The National Health Service in Britain has adopted Cognitive Behavior Therapy (CBT) as the first choice treatment for depression and anxiety. Collective experience is that medication is very expensive and has disappointing results.

The article from Times Online argues that CBT has trouble maintaining results in the long run. However, the issue isn't what therapy works best, it's about what therapy works best for whom. Anti-depressant medications and CBT has the most impressive outcomes, but these measurements seldom look at long-term outcomes.

Anti-depressants in my experience take the edge off of depressive symptoms for most people. CBT offers a good set of skills for clients to learn that enable them to redirect their thoughts and change their feelings on a moment to moment basis. These are critically important skills that everyone can benefit from.

Some depression and anxiety have deeper causes. A history of abuse, neglect, or signficant or repeated trauma can very much complicate the treatment of all mental illness. Recovery from trauma is a long difficult road, as has been demonstrated by the recent studies about war veterans with post-traumatic stress disorder. Cognitive skills training, medication, insight oriented therapy that often involves intensive reworking of emotional memories. Teaching an insightful understanding of emotions and their context and their meaning and how one can cope becomes an important, painful and time consuming part of treatment. While long term psychotherapy may be indicated in a few cases, episodic returns to therapy may be necessary over many years to learn how to cope.

The problem with interpreting research and it's appearance in the news contributes to misunderstanding because treatment of mental illness is about helping individuals. It's hard to draw broad sweeping conclusions about treatment and creating policy that allows for exceptions. Policy can never replace the assessment of the individual clinician.

Times Online

According to the most authoritative sources, at least half those patients receiving CBT for panic disorder had suffered relapse or sought new help after 24 months, which isn’t very cost effective.

Last Monday, at a conference on Practice-Based Commissioning in Manchester, Professor Layard admitted that CBT is appropriate for only about 40 per cent of patients overall. Stunningly, the largest body of evidence into counselling outcomes, the 35,000 cases comprising the CORE Survey, has been totally ignored by NICE and Layard alike. Looking at the figures just for depression, CORE shows there is no significant difference in the long-term success rates for CBT over traditional forms of therapy such as “person-centred” or “psycho-dynamic”: CBT works for 75 per cent of patients; the rest for 76 per cent.

So a summary of the evidence tends to show that alll talking treatments are roughly equal in effectiveness because it is the relationship with the therapist that counts. MORE