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: https://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.