Reading Monday’s edition of The Daily Telegraph (after I’d finished the crossword) I came across a reference to CBT. Except that it’s not CBT. And CBT that’s not CBT is fairly common…
Fear of flying
The problem occurs near the end of James Le Fanu’s Doctor’s Diary column, where he writes:
Those who need to fly regularly may benefit from a form of cognitive behavioural therapy known as ”systematic desensitisation’’. Here, the therapist first induces a state of deep relaxation, then encourages the sufferer to imagine and confront anxiety-generating scenarios.
All very well and good, except that systematic desensitization is a purely behavioural technique. There’s no cognitive element in the treatment, so it’s not CBT.
This confusion damages patients whose systematic desensitization therapy doesn’t work. They think they have had CBT and it failed, so they never try CBT again. In fact, real CBT with cognitive restructuring might well help them to overcome their fear of flying.
Chronic Fatigue Syndrome
The same problem often occurs in discussions of treatment for chronic fatigue syndrome (CFS, also known as ME). Treatments for CFS are controversial, possibly because a variety of underlying conditions can cause similar clusters of symptoms, so confusion over which therapy is which makes sensible discussion particularly difficult.
One of the controversial treatments is graded exercise therapy (GET), a purely behavioural technique with no cognitive element. GET seems to help some patients, but it can cause severe relapse in others. I won’t go into detail here about the pros and cons, how to determine who can be helped and who might be damaged, and how to make GET safe. The problem is that some patients who receive GET (and are possibly damaged by it) are told that they are having CBT, and end up confused about the difference.
CBT is a purely psychological therapy that can’t possibly cure CFS (although it can help with the depression that is one of the common symptoms associated with CFS). Telling patients that they are having CBT when they are really only having GET deters those patients from having real CBT for their depression.
As I mentioned in Pickles, there are moves afoot to regulate psychotherapy in the UK through a statutary body. But it is not clear whether this regulation will prevent false descriptions of therapies. A possible outcome is that the regulator will simply collude with it.
The existing professional bodies appear to collude with it at present. For example, the BABCP allows therapists who only do behavioural work to describe themselves as cognitive behavioural psychotherapists, and to describe their work as CBT. Their public database of therapists mostly gives no indication of the kind of approach that each therapist uses.