Swedish National Office Report on CBT
In a study of the outcomes of using CBT as a primary and almost exclusive method of treating mental health issues such as depression and anxiety, the Swedish National Office has published a damning report. See here
Main findings of report on CBT
- The widespread adoption of the method had no effect whatsoever on the outcome of people disabled by depression and anxiety;
- A significant number of people who were not disabled at the time they were treated with CBT became disabled thereby increasing the amount of time they spent on disability; and
- Nearly a quarter of people treated with CBT dropped out.
From Swedish Audit Report. accessed HERE
Application and conclusions in the UK
CBT or cognitive behavioural therapy is the darling of the NHS, many charities and NICE. This is primarily because it claims to be evidence based.
CBT leads itself to being “evidenced based” through gathering self assessed feedback from clients. This is unreliable for a whole range of reasons, including:
- Subjective self assessment does not permit one controlled stand across subjects. Introspective grading of experience is not possible.
- Assessment reduces responses down to highly simplistic responses, often statistics and does not reflect human experience or allow for situational or environmental difference.
- There is an influence on “wellbeing”, “getting well” or feeling “happy” when therapy is not always about these, we often feel “unhappy” for good reason”.
- CBT often plays into the biomedical model of being “sick” and needing to feel happy despite this, rather than considering other explanations for symptoms such as psychodynamic, cognitive behavioural analysis, developmental or humanistic explanations or social and environmental causes / factors.
- CBT is often highly simplistic. It has been termed “the art of the blindingly obvious” since it often leads subjects through exercises that reveal what they already new, providing little empowerment for change.
Illogical to use one method
Reducing provision down to one method is akin to only using one class of medical drugs, it simply does not make sense. Clients are complex and unique individuals going through a unique combination of social, biological, psychological, interpersonal and developmental processes, any of which alone may seem common or typical, but which form a vast array of potential combinations. With that variety and complexity, thinking “one size fits all” is simply illogical.
Furthermore CBT is a simplistic method formed out of other methods, making it a method within an array of methods. For example it was developed in response to psychodynamic and humanistic thinking, and provoked revised psychodynamic, humanistic and cognitive behavioural analytic thinking. It makes no sense to home in on one incomplete stage of the ever changing face of psychological therapy and prioritise it at the expense of other methods.
Its just a tool (CBT)
Cognitive Behavioural Therapy is just ONE tool in the toolbox of multi-skilled psychotherapists. Many therapists use CBT when it is appropriate, but “if all you have is a hammer, all you see is nails”. Why would anyone throw away all the other tools.
Integrated work for the unique client
Stuart uses CBT where appropriate, along with the deeper and more complex Cognitive Behavioural Analysis methods (including CBASP for long term depression). Stuart also uses psychodynamic psychoanalysis, humanistic and philosophical psychotherapy, mindfulness and clinical hypnotherapy. The approach is integrated and employs a kind of critical psychotherapy, in other words questioning what the outcome “should” be, and working with the client to determine what their desired outcome is going to be. Therapy is then tailored, incorporating methods such as CBT, CBA, IPT and psycho-education with research evidence and NICE recommendation behind them.
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