A quarter of us suffer from a mental illness at any one time, mostly anxiety or depression. The cost to our economy is enormous - £105 billion a year, never mind the personal anguish - and for too long the only treatment was pills.
What a tragedy, then, that the first attempt to provide talking therapy to patients nationwide is using the wrong kind: cognitive behavioural therapy (CBT).
The theory behind CBT is that your thoughts control your feelings. Change your thoughts, and you change how you feel. If you keep getting anxious for no reason, perhaps worrying that something awful will happen or that you will make a fool of yourself, CBT teaches you to think the opposite.
'Cognitive behavioural therapy is all about marketing - it is a cheap, quick fix'
In just six to 16 sessions, cognitive behavioural therapy claims to be able to convert you from depressed or anxious, to ‘recovered’.
The scheme introducing CBT nationwide - snappily named the Improving Access to Psychological Therapies (IAPT) programme - was created in 2009 by Professors Richard Layard, an economist, and David Clark, a clinical psychologist at Oxford University.
They sold it to the New Labour government as a way to help at least half of sufferers from anxiety or depression to recover.
And at first sight, the claims for its success seem quite impressive, with ‘recovery’ in around 40 per cent of cases who complete the treatment.
Closer inspection reveals a much less rosy picture. Cognitive behavioural therapy is all about marketing - it is a cheap, quick fix.
(It’s worth noting that Layard and Clark make no mention of this in their new book, Thrive, a polemic on the failure to treat mental illness which continues their relentless promotion of CBT.)
Many other researchers have since shown that two-thirds of those treated for depression with CBT and who had apparently ‘recovered’, relapsed or sought further help within two years.
Furthermore, around 30 per cent don’t even complete the course.
The fact is, if given no treatment, most people with depression or anxiety drift in and out of it. After two years, those given CBT have no better mental health than ones who have been untreated.
Working as a psychotherapist, I rarely encounter patients who haven’t been subjected to CBT, which failed to help them.
The problem with CBT is that no attempt is made to understand the causes of depression and anxiety. Proper therapy - such as psychodynamic therapy, which looks at why we behave as we do - can treat the causes.
The causes themselves are one of the best-kept secrets of modern science. They do not include your genes. The latest evidence strongly suggests that mental illness is not genetic.
Indeed, in a remarkable recent admission, Robert Plomin, Britain’s top gene psychologist, stated that: ‘I’ve been looking for these genes [for mental illness] for 15 years and I don’t have any.’ Off the record, many experts will admit that no genes are going to be found; that the difference in psychology between us - including even siblings - has little or nothing to do with DNA.
By contrast, the evidence for the critical role of childhood experience is becoming overwhelming.
The best study, by Professor Alan Sroufe in Minnesota, shows that 90 per cent of people who suffered childhood maltreatment have a mental illness at age 18.
Another study - by Robert Anda, of America’s National Centre for Chronic Disease Prevention - shows that adults who suffered five or more childhood adversities (such as abuse or neglect) are 193 times more likely to be mentally ill than people who suffered none.
Virtually all studies show that the more childhood adversity, the greater the risk of mental illness.
Given the strength of this evidence, it is bizarre that practitioners of CBT are explicitly required to steer patients away from their childhood.
A few anxieties, such as panic, are changed by CBT, but for the great majority, when the gloss wears off, the distress returns
The CBT theory ignores causes, teaching practitioners to concentrate only on how thoughts are causing symptoms. Major reviews of the evidence, such as that by American psychologist Jonathan Shedler, show that therapies which explore childhood causes and focus on the relationship with the therapist truly work in the long term.
If only the IAPT programme had really been evidence-based, it would have used those therapies.
Knowing Richard Layard to be a well-intentioned man and an economist, not a psychologist, I can forgive him. But David Clark is an Oxford University psychology professor.
Clark strongly stresses that CBT is the evidence-based, scientific treatment - yet fails to mention that this evidence proves it does not work in the long term.
A few anxieties, such as panic, are changed by CBT, but for the great majority, when the gloss wears off, the distress returns.
Yet thanks to Clark and Layard, CBT is now largely the only therapy it is possible to obtain from either the NHS or from private health insurance companies.
Of course these two aren’t exclusively to blame - CBT appeals to politicians and the National Institute for Health and Care Excellence because it is quick and cheap. The therapies proven to work long term, such as psychodynamic therapy, would not be so cheap because they require more sessions than six to 16.
It is no coincidence that it was under New Labour that the IAPT scheme was introduced.
Just as CBT is all about salesmanship, selling an idea of yourself to yourself regardless of your inner emotional truth, so Blair’s government put the spinning of policies ahead of what was actually true.
CBT does have some virtues. It encourages practical steps proven to improve wellbeing, such as taking exercise, meditation and yoga.
Professor Clark is a highly skilled clinician and I do know people who claim to have been helped by CBT to reduce their depression.
But all of them had done it for many years and the relationship with the therapist was what helped, not the change in thinking patterns. Studies prove this: insofar as CBT works, it’s if there is a good relationship with the therapist. But that is not what CBT is about - it discourages the emotional attachment to the therapist.
There is growing fury in the mental health field at the way David Clark has hijacked so much attention and resources for CBT.
In early November, leading figures, such as Jonathan Shedler, will gather at Dartington in Devon to discuss the overselling of the evidence for CBT’s effectiveness.
In the meantime, for the vast majority, CBT will continue to be virtually all that is on offer.
In its stead we urgently need therapies for everyone - not just those who can afford the alternatives - that treat the childhood causes of depression and anxiety through the relationship with the therapist
Read more: http://www.dailymail.co.uk/health/article-2800946/is-nhs-s-therapy-depression-total-waste-time.html#ixzz3GuF3xpVs
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