Psychologists detect a leak in the CBT Holy Grail

Edited by Jill Wright, 05 June 2015

I wonder how many health bureaucrats in Australia and overseas read the British Psychological Society's Research Digest? If so, they might be feeling a little sheepish, if not anxious or even depressed about a new meta-analysis by psychologists in Norway that indicates that CBT or Cognitive Behavioural Therapy - which policy makers have settled on as the gold standard for treatment of depression - seems to be losing its efficacy. 

CBT is a powerful and useful technique, and it is a valued part of the armoury of our practice. But bureaucrats - and much of the academic world - for much too long promoted it as virtually the only therapy with an evidence base. And that has not served the profession, or those who count on it.

Bureaucrats fell in love with CBT, and in this country at least, advanced it above all other forms of non-drug therapy, because it seemed to be a budgetary blessing. 

They calculated, over the objections of highly experienced clinicians, that not only could patients be expected to improve with a relatively small number of sessions compared to more traditional methods of therapy, but also that CBT could be "manualised" and delivered by people who did not have to undergo all those years of expensive university training.

This new look at CBT also puts that theory at risk. It shows that while its effectiveness declined overall, experienced psychologists who used CBT achieved better results than less experienced student therapists: the decline in effectiveness has been steeper for trials involving manualised CBT.

That supports our clinic's focus on carefully selecting which therapist should work with a client, rather than leaving it purely to chance. 

And - also encouraging for Psychology Melbourne - it underlines the importance of the so-called "common factors" in achieving therapeutic success, including the establishment and maintenance of the therapeutic alliance on which we have based so much of our work.

The researchers, Tom Johnsen and Oddgeir Friborg, offer some speculation on why CBT is apparently losing its power to help people with depression.

"In the initial phase of the cognitive era," they write, "CBT was frequently portrayed as the gold standard for the treatment of many disorders. In recent times, however, an increasing number of studies ... have not found this method to be superior to other techniques.

"Coupled with the increasing availability of such information to the public, including the Internet, it is not inconceivable that patients' hope and faith in the efficacy of CBT has decreased somewhat, in recent decades. Morever, whether widespread knowledge of the present meta-analysis results might worsen the situation, remains an open question."

This all reminded me of some criticisms of this too enthusiastic embrace of CBT by Professor of Psychology at Sydney University Dianna Kenny - author of From Id to Intersubjectivity and also, intriguingly, a professor of music. She was recently interviewed on ABC Radio National's All in the Mind.  The program included some fascinating insights from author and clinician Irvin Yalom. Definitely worth a listen, or a read of the transcript.

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