How effective is CBT in treating depression?
CBT was the first form of therapeutic intervention to apply scientific testing methods to validate its practice in the 70’s , and to measure the effectiveness of treatment. There are now 40 plus years of evidence based practice to draw on.
One of the largest studies conducted on psychotherapy efficiency was by Roth and Fonagy 2005, ‘what works for whom’ which showed that CBT works for most of the psychological disorders in adults they studied, and has more support in more kinds of problems than any other therapy.
In the UK CBT is recognised as a treatment for Depression, Generalised Anxiety Disorder and Panic and PTSD by the National Institute for Clinical Effectiveness (NICE ) . This is the agency which reviews studies and recommends treatments which are to be made available to the NHS.
- Depression NICE 2004a – For patients with mild depression, healthcare professionals should consider recommending a guided self help programme based on cognitive behavioural therapy.
- Depression NICE 2004a – When considering individual pscyhological treatment for moderate to severe and treatment resistant depression, the treatment of choice in CBT
- Eating disorders NICE 2004b Cognitive behavioural therapy should be offered to adults with bulimia nervosa…..and binge eating disorder
- Generalised anxiety and panic 2004c – The interventions that have evidence for the longest duration of effect, in descending order are (first) cognitive behavioural therapy…
- Post traumatic stress disorder (PTSD) NICE 2005 All people with PTSD should be offered a course of trauma focused psychological treatment (trauma focused cognitive behavioural therapy CBT ) or eye movement desensitisation and reprocessing EMDR…
What happens when I come for counselling with you?
- The first session is an introductory session – which is generally an outline of what brought you along and what is it you are looking to get out of it.
- We might look at an assessment of your current mood and the impact that this is having on your life; ie sleeping, eating, drinking patterns. What is happening with your relationships, your family and social life. And how this is affecting you physiologically, ie sore head, stomach complaints, stiff neck etc; .
- If its appropriate, CBT will be introduced as a psychoeducational approach to therapy, explaining how you can be your own ‘therapist’. How you can learn to understand why you are feeling the way you are, to recognise the thought patterns behind these feelings, and helping you challenge and change them.
- Sounds fairly straightforward, however, it is very much a collaborative approach
- You need to be fully engaged, honest and open to change.
- I won’t know what is going on in your mind, you are the expert in that
- I can help by offering insights into greater awareness, and to facilitate your understanding. I can give you the tools that will help you work out whether or not what is going on in your head is rational and helpful – or if it needs to be challenged and changed. If you have a look at some of the posts – there is an introduction to the ABC model and negative automatic thoughts, which give an indication of some of these tools.
- Although CBT concentrates on the present, and how your thoughts impact on your feelings today. There will often be references to past issues, and how these are still affecting you; my training as a person centred counsellor means that I am willing and able to help explore these issues at depth, and to help put them in a context of the ‘here and now’ approach of CBT.
- In the sessions we look at breaking down problems or issues; And trying to identify the root causes of some of the feelings and behaviour. So, after you have identified some of the thoughts that have led to these feelings, and how you can challenge and change them – we look at “homework” nothing too onerous, usually along the lines of trying to put into practice what we have gone through in the session, getting a notebook and paying attention to your moods, to recurrent thought patterns, what you are telling yourself when you are upset. Depending on the situation, you might be asked to:
- keep a drinks/ food diary – to establish your drinking or eating patterns
- recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
- keep a thought diary – to identify negative automatic thoughts
- practice being more assertive – saying ‘I will get back to you’ instead of automatically saying Yes
- At each meeting you discuss how you’ve got on since the last session. We will look at whether you have manged to do the homework and whether or not they seemed to be helpful or effective, and if the tasks seem too hard or don’t seem to be helping, that forms part of the session too.
- You won’t be asked to do things you don’t want to do – you decide the pace of the treatment and what you will and won’t try
- One of the major strengths of CBT is that you can continue to practice and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.
- Each session starts with an agenda, which goes through feedback from previous session, homework, goals and any issues that arose since the last session
How long will the treatment last?
It will depend on the type of issue that you are bringing to therapy and that you want to work with. Factors such as the length of time, the severity of symptoms, your own mood as well as your ability and willingness to collaborate will all have an influence.
In my experience, most people are able to gain significant improvement in their symptoms and mood – after 6 to 8 sessions.
Where the issues are complex, and the depression or anxiety is more chronic and long term, generally 12 to 16 sessions are indicated.
I am happy to be flexible about whether these sessions are weekly, fortnightly or monthly.
I generally start off weekly, and then allow more time between sessions to put things into practice.
What if the symptoms come back?
There is always a risk that the anxiety or depression will return.
If they do, your CBT skills should make it easier for you to recognise and control them.
Its important to keep practicing your CBT skills, even after you are feeling better.
There is some research that suggests CBT may be better than antidepressants at preventing depression coming back.
I am also happy to offer sessions on an ad-hoc basis, when specific issues come up in future that might be difficult to deal with and threaten relapse.
Although most people report that they are able to deal much better with situations that may have floored them in the past.