CBT

I thought the readings this week were a great overview of both CBT and RET (or I guess REBT, according to Ellis). I did, however, have some concerns about the Butler et al. (2006) article. The general theme seemed to be that CBT (or in some cases CT) was found to be superior than wait list, placebo or no treatment controls for most of the disorders that were discussed in the article. I'm still left wondering how well CBT does compared to other alternative treatments, such as IPT or psychodynamic therapy. Some people may be better off when they get treated with CBT than if they had not received treatment at all, but is it really the BEST, most effective treatment when compared to other therapies? I think there needs to be more research/evidence on this issue. We are doing a disservice (is that a word?) to clients if we are not confident that the treatment we are using is the best treatment out there for them. In addition, while CBT appears to work well for a subset of disorders like phobias, OCD, and PTSD, the article lacked a discussion of its effectiveness for other disorders, particularly personality disorders. The disorders within the internalizing realm (depression, anxiety, etc.) do make up a large portion of the types of clients in therapy, but by failing to address disorders or symptoms outside of that subset, we should not make the generalization that CBT is the best form of psychotherapy.

I also would like to comment on the issue of follow-up research. In general, I think there needs to be more of it and I think there needs to be a more systematic way to measure it. For instance, there was absolutely no follow up findings for CBT on chronic pain, bulimia, and PTSD in Butler et al.'s (2006) article. In my opinion, knowing the long term effects of a treatment for specific disorders are essential. For instance, if one treatment shows immediate effects but does not persist over time, then it might make sense to treat the client with an inital treatment and then provide "maintenance therapy" using another type of therapy that shows greater long term benefits (this may be unrealistic given all the insurance issues, but in an ideal world it makes sense!) In addition, when follow up studies are completed, I think it is necessary for researchers and clinicians to be extrememly clear about what exactly they are measuring, the outcome measures used, the length of time between end of treatment and folllow up evaluation, etc. When a treatment is shown to produce "clinically significant change", for instance, what does that mean? A slight reduction in symptoms or problematic behavior after 6 months of therapy might be life changing for a schizophrenic or an anti-social person, but may have much less impact on someone who is midly depressed. In such a case, are both treatments equally effective in producing "positive change" at follow up?