CBT "does not work” says second high-profile clinical psychologist

March 20, 2009
by Angela Hussain

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A second high-profile clinical psychologist has delivered a hard-hitting criticism of cognitive-behavioural therapy (CBT) claiming it is simplistic and “does not work”

Dr Oliver James accused government ministers of being "downright dishonest” when they claimed that new NHS CBT-trained therapists will cure half of 900,00 people of their depression and anxiety.

"“There is not a single scientific study which supports that claim,” says Dr James.

"Being cheap, quick and simplistic, CBT naturally appeals to the government. Yet the fact is, it doesn’t work,” added Dr James.

His attack in a newspaper column follows that of clinical psychologist Dorothy Rowe. Writing for psychminded.co.uk Dr Rowe said CBT was a "Labour quick fix”.

But CBT supporters say Dr Rowe’s views represented an "out-of-date tirade”.

The National Institute for Health and Clinical Excellence states CBT has a solid evidence base for effective treatment for a number of diagnoses, including depression and schizophrenia.

But Dr James quoted a review of CBT by Professor Drew Weston and colleagues in the 2004 Psychological Bulletin (130, 631 663).

"Weston found that two years after treatment, two-thirds of those who had CBT have relapsed or sought further help." said Dr James.

"If given no treatment, most people with depression drift in and out of it. After 18 months, those given CBT have no better mental health than ones who have been untreated," added Dr James. Findings for anxiety are similar, he said.

"Methods which go beyond the symptoms to the heart of the matter are infinitely preferable to CBT," argued Dr James.

"One is cognitive analytic therapy. Initial treatment is for 16 sessions, of which the first four are devoted to the childhood causes. Another helpful treatment is the Hoffman Process, a nine-day programme which tackles the origins of depression."

Dr James’s criticism comes after the Department of Health announced earlier this month that it is speeding up its access to psychological therapies programme whereby 900,000 people with depression and anxiety will be referred to CBT-trained therapists. Half would be cured, said ministers.

The government said it would invest an extra £13 million into the programme.

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CBT does work

From: Arj Subanandan, information officer, mental health charity, London, UK
Date: March 25, 2009

CBT does work, for some and for some mental health problems. I consider it like a plaster, but a plaster is not a panacea for all mental health problems - that's just ridiculous. In the same way the government offering the CBT plaster as the sole psychological therapy offered through the £173million IAPT program is ridiculous.

Its not just a handful of celebrity psychotherapist who agree that CBT is not the a wonder cure. One of the Keynote speechs at the BACP conference last year slated the current one-solution-fits-all approach that IAPT is preaching.

NICE's guidelines are usually of a very, very high standard. For example the ones for depression are based on a literature review that started with over 1,000 papers then reduced this to 200 high quality ones using the SIGN research guidelines. However they may only have looked at evidence for CBT and not for other therapeutic practices.

Unfortunately Oliver James is quoting but 1 study, and a swallow doesn't make a summer.

It sounds like I'm contradicting myself, but I'm not. There is solid evidence that CBT works but that evidence does not say it is a panacea for all common mental health problems and some severe mental health problems which is how it has become seen by the public and uneducated professionals.

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Most researched or most effective?

From: Adam Geraghty, postgraduate researcher, School of Psychology, University of Plymouth
Date: April 14, 2009

All therapy works - to a certain extent. There is no convincing evidence that one form of therapy is better than another. James suggests that CAT may be better than CBT, however, if the two were properly compared I would bet they would be equally effective.

The reason CBT gets so much stick is because some practitioners assume it is the most effective form of treatment. This is incorrect, it is the most researched form of treatment.

Therapy research needs to be carried out, or supervised by impartial highly trained researchers. There are massive allegiance effects in therapy outcome studies. That is, if you are a CBT therapist conducting research on CBT you are highly likely to find that it works. The same is true off all other therapies. Perhaps because of the 'file drawer' effect.

The fact is, we do not understand why therapy works. We know that it works, not why. Until we understand more about this, claims that one therapy is better than another, will be unfounded and not get us anywhere.

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Better off talking to dead grandmother

From: Mark Suckling, unemployed, England, UK
Date: May 8, 2009

I have just started cognitive therapy. And if I had to be honest it has made me more depressed. Being unemployed you begin to concentrate on the minutest detail of everything. For instance an item of food has gone up 30p. This has a knock-on effect all the way down the line as you are fixed to an income.

My therapist had no idea how much unemployment benefit was. She thought my wife and I were both receivng £94 a week. Instead of just £94 for both. I told her that I was concerned that I wasn't getting enough nourishment as I only could afford £20 a week for food. She then told me she spends £120 a week on her shopping. I have to walk everywhere because I can't afford bus fare. I have had problems with my knees for years. And after walking three miles to the session and three miles back. They hurt. And without missing a beat she suggested maybe jogging would help my depression.

Try as you may, empathy is no substitute for walking in another person's shoes. Only then can you truly understand depression.

I dread going back to these sessions. Basically the ethos is a buck-up and pull yourself together philosophy. I would have been better off talking to my dead grandmother. At least I respected her.

