Is Cognitive Behaviour Therapy (CBT) better than any other therapy?

Cognitive Behaviour Therapy (CBT) is described by Chief Medical Officer's Working Group Report of January 2002 as “a tool for constructively modifying attitude and behaviour".

CBT is a popular therapy and appears to be the government's favourite even though there are many other evidence-based effective therapies.  The government is investing £173 million into a project entitled Increasing Access to Psychological Therapies (IAPT) and as part of this project are going to employ CBT therapists and only CBT therapists; they are not employing therapists from other approaches such as Person-centred, Psychodynamic, Gestalt and Emotion-focused to name but a few. The reason for choosing CBT above all other types of therapy appear to be largely due to a report by Lord Layard (aptly called the Layard Report). 

The Layard Report recommends increasing access to psychological therapies, especially CBT (almost exclusively), in order to help alleviate the suffering of people with mental health problems.  The reason for choosing CBT seems to be due to the larger body of research studies in CBT when compared to that from other approaches.  The research studies simply imply that CBT is an effective therapy - they do not imply that it is more effective.  There is substantial evidence which imply that other types of therapy are at least as equally effective as CBT. 

The majority of evidence also suggests that no one therapy is better than another. Therefore it would seem more appropriate to give clients a choice and let them choose which therapy they want. If clients have no choice of therapy, then this may have serious implications, as not all clients (some of which will be extremely vulnerable) will necessarily be responsive to CBT.  In fact there is some evidence that CBT is ineffective for some conditions such as Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS).  An ME charity (Invest in ME, click HERE for link) has said that ‘there has been little evidence that CBT is a tool to support patients or to help them cope with the ravages of serious organic disease’.  Furthermore there is some evidence that CBT might actually be harmful.  Below are some examples of studies.

In a survey of 3074 M.E./CFS patients conducted between 1998 – 2001, 55% of patients said that CBT had made no difference to their illness, whilst 22% said CBT had made their illness worse (Directly from the Horses’ Mouths, Doris M. Jones MSc, Reference Group Member, CMO’s Working Group. This survey was part of the Working Group on ME/CFS set up by the Chief Medical Officer Sir Kenneth Calman in 1998)

Below is a joint statement made at the World Conference for Person-centred and Experiential Psychotherapies during July 2008.

CBT superiority is a myth

The government, the public and even many health officials have been sold a version of the scientific evidence that is not based in fact, but is instead based on a logical error. This is how it works: 1) More academic researchers subscribe to a CBT approach than any other. 2) These researchers get more research grants and publish more studies on the effectiveness of CBT. 3) This greater number of studies is used to imply that CBT is more effective. This is a classic example of the logical fallacy known as ‘argument from ignorance’ i.e. the absence of evidence is taken as evidence of absence. Although CBT advocates rarely make this claim so boldly, their continual emphasis on the amount of evidence is misunderstood by the public, other health care workers, and government officials, a misunderstanding that they allow to stand without correction. The result is a widespread belief that no one takes responsibility for. In other words, a myth. This situation has direct negative consequences for other well-developed psychotherapies, such as person-centred and psychodynamic, which have smaller evidence bases than CBT. These approaches are themselves supported by substantial, although smaller, bodies of research. The accumulated scientific evidence clearly points to three facts: 1) People show large changes over the course of psychotherapy, changes that are generally maintained after the end of therapy. 2) People who get therapy show substantially more change than people who don’t get therapy, regardless of the type of therapy they get. 3) When established therapies are compared to one another in scientifically valid studies, the most common result is that both therapies are equally effective. A case in point is person-centred and related therapies (PCTs): In a meta-analysis of more than 80 studies to be presented by Robert Elliott and Beth Freire at the Norwich conference, PCTs were shown to be as effective as other forms of psychotherapy, including CBT. In view of these and other data, it is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England. Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment. We urge our CBT colleagues and government officials to refrain from acting on this harmful myth and to broaden the scope of the Improving Access to Psychological Treatments (IAPT) project to include other effective forms of psychotherapy and counselling.'

7 July 2008, PCE Conference, University of East Anglia
'Joint Statement Issued by Professors Mick Cooper and Robert Elliott (both University of Strathclyde), William B Stiles (Miami University) and Art Bohart (Saybrook Graduate School):

Below are excerpts from readers letters from the Guardian Newspaper.

'Happiness is...not a reliance on CBT'

Thursday June 26, 2008
The Guardian

'It is a depressing fact that Richard Layard is not a therapist of any sort and nor is he a psychologist (Will this man make you happy?, June 24). He is an economist and has the ear of government. If the government and associated bodies were seriously interested in how to address the increasing levels of unhappiness, despair and alienation that permeate British society, and truly believe that therapy has something to offer, then they would have consulted widely. They haven't. They have restricted their "consultation" to those who tell them what they want to hear with very few exceptions. There are thousands of psychotherapists and psychoanalysts who are deeply opposed to the current moves led by Layard because we have built up a wealth of experience in our practices that illustrates an impossibility in ideals of happiness.'
Vivien Burgoyne
London

'Richard Layard's reckless overclaiming on behalf of cognitive behavioural therapy, the government's improved access to psychological therapies and his own idiosyncratic approach to happiness and wellbeing is, by now, notorious. In 10 years' time, we will have just as much ordinary human misery and, as the CBT relapse rates suggest, clinical depression. How many of the clients of the as yet untrained government therapists will be told that the goal of their personal therapy is to get them off benefits and back to work? It is simply not the case that psychodyamic and humanistic-integrative therapies have no research to support their efficacy. They do - but as much of it is done on a different basis from the inappropriate false-scientific methods used by a great deal of the CBT research, it doesn't count, according to Nice.'
Professor Andrew Samuels
Centre for Psychoanalytic Studies, University of Essex

'While I am not surprised that Richard Layard, an economist, has focused on our "wants", which are infinite and insatiable, I am astounded he does not appear to have even considered our basic human needs, which are few, finite and classifiable. Such needs are fundamental to our wellbeing and thus our happiness. A Chilean economist, Manfred Max-Neef, proposes a more thoughtful approach to our wellbeing. He proposes nine fundamental human needs to be satisfied, including subsistence, protection, affection, understanding, participation, leisure, creation, identity and freedom. Such needs remain constant through all cultures and across historical time periods. CBT may offer us, as research suggests, a temporary distraction, but such distraction and failure to acknowledge the true cause of our difficulties leaves them unresolved. The potential - as many sufferers know - is then for long-term greater unhappiness.'
Margaret Hueting
Eastbourne, East Sussex