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Monday, June 8, 2015

Is Cognitive Behavioural Therapy Becoming Less Effective?

A recent meta-analysis examined the efficacy of CBT for unipolar major depression, finding a trend towards lower effectiveness over the past few decades. A copy of the paper may be obtained here. The authors hypothesized that diminishing effectiveness may be related to one of two factors: (1) as the therapy has become wildly popular, therapists may be diverging from the manualized protocols for CBT, in other words not administering the therapy to the same high standards as earlier clinical trials did, or (2) as more experience has been gained with the therapy, some of its mystique may have worn off - leading to lower placebo response in the active treatment arms. On the latter point, it is important to remember that in a trial the subset of participants receiving CBT has outcomes that are determined both the specific impact of the treatment and non-specific factors related to the therapy. I wonder if there might not be another explanation. In past decades, few people outside of the mental health world were even aware of CBT and often even the first few, psychoeducationally oriented, CBT sessions were real eye openers for them. The basic concepts of CBT sometimes led to a big change in peoples' ways of looking at the world. In this day and age, however, everyone has heard of CBT, many of read books about it or encountered similar ideas about the relationship between thoughts and emotions in popular media. Skillfully delivered CBT has a lot to offer people who only have a cursory knowledge of it, of those who have tried to do it themselves with books or websites devoted to CBT. However, nowadays, some proportion of the gains may already have been made before people enter therapy.

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