About CBT
About CBT is broken down into the following sections:
1. Introduction
2. Keywords or terms used in reference to CBT
3. The history and development of CBT
4. Standards and levels of practice of CBT
5. Availability and access to CBT in Ireland
6. Conditions or disorders where CBT has been shown to be effective
1. INTRODUCTION
Behavioural and Cognitive Psychotherapies are typically collectively referred to as CBT. CBT is a form of psychotherapy or talking therapy but unlike many other talking based therapies, it is widely researched and is based on scientific principles.
It has been shown to be helpful for a wide range of emotional, psychological, behavioural and physical disorders. It features widely in the National Institute for Health and Clinical Excellence Guidelines (NICE) in the UK, an independent body established to promote scientifically evaluated good practice in physical and mental health.
www.nice.org.uk
The client and therapist work together in what is referred to as “a collaborative style”. The therapist enables the client to understand problems in terms of the relationship between thoughts, feelings and behaviour, sometimes referred to as the “vicious circle”.
The approach usually focuses on difficulties in the here and now and relies on the client and therapist developing a shared view of the problem. It involves the identification of personalised, time-limited therapy goals.
The formulation driven strategies that are agreed upon are continually monitored and evaluated. The duration of treatment varies greatly depending on a number of factors but typically sessions are weekly or fortnightly, last 50 minutes and treatment takes place over a period of 10-15 sessions.
2. KEYWORDS OR TERMS USED IN REFERENCE TO CBT
CBT is an umbrella term used to describe a range of models, techniques and approaches that all share the premise that how we think and behave impacts how we feel.
Here is a list of terms, approaches, models, treatments and techniques that come under the umbrella of CBT:
Cognitive Therapy; Cognitive Behavioural Psychotherapy; Cognitive Behavioral Psychotherapy; Behaviour Therapy; Behavior Therapy; Cognitive Behaviour Therapy; Cognitive Behavior Therapy; Behavioural Psychotherapy; Behavioral Psychotherapy; Rational Emotive Behaviour Therapy - REBT; Rational Emotive Therapy - RET; Acceptance and Commitment Therapy - ACT; Mindfulness Based Cognitive Therapy - MBCT; Mindfulness Based Stress Reduction - MBSR; Behavioural Activation Therapy - BAT; Dialectical Behaviour Therapy - DBT; Relational Frame Theory - RFT; Exposure Therapy; Exposure with Response Prevention - ERP; Cognitive Restructuring; Eye Movement Desensitisation/Reprocessing - EMDR; Compassionate Mind Training - CMT; Compassion Focussed Therapy - CFT; Anxiety Management Training - AMT; Imaginal Exposure Therapy; Activity Scheduling; Graded Exercise; Sleep Hygiene Training; ……..
3. THE HISTORY AND DEVELOPMENT OF CBT
This will be added very soon, please return to this section in the near future.
4. STANDARDS AND LEVELS OF PRACTICE OF CBT
When seeking help it is important to remember that there are different levels of the practice of CBT. Each requires very different skill levels on the part of the person talking to the “client”.
The British Association of Behavioural and Cognitive Psychotherapies (BABCP)
www.babcp.com details the 4 levels as follows:
Level One: FORMULATION DRIVEN CBT (individual or group CBT for a range of people and problem areas) –
This is a form of psychotherapy. The clients are not able to help themselves and have sought help from a trained professional and require expert interventions from an appropriately trained and supervised CBT psychotherapist. The relationship between the therapist and the client is paramount and expert skills are required to engage the client in a therapeutic alliance. Once this is established therapy can proceed collaboratively through assessment, formulation and intervention. The therapist using various cognitive and/or behavioural techniques as appropriate. They would evaluate the efficacy of any intervention and change tack if necessary.
Level Two: CBT APPROACHES - Specific CBT interventions for specific problem areas (e.g. concordance training; relapse prevention work in people with a diagnosis of Schizophrenia; identification of symptoms and specific CBT intervention in post-partum depression; anger management groups, anxiety management groups, pain management etc).
This is not a form of Psychotherapy as the health workers are implementing a technical intervention, they are not required to formulate and adapt the treatment. The health workers will have received training in specified CBT interventions for particular problem areas, and should be receiving supervision from a CBT psychotherapist.
Level Three: ASSISTED SELF-HELP (computerized CBT, self-help material presented to a support group or individuals by a health worker, such as a mental health worker or assistant psychologist) –
This is not a form of Psychotherapy and only limited, if any, formal CBT skills or training are required by the individual introducing the approach, such individuals should not be claiming that they are ‘doing’ CBT.
Level Four: SELF-HELP (books, bibliotherapy) –
This is not a form of psychotherapy and no CBT skills or training are required by the individual reading the self-help material.
5. AVAILABILITY AND ACCESS TO CBT IN IRELAND
The provision of CBT at the top level, “Formulation driven CBT” is unfortunately limited in Ireland at present.
In May 2017, the Irish Council of Psychotherapy (ICP) register listed 37 accredited Cognitive Behavioural Psychotherapists. Whilst some of these psychotherapists work in the private sector and accept direct referrals many others work within the HSE or other organisation which have limitations such as catchment and boundary restrictions.
This is an area of great concern to the small number of practising accredited CBT Psychotherapists. For further information about these concerns read, “I need CBT. How do I find a good therapist?” on my homepage. An example of the concern is that on the same register of only 37 CBT therapists, if a member of the public searches the list for someone declaring a “specialist interest” in, for example, Obsessive-Compulsive Disorder (OCD), 334 names come up. Yet the National Institute of Health and Clinical Excellence (NICE) in the UK identify only two effective treatments for OCD; Cognitive Behavioural Psychotherapy and Medication.
Therefore one may conclude that many individuals are declaring an interest in a disorder or condition and may deal with people who have that problem, without being trained to an accredited level in what is commonly referred to as an "evidence based approach", in other words, a therapy that reseach has shown to be effective. Of-course, they could be providing CBT at levels 2-4, which does not require accreditation, but which is not considered a form of psychotherapy.
The advice of a medical or mental health professional can be helpful to ensure some level of safety and reliability when seeking a therapist as can the professional registers who have lists of accredited CBT therapists.
6. CONDITIONS OR DISORDERS WHERE CBT HAS BEEN SHOWN TO BE EFFECTIVE
This will be added very soon, please return to this section in the near future.
7. GLOSSARY
This will be added very soon, please return to this section in the near future.......
