Critical Evaluation of The Effectiveness of Cognitive Behaviour Therapy

Psychological therapies, also referred to as talking therapies, are used to support people who are suffering from psychological issues such as depression, anxiety and/or obsessive compulsive disorder. There are a range of these therapies available, a few of the well-established ones are Cognitive Behavioural Therapy (CBT) and interpersonal therapy (IPT). An individual will be better suited to one therapy than they are to another, the therapies involve the use of a therapist and sessions can be delivered face‐to‐face by a therapist, via the Internet, by telephone call, or by computer programme (Eccleston et al., 2014) . It takes a considerate period of time for a psychological therapy to become established and thus deemed as effective, this is because it is dependent on intensive research being carried out, much of which is longitudinal. In this essay, the establishment of the effectiveness of psychological therapies will be explored, additionally Cognitive Behavioural therapy will be critically evaluated in order to understand how effective it is as a therapy.

The effectiveness of psychological therapies has been established through years of conducive research and meta-analytical study which allows for scientific based, empirical evidence to be congregated. Fischer (2005) states that the effectiveness of psychotherapies can be defined as symptomatic relief and how well a client is able to continue to analyse themselves once therapy sessions have concluded in order for past conflicts to no longer overwhelm them and interfere with their present life. The nine goals of psychoanalytical therapy are symptom relief; insight; agency; identity; self-esteem; recognizing and handling feelings; ego strength and self-cohesion; love, work and mature dependency; and pleasure and serenity Mcwilliams (1999). Effectiveness of therapies is shown through improvement in the client’s situation, it is important to be informed on the effectiveness of a therapy so that clinicians know whether or not it would be beneficial to use on their client/patient.

Empirical data collected from the mass amount of research conducted is one of the central ways in which the effectiveness of psychological therapies is established, this is because the data highlights the validity and efficacy of the therapy as well as shedding light on any discrepancies, which in turn informs on whether or not the therapy is affective. An example of this is a 16-week randomised clinical trial conducted by Mufson et al., (2004), patients consisted of sixty-three adolescents who had been suffering from depression. The studies focus was on the effectiveness of interpersonal psychotherapy for depressed adolescents opposed to treatment as usual (TAU), which would’ve involved a combination of medication and psychotherapy (Blais et. al, 2013). Findings suggested that Interpersonal therapy compared to treatment as usual (TAU) displayed greater reduction in symptoms and improvement in overall functioning, from use of the analysis of covariance it was emphasised that IPT was the better treatment as results exhibited that there was significantly fewer clinician-reported depression symptoms on the Hamilton Depression Rating Scale (P=.04),. Although this is just one study, which isn’t quite enough to establish the effectiveness of a psychological therapy, support from additional studies which contain alike results would eventually allow the psychological therapy to be established as effective or not.

Moving forth, Cognitive Behavioural Therapy (CBT) is a frequently used psychological therapy in today’s society. It is used to treat many of the stress and anxiety related issues that are mentioned in the DSM-V 5, the aim of this therapy is to reconstruct the way one thinks in order to replace maladaptive thoughts with more positive ones, which in turn improves ones quality of life. CBT highlights that how we think, feel and behave are all connected, Beck (1964) stated that it is not a situation in and of itself that determines what people feel but rather the way in which they construe a situation, which further instills the idea that the way a person thinks is crucial to their mental well-being. In CBT sessions the therapist guides the patient to develop strategies which help them manage stressful situations which lead to have negative thinking and distorted thoughts more effectively in the long term (Beck, 2011).

CBT has been proven to be effective in the treatment of psychological disorders such as schizophrenia- more specifically the beneficial effect on positive symptoms which consist of delusions and/or hallucination and the negative symptoms which consist of lack of emotion, loss in interest of everyday activity and loss of tough with friends and family (Rector & Beck, 2001). Moreover, Zimmerman et al., (2005) found substantial evidence that CBT is a rather promising aid to pharmacotherapy for schizophrenia patients who suffer from acute psychosis rather than a more chronic condition. Wykes and Collegues (2008) more recent meta-analysis examined controlled trials of CBT for schizophrenia and confirmed findings from former meta-analyses, which suggests that CBT had a small effect size compared to control conditions on positive and negative symptoms.

Furthermore, a review of met analyses was conducted by Hoffman et al (2012) which examined CBT’s efficacy for several health disorders, inclusive of but not limited to; anxiety disorders, schizophrenia and substance use disorder. Of the 269 reviewed studies, an overwhelming amount of evidence supported the view that CBT is effective in the treatment of a range of psychological disorders. one particular met-analysis made a comparison between the efficacy of psychological treatment specific phobias and obsessive-compulsive disorders, the findings demonstrated that CBT had the greatest effect size for both disorders, and it was maintained for two years post treatment (Rumland and Margraf, 2001). From these results it can be inferred that CBT is the most effective treatment compared to others used also that CBT’s positive effects have longevity as symptoms were significantly improved over a long period of time.

