Editorial: Cognitive Behavioral Therapy: An Example of Evidence-Based Psychotherapy
Gilboa-Schechtman, Eva, Marom, Sofi, The Israel Journal of Psychiatry and Related Sciences
Evidence-based medicine aims to apply the best available evidence, gathered in a scientific, systematic way, to medical decision making. As applied to mental health, evidence-based psychotherapy (EBP) calls upon clinicians to rely on scientific methodology in their clinical decisions; to work with clients using scientifically validated methods, tools and techniques, and to inform their clients of scientifically-based findings and approaches to their problems (1). EBP is contrasted with approaches that are based mostly on clinicians' personal experience and intuition. Over the past decades, few debates have aroused the passions of mental health professionals more than the question whether empirical research could and should inform the practice of psychotherapy, or, should psychotherapy be evidence-based (2).
Opponents of EBP doubt the utility of basing treatment on scientific research. For example, Peter Zeldow stated, "I have come to view clinical psychology's preoccupation with empiricism as a naive, triumphalist narrative... I do not expect another 50 or 100 years of research to solve most of the problems that confront clinicians on a daily basis" (3, p. 3). This view highlights the subjective, almost art-like nature of therapy. By contrast, the psychoanalyst Peter Fonagy, a supporter of EBT, writes, "The claim that psychotherapy is an art form is not just romantically self- aggrandizing, it is also a powerful defensive strategy. Who could blame Leonardo da Vinci for not getting it right every time? And perhaps beauty - and therapeutic benefit - is in the eye of the beholder?" (4, p. 442). Whether the only alternative to "romantically selfaggrandizing" or "triumphalist" and futile, EBP is at the center of a philosophical, scientific, ethical and practical debate.
The term Cognitive Behavioral Therapy (CBT) refers to a family of treatment approaches aimed to influence dysfunctional emotions, cognitions and behaviors through goal-oriented, systematic and time-limited procedures. Because CBT deals with measurable indices of distress, it lends itself to scientific studies more readily than do other treatment methods. CBT is by no means the only approach that can be evidence-based. Nor is the choice of CBT methods a guarantee that treatment be successful. Yet, CBT as a therapeutic movement has made an early and strong commitment to evidence-based psychotherapy, while for several other approaches the link between therapeutic progress and a priori defined and measurable outcomes appeared less intuitive. As is emphasized throughout this special issue, one of the advantages of the empirical approach to therapy that CBT takes is that it provides benchmarks for determining expected results of treatment and also allows for careful examination of techniques and processes that allow for modification and improvement in outcomes.
Mirroring similar developments in medicine, the controversy regarding evidence-based psychotherapy has reached climactic fervor in recent decades, in view of the reorganization of health care around the world. The need to provide affordable mental health care has contributed to favoring evidence-based and time-limited psychotherapy. CBT, being mostly evidence-based and focusing on time-limited interventions, has fared well in these reorganizations. For example, the British National Institute of Clinical Excellence (NICE) recommends CBT as the treatment of choice for a wide range of psychological problems, such as depression, anxiety, panic attacks, phobias, and OCD, as well as eating disorders (e.g., 5). In the United States, the National Institute of Mental Health (NIMH) also recommends cognitive behavioral interventions in the treatment of many anxiety disorders (6). CBT has also enjoyed widespread acceptance in many other European countries.
In Israel, the status of evidence-based treatment and of CBT is still controversial. On the one hand, many private practitioners are often only vaguely familiar with CBT techniques and tend to use them rather sporadically. …