Saturday, 5 November 2011

Is Cognitive Behavioural Therapy really the answer to Britain's depression 'epidemic'?


So there are going to be even more CBT therapists - on top of the 10,000 we’ve already been promised, the Health Secretary has just announced plans to fast-track hundreds more. All these therapists are going to cost millions (around £250million). So what a waste it would be if the Government’s psychotherapy plans were founded on false evidence of what works. Throwing away taxpayers’ money wouldn’t be the worst of it. Think of the thousands of people suffering from anxiety and depression who would have their hopes raised then dashed. Luckily, despite what the doom-mongers are saying, that’s not what is about to happen. In fact, the Government’s plans are a once-in-a-lifetime chance to cure many of the one in six of us who suffers from these conditions. Sadly, such exciting possibilities are lost on some critics who rail against the type of therapy that will be offered - CBT. This treatment draws on the obvious truth that how we feel is inextricably linked to the way we think and behave. It isn’t remotely sinister and is rather simple - and it works. Many of my patients have been helped by CBT. Sally’s was a typical case. A 42-year-old mother of two, she had been depressed for a year. She tried to put a brave face on things, but knew it was affecting her kids, and that was breaking her heart. Looking at her thought patterns, it was clear that she believed she was a failure and couldn’t do anything right. This meant she had stopped trying to do new things and had become withdrawn. But when together we looked for evidence to support these negative thoughts, it wasn’t there. Despite thinking otherwise, Sally was a good mother and people liked being around her. But her depression had skewed her perception. We started to make a list and focused on these positives, and slowly Sally’s mood lifted. Eventually, she had the confidence to do voluntary work. This led to a further reappraisal of those negative thoughts and she began to see that she was far from a failure. That process, examining our thoughts, testing them against reality and finding a new, more realistic script lies at the heart of CBT. It is not about brainwashing people with positive thoughts; it is about replacing negative thoughts with more realistic ones. Of course, it doesn’t work for everyone. Lord Layard, the economist who’s the inspiration for this expansion of NHS therapy, thinks it will help half of all those who are treated. Some people just don’t take to its approach and others have deeper problems. Cost is, of course, a factor. CBT is quicker as it usually involves 16 weeks therapy, whereas other therapies tend to be open-ended and are, therefore, more expensive. Maybe cost shouldn’t be a factor, but it always will be. What about those other therapies, I hear Oliver James and others ask? The truth is, there is more evidence for CBT’s efficacy, and in an age of evidence-based medicine those other therapies will always be on the back foot. In any event, of course, in the modern NHS patients are supposed to be offered a choice. Here, I do have some sympathy with the scheme's critics. I think other therapies should also be on offer, and I suspect, over time and given local realities they will be. But I won’t have people undermining the Government’s plans. I have seen CBT work. It was CBT therapy, in 1998, that first made me hopeful that my depression could be cured. Like many, I needed deeper therapy, too, but many others don’t want to dig deeper if they don’t have to. That is why CBT is a good first foundation for this new psychotherapy service. Therapists spend a lot of time trying to get patients to give up knee-jerk negativism and embrace the hope that things might turn out better than they expect. With all due respect, I would give the same advice to the critics of CBT.  * Derek Draper's book Life Support: A Survival Guide For The Modern Soul is published by Hay House on April 2 (£8.99). WHAT IS CBT?                                                                    CBT is a short-term psychological treatment based on the idea that negative thinking and behaviour can trigger problems such as depression or panic attacks. During treatment, the therapist helps you identify these negative thoughts - and encourages you to work out a way of looking at things more positively. CBT is used to help with a wide range of mental health and physical conditions, including phobias, anger, relationship problems, sleep problems and eating disorders. The process was developed by the American psychiatrist Aaron Beck in the Sixties. He believed that our emotions and moods were influenced by our patterns of thinking. But rather than focusing on past events in your life such as your childhood - as most of the older psychotherapies do - CBT focuses on the here and now. Sessions of CBT usually last around an hour - it’s common to have between six and 16 sessions during a course of treatment. If you feel CBT may be suitable for you, talk to your GP about a referral - it is available on the NHS, but there is usually a waiting list of several months. There are private CBT therapists, who charge around £50 to £100 a session. But first check that your therapist is registered with the British Association of Behavioural and Cognitive Psychotherapies (BABCP).