Yoshinaga et al, (2013) measured the effectiveness of CBT on Social Anxiety by using the Liebowitz Social Anxiety Scale on a fairly small sample size of 15 participants. The intervention took place over a fourteen-week period, anxiety levels were measured by researchers pre-intervention and post intervention. CBT was found to be effective in the reduction of social levels, this is despite there being a vast amount of limitations. An increase of the sample size used would be more effective in the detection of anomalies and differences that could affect the results gathered also, a control group of those who were taking medication at the time of the study would’ve be of major use as it would allow the researchers to understand whether it was the CBT alone that was effective or rather a combination of medication and CBT. A follow up to this study would’ve been beneficial in determining if the intervention had long-term effectiveness. Furthermore, a large sample of controlled studies of psychotherapy for adult’s depression was examined by Cuijpers et al (2010) to determine whether or not it is possible that publication bias was present - publication bias is when researchers only record and public results that they wish to, most likely ones that show psychotherapy to be effective. From this study researchers unveiled a great indication that publication bias may have been present, leaving room for uncertainty as to whether or not the effectiveness of CBT has been highly overestimated.

In conclusion, the studies presented within this essay demonstrate that CBT is indeed an effective intervention for a vast amount of stress-related conditions, meta-analysis and other studies were able to provide a vigorous amount of evidence pertaining to the effectiveness of interventions using CBT. However as discussed, there are some methodological discrepancies that have been highlighted such as, lack of control group and small sample sizes. It has also been argued that CBT isn’t actually that great of an intervention but rather just a ‘quick fix’ for clinicians and researchers this was explored when discussing the issue of publishing-bias, perhaps CBT isn’t as effective as some would like it to be, but due to the bias it’d be hard to unveil as ‘bad’ or undesired results are not published.

References

• Beck, A. (1970). Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy, 1(2), 184-200. doi: 10.1016/s0005-7894(70)80030-2
• Blais, M., Malone, J., Stein, M., Slavin-Mulford, J., O'Keefe, S., Renna, M., & Sinclair, S. (2013). Treatment as usual (TAU) for depression: A comparison of psychotherapy, pharmacotherapy, and combined treatment at a large academic medical center. Psychotherapy, 50(1), 110-118. doi: 10.1037/a0031385
• Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S., & Andersson, G. (2010). Efficacy of cognitive–behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. British Journal Of Psychiatry, 196(03), 173-178. doi: 10.1192/bjp.bp.109.066001
• Eccleston, C., Palermo, T., Williams, A., Lewandowski Holley, A., Morley, S., Fisher, E., & Law, E. (2014). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd003968.pub4
• Fisher, P. L., & Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive–compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy, 43, 1543-1558. (2019). Retrieved from http://www.sciepub.com/reference/80741
• Hahlweg, K., Fiegenbaum, W., Frank, M., Schroeder, B., & von Witzleben, I. (2001). Short- and long-term effectiveness of an empirically supported treatment for agoraphobia. Journal Of Consulting And Clinical Psychology, 69(3), 375-382. doi: 10.1037//0022-006x.69.3.375
• Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy And Research, 36(5), 427-440. doi: 10.1007/s10608-012-9476-1
• Mufson, L., Dorta, K., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M. (2004). A Randomized Effectiveness Trial of Interpersonal Psychotherapy forDepressed Adolescents. Archives Of General Psychiatry, 61(6), 577. doi: 10.1001/archpsyc.61.6.577
• RECTOR, N., & BECK, A. (2001). Cognitive Behavioral Therapy for Schizophrenia: An Empirical Review. The Journal Of Nervous And Mental Disease, 189(5), 278-287. doi: 10.1097/00005053-200105000-00002
• Wykes, T., Huddy, V., Cellard, C., McGurk, S., & Czobor, P. (2011). A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes. American Journal Of Psychiatry, 168(5), 472-485. doi: 10.1176/appi.ajp.2010.10060855
• Yoshinaga, N., Ohshima, F., Matsuki, S., Tanaka, M., Kobayashi, T., & Ibuki, H. et al. (2013). A preliminary study of individual cognitive behavior therapy for social anxiety disorder in Japanese clinical settings: a single-arm, uncontrolled trial. BMC Research Notes, 6(1). doi: 10.1186/1756-0500-6-74
• Zimmermann, G., Favrod, J., Trieu, V., & Pomini, V. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: A meta-analysis. Schizophrenia Research, 77(1), 1-9. doi: 10.1016/j.schres.2005.02.018