The Future of CBT?

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Dr.Dot
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Post by Dr.Dot » Mon Oct 12, 2009 6:57 pm

Ruthie wrote:
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.
It is I agree, to some degree, a product of delivery. Formulation may be validating, but following a model of of a disorder not so! As other have said about the relationship etc, is the most important part of therapy. CBT with its very prescriptive format and at times manualised approach to disorder, provides a model that can deliver the therapy, without a meaningful relationship, cCBT for example. That is invalidating, imho.
Dorothy: Now which way do we go?

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Post by Ruthie » Mon Oct 12, 2009 7:25 pm

I think it depends on the problem. I think cCBT and other self-help approaches can be helpfl for relatively simple and straight forward problems that most of us face from time to time. I'm sure we've all taken some hope or help from self-help guidance along the way.

I also don't think following a model of disorder is necessarily invalidating. It can be guiding and can provide some focus and structure to the questions we ask and the way we explore things as therapists. We all follow some model in our minds, be that a psychodynamic or social constructionist view of a clients' difficulties or a cognitive one.

I think a lot of the criticisms levelled at CBT can be levelled at any of the therapies. CBT perhaps falls prey to them more often as it (arguably) has simplified itself to make it more accessible.

Having said that I have used CBT in primary care with clients with relatively straight forward problems who don't have huge amounts of emotional baggage and interpersonal difficulties. They came in, they formed a trusting relationship quickly and we more or less followed the manual and we got good results. To me, it felt quite different from CBT with most of the people we see as clinical psychologists who have more complex difficulties and who therefore need a more flexible approach that attends more explicitly and sensitively to the therapeutic relationship and allows for a more complex understanding of their difficulties.

I think cCBT may be a helpful self-help tool for people with simple and straight forward difficulties. But it's probably not one I will draw on as a CP seeing clients with more complex difficulties an for whom it would be both invalidating and inappropriate.

Ruthie

PS. The very first chapter of Aaron Beck's very first book was entitled, "The therapeutic relationship" - as far as Beck is concerned, it should be central.

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Dr.Dot
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Post by Dr.Dot » Mon Oct 12, 2009 9:29 pm

I think in general, we are in agreement. :twisted:
Dorothy: Now which way do we go?

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Post by Ruthie » Mon Oct 12, 2009 9:56 pm

Shame, I'm rather enjoying the debate! :lol:

DrFurbs
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Post by DrFurbs » Tue Oct 13, 2009 9:49 am

So with regards to CBT practice within NHS constraints, such as funds, manpower etc, what is the future? Are third wave therapies still applicable?

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Post by rox » Tue Oct 13, 2009 4:30 pm

Might that depend on whether NHS funding is restricted to providing NICE-approved therapies, and whether third wave therapies become NICE approved?

There's a chapter on CBT developments in this book: http://www.amazon.co.uk/Introduction-Co ... 605&sr=8-1
...and also a chapter on alternative methods of delivery e.g. moving away from the traditional one hour a week thing, groups etc. - I guess anything cost-effective is going to be relevant to CBT's future in the NHS!

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Post by DrFurbs » Wed Oct 14, 2009 9:10 am

A meta-analyses of third wave treatments here:

http://www.library.nhs.uk/MENTALHEALTH/ ... sID=319427
Third wave treatment with ACT and DBT showed moderate treatment effects, but studies did not fulfil criteria for empirically supported treatments.
Is he saying that these therapies, although moderately successful, dont have enough RCT empirical data to pursue?

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Post by Dr.Dot » Wed Oct 14, 2009 10:30 am

I have had a quick scan of that paper, it seems good, but rather complicated! Anyway, the third wave therapies under review seem pretty diverse and intergrative (including some psychodynamic principles for example), which makes it rather difficult to asses the efficacy of all 3rd wave therapies in one meta-analysis. Espcially when the target 'problems' are so varied.

Anyway he is saying that the methodology is often not stringent enough, or the methodology hasn't been reported well enough to know whether it is stringent enough. Though there are reasonable effect sizes for some of the therapies. So they were testing out if the 'model(s)' has support, which some of them evidently do...however, each research team will have a slightly differnt interprtation of that model and how it is applied to a certain 'problem' in the ACT studies for example, there is maths anxiety, boderline personality disorder, and diabetes. The principles of ACT reamain the same (acceptance of how thigs are for you, and living to your values, and mindfulness to cope along with changing your realtionship with langauge), but the application is likely to be different to some degree, and how it is recived by the populations (and each individaul in the population) is likely to be different.

BTW, some of the therapies in the meta analysis are all new to me, never heard of them! In my view, 3rd wave therapies is becoming a catch all catergory encompassing a wide range of intergrative approaches, that are evolving...
Dorothy: Now which way do we go?

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