Page last updated at 03:09 GMT, Saturday, 8 November 2008

Is cognitive therapy the answer?

By Jane Dreaper
BBC News health correspondent

Man in therapy
CBT has been hailed as quick and effective

There was huge excitement last autumn when the health secretary, Alan Johnson, announced that 170m would be spent on talking therapies in England.

The programme focuses on one specific branch of treatment - Cognitive Behavioural Therapy (CBT).

But a tide of doubt has begun to be expressed about whether CBT is getting too much prominence - and money.

However, the therapy's supporters say its attackers do not understand the latest versions that are being used for NHS treatment.

The London borough of Newham has been an important test bed for the idea of getting CBT to a wide number of people.

It is the home of the 2012 Olympics, but also an ethnically diverse area with significant deprivation.

Outside East Ham tube station, the nearby pub is appropriately called the Overdraft Tavern and it seems likely that there is plenty of unhappiness to treat in the area.

'I was angry'

Rita Edgar-Dimmack, 51, sought help from CBT after 20 years in an abusive marriage.

I think this is a dream service
Dr Ben Wright
CBT specialist

She said: "I left my husband with nothing. I was angry with myself because I'd stayed so long, and I got depressed.

"My GP, who'd known me for years, noticed my personality had changed. He handed me a leaflet on CBT.

"A few weeks later I rang, and then came in and saw a therapist.

"He started me with a booklist, and said he wanted me to do some reading.

"I started reading books on depression. Each week, he'd have me do something else - like keeping note of my moods.

"He also started me thinking about the times when I did incredible things, and wasn't stupid or inept. That's when I started to heal."

Practical skills

CBT looks at difficulties in the here and now. It includes homework and aims to build up practical skills.

Dr Ben Wright, the doctor in charge of the CBT programme in Newham, said: "I think this is a dream service. Patients can refer themselves and get access to quick treatment."

The CBT community has managed to sell to the government and its agencies a notion of research that is allegedly scientific
Professor Andrew Samuels
Essex University

The service has a good record for getting unemployed people back to work, or at least moving in that direction through training or volunteering - thanks to ties with specialist charity workers.

Dr Wright added: "They will speak to people, and help them get vocational plans.

"Our focus is first and foremost on the person and what they want.

"Employment, however, is a very important pathway for social inclusion and most people find that's the way in which they want to get back on with their lives."

'Hoodwinked'

It seems compelling, and pilot schemes in Newham and Doncaster helped persuade the government to fund CBT on a massive scale.

But critics are nervous about therapy being linked with employment services and some say, in quite strong terms, that ministers have been hoodwinked.

CBT is a rapidly evolving field - the versions we have now are very different from the ones we had 10 years ago
Professor David Clark
Institute of Psychiatry

Andrew Samuels is a psychotherapist and professor at Essex University.

He said: "What you're witnessing is a coup, a power play by a community that has suddenly found itself on the brink of corralling an enormous amount of money.

"The CBT community has managed to sell to the government and its agencies a notion of research that is allegedly scientific.

"Science isn't actually the appropriate perspective from which to look at emotional difficulties. This kind of pseudo-scientific shambles simply isn't the right way to do it.

"In CBT, the client is a recipient of instructions or suggestions. They're told their thinking is wrong.

"Everyone has been seduced by its apparent cheapness."

'No axe to grind'

His private practice is fully booked - and so he says he does not have an axe to grind in his attack against the promotion of CBT as a superior therapy.

The debate appears to have focussed on 'CBT good' or 'CBT bad' without any recognition that CBT is good for some people
Sophie Corlett
Mind

Andrew Samuels insists he is not a lone voice, though he says colleagues who email supportive messages privately are reticent about speaking publicly.

Other psychoanalysts have recently written newspaper critiques of CBT.

But a professor at the Institute of Psychiatry, David Clark, says it is the critics who are guilty of misunderstanding.

He said: "CBT is a rapidly evolving field. The versions we have now are very different from the ones we had 10 years ago, and in many cases quite a bit more effective.

"CBT researchers are always looking at what you can do to fine tune the treatment, and make it a little bit more effective and efficient.

"It's a serious misunderstanding to say that CBT tells patients how to think.

"Rather than saying any thoughts are wrong, we explore the evidence.

"I think the government chose this expansion because of the moral case - there's a large number of people with common mental health problems which are severely disabling.

"They haven't had treatment before and they should be offered it because we know there are effective treatments."

Common concern

Back in East London, at the headquarters of the leading mental health charity Mind, talking treatments are a common concern for people who ring their information service.

Policy director, Sophie Corlett, said: "The debate appears to have focussed on 'CBT good' or 'CBT bad' without any recognition that CBT is good for some people.

"I feel that some of the arguments seem to have almost disintegrated into arguments between the therapies.

"I think it's got to the point where it's become unhelpful within the professions.

"There is a case for saying that CBT has been promoted above its usefulness.

"It's extremely useful for large numbers of people. Some people have assumed therefore that the evidence base is superior - but for some, it may be of no use at all.

"There needs to be recognition of different approaches for different people."

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