Does Cognitive Therapy Work - and Should the NHS Provide More of It for Depression?
Laurance, Jeremy, The Independent (London, England)
The big question
Why are we asking this now?
There is growing frustration among GPs at the difficulty they face in providing psychological therapy for patients with mental problems including depression. A survey by the Royal College of General Practitioners (RCGP) published at the weekend found almost two-thirds of respondents said they were "rarely" able to obtain treatment for patients within two months. Getting help for children who had suffered abuse or trauma was even more difficult. Professor Steve Field, the president of the RCGP, said: "People should have access to approved treatments, and this has to be a wake-up call."
Why is psychological treatment important?
Because, as Professor Field said, "if patients can't get access to talking therapies, then they will be on medication". A couple of decades ago, the advice to those who were depressed and out of work was to get "on yer bike". Today it is as likely to be to get on the couch.
What does this mean for patients?
Whereas in the past, GPs might have prescribed Prozac or other antidepressants, cognitive-behavioural therapy (CBT) is now the treatment of first choice - where it is available - for the millions who turn up complaining they cannot cope. In 2007, the Government earmarked 173m to train 3,600 extra therapists by 2010.
So why the shortage of therapists?
The cash is no longer ring-fenced and has allegedly been siphoned away to pay for other projects. The RCGP and Mind, the mental- health charity, are campaigning for a commitment from all three main political parties to ring-fence cash for talking therapies. The National Institute for Health and Clinical Excellence (Nice) says CBT should be the first-line treatment for mild to moderate depression, followed by drugs only if it proves unsuccessful.
What is the Government's response?
According to the Department of Health, more than 230,000 people have benefited from the extra therapists appointed since 2007, and almost three-quarters of primary care trusts now offer the service, up from a quarter two years ago.
What is cognitive therapy?
A mental technique in which patients are taught to break habitual ways of seeing things and to think positively. The aim is to help them replace dysfunctional thoughts such as "I knew I would never be able to cope with this job" with alternatives such as "The job is not going well, but I can work out a plan to deal with the problems." Negative thinking is very prevalent in Western societies, with their emphasis on competition and success.
Is it better than other forms of therapy?
It is often claimed that its advantages over other forms of therapy are that it is brief, it is direct and it works. It is one of the few therapies for which there is clinical evidence of its effectiveness. Instead of focusing on the causes of distress that may lie buried in the past, the therapy examines ways to improve the patient's state of mind now. A course of treatment would usually last for six to eight half-hour sessions with a trained counsellor.
But how effective is it?
Less so than its supporters think. Although approved by Nice, a review of 175 trials in the British Journal of Psychiatry published this month concluded that the effects had been exaggerated. Two- thirds of people (67 per cent) improved with therapy, which sounds impressive. However, 40 per cent improved without therapy. So the treatment delivered an extra 27 percentage-point "effect".
How has this …
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Publication information: Article title: Does Cognitive Therapy Work - and Should the NHS Provide More of It for Depression?. Contributors: Laurance, Jeremy - Author. Newspaper title: The Independent (London, England). Publication date: March 23, 2010. Page number: 42. © 2009 The Independent - London. Provided by ProQuest LLC. All Rights Reserved.