Has CBT Become Less Effective?
Cognitive Behavioral Therapy (CBT) remains the mainstay psychological treatment for countless disorders. Its advocates readily point to its track record in many instances as equating to or bettering medication. It is a relatively quick, scientifically proven, and effective treatment method. It has no side effects, is cheap to run, has a sound theoretical basis and its principles are easy to understand. So what’s the problem?
As with any treatment method there have always been perceived benefits and limitations to CBT. The journalist Oliver Burkeman of The Guardian, recently reported on an article in the Psychological Bulletin where researchers analysed 70 studies over three decades. The startling conclusion reached was that CBT appears to be getting less effective. It's a curious finding; after all we don't build up a tolerance to CBT in the way we might an antibiotic. In fact the authors, Tom Johnsen and Oddgeir Friborg, say it appears to be half as effective in treating depression than it once was.
Explanations vary. Burkeman notes that as a therapy grows in popularity it attracts more practitioners who are less experienced and competent. But the paper also raises the idea of the placebo effect. When CBT was first released on the masses it seemed as if a miracle cure had been discovered. Follow up studies, randomized controlled trials, comparisons with medication all pointed to successful outcomes. And while there’s no doubt very many people were helped by the approach there was always an acknowledgement that others were not. Belief is central to CBT. The belief that we may die during a panic attack would be challenged, for example. But belief is also central to the placebo effect. If we truly believe something is helping, it probably is, at a psychological level.
Perhaps insights and expectations are now more realistic? I've always supported CBT but I've watched it morph and expand into all sorts of areas as treatment options. I've seen good and not-so-good practitioners. Is it just possible, as Burkeman suggests, that we are changing as people? Might therapy outlive its usefulness as our character changes? Talk therapy comes in many forms and is subject to changing times and trends. Analytic psychotherapy gave people answers to questions about emotions and moods. In more modern times our understanding is better but the actions we need to take in order to make adjustments or correct things often seem too much effort or are unpalatable.
So, is CBT passed its sell-by date? Not by a long way, but I think the days of over-zealous claims and the ever expanding bubble of treatments under the CBT banner should be put under greater scrutiny. At its best CBT remains, I believe, a highly effective therapy.
We now move into an era of mindfulness and meditation. Many CBT therapists have already embraced mindfulness concepts and embedded them as part of CBT therapy, so it will be interesting to see what develops.