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My clients had to unlearn CBT

From: John Threadgold counsellor, London
Date: November 27, 2009

I have had several clients who have had to unlearn the CBT strategies, and begin the painful process of actually facing the pain, thereby begining the real process of healing.

Focusing and mindfulness are vastly superior to CBT when it comes to resolving issues on a deep and longstanding basis.

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My CBT involved facing the pain

From: Liam Murray, London
Date: March 5, 2010

The basic principle of all therapy is that you make the changes with your life. The relationship with the therapist is important and to be prepared to go through the pain and to feel your way around. Some psychoanalyists claim that just because CBT involves instructive exercises, that this doesn't allow you to be the instigator of change, however I have not found that to be the case.

A lot of people purportedly do CBT but you will find that it is an abbreviated version both timewise and in terms of quality. This is worrying and its not so much that the governement spends so much money on CBT as that we know they will invariably provide a low quality form of CBT.

The proper version of CBT involves significant amounts of work on past life experiences, before going through the process of changing the way we think. It is NOT "positive thinking", it is about realistic thoughts and learning to be less anxious and letting go.

You can't generalise whether or not CBT is good or bad and a lot of criticisms of CBT are sly and manipulative in that they attack what CBT is not e.g. John Threadgold mentions CBT doesn't help "begin the painful process of actually facing the pai". So how is that the CBT I did involved "actually facing pain"? The therapy where I was asked about my life experiences in meticulous detail in the first 3 sessions, asked to do a lot of exercises in relation to past life experiences, and continously asked to go into detail about any tramautic events that came up during the course of treatment? Did my pain not count, or is it just that he is attacking the therapy his clients got which purported to be CBT? The fact is that what the therapy has done for me is help understand how to deal with these emotions and has put some long standing anger to bed.

Anyone who wishes to start therapy is to feel around and question the information available. Studies have been done that demonstrate that the general principles are accurate e.g. ther are studies relating to the CBT anxiety model that verify that self-processing contributes to anxiety and studies that verify that the CBT strategies do decrease anxiety. The key thing is to be convinced a therapy can help.

My problem is with people like John Threadgold who don't go into detail on their claims. Does he know how many clients that did CBT but didn't have to visit him afterwards? All therapies have failure rates as external factors (impending divorce/job loss/deaths) that occur during therapy can play a part. It takes time to click with you and relapses are going to be common if the therapy is not real CBT. No success stories are going to show up at his door, so we can't quantify how many successes there are and he doesn't really prove anything in what he says. Yes, his therapy probably worked on these clients, but we need to be careful with this information. I think it's deeply unprofessional to cynically use these cases in this manner. It's precisely because of therapists like this that traditional psychoanalysis has a bad reputation and people are moving away from psychoanalysis to CBT.

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CBT goes only so far....

From: Sharon Smith, Healthcare Support Worker, Acute Adult Mental Health, UK
Date: August 26, 2010

In my experience whilst working on an adult acute psychiatric ward CBT was not an effective form of therapy. It worked to the extent that individuals were able to channel their distress at that time through CBT but the same aims could have been achieved by adopting a compassionate and understanding attitude during time spent interacting in general.

CBT is a technique that can only go so far... it does not eradicate a person’s problem and rarely does it change their attitudes towards it, instead it only offers the opportunity of insight into the problem – sometimes it is better to deal with the problem with active solutions than it is to change your cognitions of the problem. For example, as illustrated by the gentleman who was unemployed – addressing issues regarding unemployment and financial issues would be more helpful than trying to persuade you to change the way you perceive your unemployment.

The IAPT initiative, especially for low intensity therapy is ridiculous - only those suffering from mild anxiety to depression are usually treated with this - the waiting list is 18 MONTHS and then you get to sit in front of a computer screen to receive your CBT (how impersonal). Then you have someone offering you self-help material rather than sitting with you to explore your problems! At least high intensity involves some form of meaningful interaction. However, as mentioned already depression, anxiety, PTSD, schizophrenia - they all have unique presentations and therefore broad brushing individuals is a concept that I cannot understand and cannot believe that both the mental health profession and psychology profession are allowing the 'famous and politically driven agenda of CBT' to be the only form of therapy we are prepared to offer people who really need our help!

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Assess the client

From: Karolina Bogdanowicz, MSc Clinical Psychology Student, University of Sussex, England, UK

Date: April 28, 2011

Assessment of the client is crucial. As more research focuses on CBT, more studies are published on CBT. This reinforces the logical error that CBT is superior and this has a direct negative effect on other forms of therapy, which are well documented but have smaller bodies of research.

When therapies are compared to one another, they usually appear to be equally effective, therefore, excessive spending on CBT and discouraging other firms of therapy is not fair.

CBT works for some people and only some. Others will benefit from all round-person centered therapy whereas others will benefit by discussing issues derived from childhood or other pase experiences.

It is therefore extremely important to asses and listen to the client first in order to establish which therapy would suit him/her best.

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Done properly, CBT is no quick fix

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