Therapy on the NHS? What a Crazy Waste of [Pounds Sterling]600million! as the Government Promotes Cognitive Behavioural Therapy as the Panacea for All Mental Ills, a Psychologist Gives His Scornful Response GoodHealth

Daily Mail (London), October 24, 2006 | Go to article overview

Therapy on the NHS? What a Crazy Waste of [Pounds Sterling]600million! as the Government Promotes Cognitive Behavioural Therapy as the Panacea for All Mental Ills, a Psychologist Gives His Scornful Response GoodHealth


Byline: OLIVER JAMES

DEPRESSION and anxiety cost the economy [pounds sterling]17 billion a year. Forty per cent of those claiming disability allowance do so as a result of mental illness. It's an expensive business, but the Government has found a quick-fix solution: cognitive behavioural therapy (CBT).

Unlike traditional psychotherapies, CBT does not dwell on past events or traumas. Instead, the focus is on the patient's fearful and negative thoughts - the therapist helps the patient deal with these by thinking positively. It takes between six to 16 sessions, but by the end, the patient is 'cured'.

Being cheap, quick and simplistic, CBT appeals to Tony Blair.

In June this year, Professor Richard Layard - labelled the government's 'happiness tsar' - proposed the training of 10,000 CBT therapists to be based in 250 centres across the country. A trial is planned.

Layard claims CBT 'can lift at least a half of those affected out of their depression or their chronic fear'.

Since a course of CBT costs only [pounds sterling]750 - about the same as a month's disability allowance - the treatment would pay for itself by getting patients back to work. The [pounds sterling]600 million cost of the new CBT nationwide service would soon be similarly recouped.

Sounds great? If only life were so simple. The truth is more complicated.

CBT is a form of mental hygiene.

However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of positive polish. But shiny surfaces tend not to last.

Take the example of Mrs B, 32, a mother of three who suffered from panic attacks, agoraphobia (fear of open spaces) and claustrophobia (fear of enclosed spaces).

On one occasion, she had been driving through London and panicked she couldn't find her way home. She ran out of petrol and the police found her at the side of the road, sobbing.

When she got home, she felt 'trapped' inside. But if she went into the garden it seemed too big - she feared she would 'disappear into the hugeness of the sky'. Only when her husband come home did she calm down.

Her doctor sent her to a clinical psychologist for ten sessions of CBT.

He got her to describe the thoughts that came into her mind during attacks, like that she was about to have a heart attack or that the room would contract and crush her.

THEN he asked her to consider if these thoughts were realistic, and to replace them with less disturbing ones. He also taught her to think positively.

For a few weeks, she felt better.

But within six months the symptoms returned. Contrary to Layard's optimism, this is what usually happens after CBT.

At the point when the treatment finished, she would have been rated a success. But as many researchers have shown, where patients have been examined two years later, at least half of panicky ones have relapsed or sought further help.

Even immediately after the end of a course of CBT, the average patient is still having a panic attack every ten days.

The results for depression are even worse. Two-thirds of those treated for depression with CBT have relapsed or sought further help within two years. If given no treatment, most people with depression or anxiety drift in and out of it. After 18 months, those given CBT have no better mental health than those left untreated.

However, in the short-term, CBT does have some effect. It reduces the intensity and number of symptoms for many people.

But even this is of questionable advantage, because CBT is very focused, targeting specific behaviours in isolation. Will, a workaholic property millionaire, is an example of how superficial this is.

After losing a small fortune (since regained), he became depressed and underwent CBT.

He says: ' "What you think is what you feel" is very true. I rigidly and fastidiously try to prevent myself sitting on negative thoughts. …

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