The Future of CBT?

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DrFurbs
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The Future of CBT?

Post by DrFurbs » Sat Oct 10, 2009 1:06 pm

Hi guys, I'm stuck at point in my essay where Id like to talk about the future of the CBT approach. I'm looking through the Dept Health guidelines etc but I'm unable to really find any information.

Would I be right if I talked about IAPTs as there seems to be quite an emphasis on CBT for this initiative. I not required to do any thing lengthy on this, but I would like to add something regarding where its going as set out by some guidelines if possible.

Any tips would be appreciated.

E.

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mungle
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Post by mungle » Sat Oct 10, 2009 6:58 pm

IAPT use the NICE guidelines for anxiety and depressions which both mention CBT. You would find CBT mentioend in guidelines for other things such as eating disorders, ME etc. You might find something in guidelines for drug and alcohol work.

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Post by DrFurbs » Sat Oct 10, 2009 7:01 pm

Yeah I have seen a couple of articles on there but dont really mention the future of CBT in the NHS context.

I think I might need to dig a bit further tho, as I only screened over 2 PDFs...

thanks any ways.

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Post by Ruthie » Sat Oct 10, 2009 7:50 pm

The future of CBT in what sense? I think it is here to stay and there will be an increase in CBT provision and use of CBT by lots of professional groups within the NHS.

However, within CBT itself, the third wave approaches are growing - but need further research to be established. Third wave is more focused on how people relate to their cognitive and emotional experiences rather than changing them as such. So things like metacognitive therapy, mindfulness based CBT, DBT, ACT and compassionate mind might come under that umbrella.

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Post by russ » Sat Oct 10, 2009 8:55 pm

Ruthie wrote: Third wave is more focused on how people relate to their cognitive and emotional experiences rather than changing them as such.
Or bolting on diametrically opposed theories and practices much older than cognitive therapy, and calling them CBT :evil:

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Post by Ruthie » Sun Oct 11, 2009 12:42 pm

russ wrote:Or bolting on diametrically opposed theories and practices much older than cognitive therapy, and calling them CBT :evil:
By integrating other helpful practices :mrgreen:

Although I am curious as to what you mean by diametrically opposed theories?

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Post by russ » Sun Oct 11, 2009 12:54 pm

Ruthie wrote: Although I am curious as to what you mean by diametrically opposed theories?
I personally don't think you can get much more opposed than Buddhism (from whence mindfulness comes, cf core process psychotherapy) and Cognitive Therapy.

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Post by Dr.Dot » Sun Oct 11, 2009 4:45 pm

I think they are opposite in their approach, and as such rather opposed. CBT is built on change, Mindfulness and ACT is built on acceptance. Acceptance is change. But more covertly, and far less challenging to someones ego: CBT can leave people thinking they are not good enough, if they are told implicitly or explicitly that their thoughts and their for their feelings are irrational, and thus can be really rather invalidating (because they are being challenged on them and asked to think of alternatives). Mindfulness, ACT and DBT are all about validating experince and noticing what there is (I am not suggesting that all CBT therpaists are invalidating, but it is not explicit in the model to validate someones thoughts and feelings as OK to experince. (Although some therapists of course do). DBT is, as far as I can see, all about reconciling opposite positions, within one object, and normalising that, not dissimilar to bringing about a reonciliation between the Id and the Superego.

The third wave therapies are far more in tune with the behavioural model, than the cognitive, the 'noticing' as far as I am concerned is all about watching when someones unconcious is compelling them to act (or act out), you could say that was operant behaviour or procedual memory. As far as I am aware the CBT model doesn't really go much on all that, given that if the thoughts or other cognitive processes are unconcious you can't work with them.
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Post by DrFurbs » Sun Oct 11, 2009 6:16 pm

But where is the evidence that 3rd wave therapies will work? I mean coming from an empirical view, CBT is pretty well established with RCT.

btw thank you all who participated, this has really got my juices going now.

Thanks again.

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Post by Dr.Dot » Sun Oct 11, 2009 6:27 pm

There is evidence for 3rd wave therapies, just not as much, as in quantity of papers, as there is for CBT. Also, there is a huge publishing bias in the literature, it is really rather rare for CBT studies to be published if there has been a less positive outcome.
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Post by Ruthie » Sun Oct 11, 2009 9:59 pm

Dorothy wrote:CBT can leave people thinking they are not good enough, if they are told implicitly or explicitly that their thoughts and their for their feelings are irrational, and thus can be really rather invalidating (because they are being challenged on them and asked to think of alternatives).
That would be really dreadful CBT therapist! CBT is (or should be) based on a collaborative and open therapeutic relationship where clients are able to explore their thoughts, feelings, emotional and physical reactions. It certainly shouldn't make clients feel stupid or irrational. I think it is implicit in the model actually - because the model helps to understand how clients formative experiences have led to their core beliefs and assumptions and why particular events trigger difficult thoughts, feelings and behavioural patterns for them. Formulation should be inherently validating.

Having said that I agree with you that the third wave approaches are different and complimentary to traditional CBT rather than opposed. Knowing that a thought is perhaps not likely to be true or not helpful, doesn't necessarily stop you having it or feeling distressed by it. Sometimes, watching, accepting and letting it come and go whilst also behaving in a way that helps you move towards your own goals and values is more helpful. But that compliments the traditional approach, rather than replacing or opposing it imho.

I actually think that Buddhist thought, particularly around mindfulness and compassion orientated approaches can be a very helpful thing to integrate into any therapeutic orientation.

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Post by Ruthie » Sun Oct 11, 2009 10:05 pm

DrFurbs wrote:But where is the evidence that 3rd wave therapies will work? I mean coming from an empirical view, CBT is pretty well established with RCT.

btw thank you all who participated, this has really got my juices going now.

Thanks again.
I think it is also important to remember that CBT has been the most heavily researched of the psychological therapies and there isn't evidence that it is superior to other approaches. The third wave therapies haven't been as heavily researched, but mindfulness based cognitive therapy, ACT or even compassionate mind training you'll find a small but growing evidence base for some of them.

RCTs are the gold standard, but they're not always feasible (eg. due to resource constraints) and we've got to work with what we've got while continuing to build and add to the evidence base in whatever way we can.

Ruthie

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Post by Spatch » Sun Oct 11, 2009 10:27 pm

Hi guys, I'm stuck at point in my essay where Id like to talk about the future of the CBT approach.
Robots. With metallic voices and mind probes.

Probably.

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Post by BlueCat » Sun Oct 11, 2009 10:46 pm

Forgive me if I'm wrong, and I can't off the top of my head quote any papers (but know where to put my hands on them if necessary), but isn't the single most predictive aspect of therapy the therapeutic relationship itself, followed in second place by the degree of belief the therapist has in their methods?

Spoken by a narrative-behaviourist, by the way!

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Post by miriam » Mon Oct 12, 2009 11:19 am

Yeah, that's borne out in What Works for Whom and in the Scott Miller stuff on therapeutic effectiveness... though in the latter the effects of regular feedback from client to therapist were much bigger. He's quite slating of the 'evidence' for DBT by the way, says its all based on 50 white american women improving from work with one therapist!
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