy treatment for conditions such as depression, stress, anxiety, trauma, eating issues, low self-esteem, anger management, relationship difficulties, work and career issues and phobias / obsessive compulsive disorder.