Education And Debate

All you need is cognitive behaviour therapy?Commentary: Benevolent scepticism is just what the doctor orderedCommentary: Yes, cognitive behaviour therapy may well be all you needCommentary: Symptoms or relationshipsCommentary: The “evidence” is weaker than claimed

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7332.288 (Published 02 February 2002) Cite this as: BMJ 2002;324:288
  1. Jeremy Holmes, consultant psychiatrist in psychotherapy (j.a.holmes@btinternet.com)
  1. Department of Mental Health, University of Exeter, North Devon District Hospital, Barnstaple EX31 4JB
  2. Vine House Health Centre, Abbots Langley WD5 0AJ
  3. Academic Division of Clinical Psychology, School of Psychiatry and Behavioural Science, University of Manchester, Wythenshawe Hospital, Manchester M23 9LT
  4. Cassel Hospital, Richmond TW10 7JF
  5. Clinical Psychology Services, Hull and East Riding Community Health NHS Trust, Victoria House, Hull HU2 8TD
  • Accepted 28 August 2001

Psychotherapy, traditionally psychiatry's Cinderella treatment, has finally reached the consciousness of mental health policy makers. The trend started with the 1996 NHS Strategic Review, Psychotherapy Services in England.1 This set out a programme for coordinated, evidence based, comprehensive, safe, and equitable provision of psychotherapy—and pointed to the gap between these ideals and current reality. A sister publication, What Works for Whom? summarised the evidence for psychotherapy “best buys” in all the major psychiatric diagnoses.2 Then came the Mental Health National Service Framework and the National Plan, which emphasised psychological therapies as equal players alongside physical and social measures in the management and prevention of mental illness. 3 4 Most recently, the Department of Health's Treatment Choice in Psychological Therapies and Counselling provides an evidence based guideline to help family doctors and psychotherapists allocate common mental disorders to appropriate psychological therapies.

Summary points

Psychological therapies increasingly form an integral part of government planning for mental health care, and cognitive behaviour therapy tends to be seen as the first line treatment for many psychiatric disorders

The superior showing of cognitive behaviour therapy in trials may be more apparent than real

Psychotherapy is concerned with people in a developmental context and cannot be reduced to the technical elimination of “disorders”

Psychotherapy research and practice must move beyond “brand names” of different therapies to an emphasis on common factors, active ingredients, specific skills, and psychotherapy integration

Cognitive behaviour therapy as treatment of choice?

In each of these publications due homage is paid to psychotherapy as a multifaceted, pluralistic enterprise in which a range of therapies is required to meet patients' various needs. Yet, when detailed recommendations are examined there is no doubt that cognitive behaviour therapy is promoted as the therapy of choice. Thus the national service framework cites cognitive behaviour therapy as the first line treatment for …

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