Star Wars - A Response to Darian Leader (Guardian, September 9th 2008)

I was quite surprised with the creativeness of the article published on the Guardian last September 9th 2008 by Darian Leader. Slightly disappointed with the fact that readers are not able to comment on the article. Don't take me wrong, although it's nicely written, with points, ideas and even references to historical figures that make history sound something really funny and interesting, his knowledge of CBT is futile, shallow and deserves a profound need of appropriate education.

Anyway... I won't bore you readers with the actual facts of how CBT works and what it really means, because this has already been extensively discussed elsewhere.

A few points to consider, however with regards to this particular article is the misunderstanding that CBT is interested merely in the reduction of symptoms. Let me frame it once and for all that CBT is interested in supporting people, from all backgrounds, in developing behavioural and cognitive repertoire that are functional, helpful, and supportive for minimising human suffering, thus in many ways improving people's quality of life. That may or may not be necessarily linked to the reduction of symptoms!

Let's not create confusion between measuring outcomes for the sake of it, and measuring outcomes as a way to improve patient care and to give direction to therapy, which is often something forgotten in less evidence-based psychotherapy models. Behavioural psychology is scientifically based, because it is scientific, testable, and interested in prioritising what works over what doesn't.

On top of all that, I think Darian Leader misleads readers to believe there is only one type of CBT. Cognitive Behavioural Psychotherapy is a broad term referred to more than 20 individual models of CBT, where each one of them has a certain defined characteristic. The Aaron Beck's 'Cognitive Therapy' (60's-till today) is very different than the more philosophically based Albert Ellis work on 'Rational-Emotive Behaviour Therapy' for instance. Furthermore, we have other models which are more mindfulness-based like the 'Acceptance and Commitment Therapy' of Hayes et al. and the 'Mindfulness-based Cognitive Therapy' of Segal et al. The latter models are considered the third wave of cognitive and behavioural psychotherapy, where the reduction of symptoms is not a priority, but refers to the contextual understanding of mental health (please see Relational Frame Theory, by Hayes et al. 1999 for details).

CBT is a big umbrella term for all types of Behavioural and Cognitive Psychotherapies, and some therapists even prefer to use its therapies in a eclectic and integrative way, rather than rigidly focused on one particular model. Some are more behavioural, some more cognitive based. Although recent findings do point out to the importance of behavioural components over cognition, as well as the impact of metacognition on quality of life and mental health (Wells et al.)

The CBT community is rather disappointed -obviously - with articles like this that seem to really miss the bigger picture. The IAPT (Improving Access to Psychological Therapies) programme is not just benefiting CBT. I for instance for a service that is receiving government funding for the provision of all types of counselling and psychotherapy models. The Department of Health has become, nevertheless, more vigilant with regards to making sure these services are evaluating outcomes, and I do agree that a more flexible system for evaluating outcomes should be put in place.

My invitation is that we therapists start working together into ameliorating our protocols for helping people live more vital lives, not necessarily without symptoms, as Darian Leader suggests CBT does - rather wrongly, for the reasons stated in this article. So we ought to be working together without being personal about the fact that Evidence-based treatments, i.e. treatment protocols that work for improving patient care will receive more funding (especially within the NHS) than those which don't.

And if we can, once and for all, understand that CBT is not just the well propagated Cognitive Therapy by Dr. Aaron Beck; then we will start really progressing at adequately transforming people's lives through the use of legitimate and evidence-based journalism!