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What if you could just forget ab ...

Posted Mar 03 2009 3:41pm

What if you could just forget about all that complex cognitive challenging, understanding of logical fallacies and the mental demand this asks of the clinician working in the room? A new paper out in the latest Clinical Psychology Review suggests that maybe you can. Richard Longmore and Michael Worrell have a provocative paper (can't make a link) entitled: Do we need to challenge thoughts in cognitive therapy?

..... is the direct, explicit modification of maladaptive cognitions a necessary or sufficient intervention in CBT? Hayes (2004) identified three empirical anomalies in the CBT outcome literature. First, component analyzes do not show that cognitive interventions provide added value to the therapy. Second, CBT treatment is often associated with a rapid, early improvement in symptoms that most likely occurs before the implementation of any distinctive cognitive techniques. Third, measured changes in cognitive mediators (the thoughts and beliefs held by the cognitive model to underpin disorder) do not seem to precede changes in symptoms.

Longmore and Worrell take us through a range of depressive and anxiety disorders including OCD and provide research showing that behavioural components are as effective if not more effective than the CT component. In other words leaving out cognitive challenging doesn’t make a lot of difference to outcome. I would have to say the paper appears pretty convincing and it will be interesting to see what scholarly refutation to this is raised. Studies on behavioural activation by Jacobson et al in the mid nineties raise some interesting questions.

Jacobson et al. (1996) study has potentially serious implications for both the theory and practice of CBT for depression. In practical terms, behavioral activation is simpler and more cost effective, both in the training of therapists and delivery to patients. Further, they suggest that efficacy of behavioral interventions in the trial must lead to doubt regarding the significance of cognitive factors in the etiology and maintenance of depression.

This study is currently being replicated and preliminary results suggest:

Here, it is stated that Behavioural Activation proved as effective as antidepressant medication, and that both produced superior outcomes to cognitive therapy, which was no more effective than the pill placebo condition. Given that the Washington University study purports to be the largest outpatient therapy trial for depression yet undertaken, these would appear to be perplexing results for the proponents of cognitive therapy as a treatment for depression. However, putting aside the comparison with BA, the Washington results would seem to contradict many previous studies which have shown CT to be equally effective as pharmacotherapy as a treatment for moderate depression and severe depression. Therefore, it will be necessary to wait for the publication of the study's data before its full implications can be assessed.

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