Does cognitive therapy work; should the NHS provide more of it for depression?
Excellent article in the UK’s newspaper The Independent on the growing adoption of cognitive-behavioural therapy (CBT) by the National Health Service (NHS). Very relevant to the US too, given that a growing number of insurers are offering computerized CBT. Quotes:
“Why are we asking this now?
There is growing frustration among GPs at the difficulty they face in providing psychological therapy for patients with mental problems including depression. A survey by the Royal College of General Practitioners (RCGP) published at the weekend found almost two-thirds of respondents said they were “rarely” able to obtain treatment for patients within two months. Getting help for children who had suffered abuse or trauma was even more difficult. Professor Steve Field, the president of the RCGP, said: “People should have access to approved treatments, and this has to be a wake-up call.”
What does this mean for patients?
Whereas in the past, GPs might have prescribed Prozac or other antidepressants, cognitive-behavioural therapy (CBT) is now the treatment of first choice – where it is available – for the millions who turn up complaining they cannot cope. In 2007, the Government earmarked £173m to train 3,600 extra therapists by 2010.
So why the shortage of therapists?
The cash is no longer ring-fenced and has allegedly been siphoned away to pay for other projects. The RCGP and Mind, the mental-health charity, are campaigning for a commitment from all three main political parties to ring-fence cash for talking therapies. The National Institute for Health and Clinical Excellence (Nice) says CBT should be the first-line treatment for mild to moderate depression, followed by drugs only if it proves unsuccessful.”
Keep reading The Big Question: Does cognitive therapy work – and should the NHS provide more of it for depression? (The Independent)
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I guess you can say that like any other treatment known to man, it’ll all depend on how the patient responds to it. I find cognitive behavioural therapy to be very useful, but it didn’t work for my friend.
Good point, Abbey. Yes, it is important to think of medical and psychological interventions as useful “tools in the toolkit”, not as “magic pills”.
Unfortunately one of the problems in the NHS is that bodies such as NICE rubberstamp therapies such as CBT as cost effective, only for there to be partial takeup by the Primary Care Trusts. There are considerable barriers to adoption in the NHS, but particularly in mental health which has always been underresourced. Ultrasis, which has a Computerized CBT platform called “Beating the Blues” has had real difficulties getting traction despite being the only therapy of its type to be NICE approved. In theory this should mean a scalable and cost effective treatment should be available to everyone, but the postcode lottery persists.
Dr. Jamie — thank you for a great comment. Indeed, progress is often slower than we’d like, but in fact adoption of CCBT in the UK is advancing very well (compared to the US), and we see Ultrasis has become a very promising company — we are including them in our next annual market report so that providers and insurers in North America can perhaps emulate/ partner.