Wednesday, 5 November 2008

To be, to be CBT, or to be CCBT or even to watch CBBC.

It appears that Cognitive Behavioural Therapy has come back from the dead.

I did mention it in my “This Guy Sings The Blues” blog a while ago-

And a certain “Nigel Thickarse” has blogged about it recently-

First the basics, there are two types of CBT, the “proper” CBT which is actually delivered by a living, breathing “Therapist” including the “Self Help Manuals”, and then there is CCBT which is Computer Cognitive Behaviour Therapy delivered by “Ms CPU” in the corner of your local library.

CBT or CCBT is supposed to be a “treatment” for depression, and anxiety.

The NICE guidelines 2006 for Professionals can be found - and the NICE information for patients 2006 is-

This is the NICE description of CBT for patients.

Cognitive behaviour therapy is a kind of psychotherapy that is based
on the idea that what we think about ourselves and the world around
us affects how we feel and our behaviour. By changing the way we
think, we can change our behaviour and emotional reactions.
Cognitive behaviour therapy involves sessions with a therapist but the
methods are also used in self-help manuals, audio tapes and videos.

And CCBT for patients.

In computerised cognitive behaviour therapy – or CCBT for short –
the cognitive behaviour therapy is delivered using a computer. The
CCBT may be in addition to or instead of sessions with a therapist.
There are several different CCBT programs available to treat anxiety
and depression.

Before someone starts using CCBT it’s recommended that they are
assessed to make sure the treatment is suitable for them, and they
need to be given support in using the program. CCBT is not suitable
for an individual with more severe symptoms of anxiety or depression
who needs more intensive treatment and support from healthcare

CCBT packages currently available include:

_ Beating the Blues, COPE and Overcoming Depression for treating

_ FearFighter for panic/phobia, and

_ OCFighter (previously known as BTSteps) for obsessive-compulsive
disorder (OCD).

And the NICE recommendations for CCBT.

NICE has made the following recommendations about the use of
CCBT to treat depression and anxiety within the NHS in England and
Wales. It recommends using:

_ Beating the Blues for people with mild and moderate depression.
_ FearFighter for people with panic and phobia.

There is not enough evidence to recommend COPE and Overcoming
Depression for managing depression. But people can use them
specifically as part of ongoing or new clinical trials.

In September 2008 NICE reviewed CBT and CCBT.

They came up with the conclusion that,

British Association of
Behavioural and Cognitive

1). There should be a firm repositioning of the CCBT technology to make it
absolutely clear that the evidence base now confirms that book based CBT and
CCBT are equally effective. The Gellatly et al (2007) paper published last month in
Psychological Medicine confirms this - and also provides invaluable advice as to
how CBT self-help should be delivered

Key points:

• Telephone and face to face support are equally effective

• Supported self-help of depression CBT self-help materials is far more
effective than unsupported/unguided self-help.

• The support should focus on monitoring/support rather than adding “therapy”
• The support can be provided by unqualified staff

• The self-help should be CBT in focus ie it is CBT self-help that is effective,
not information alone and not self-help in general

• CCBT and written CBT self-help are equally effective

2). We are concerned that the focus of the current NICE CCBT review on just
computers has distorted the introduction of stepped care models. There should be a
firm repositioning of the CCBT technology to make it absolutely clear that the
evidence base now confirms that book based CBT and CCBT are equally effective.

Or in “English” it is just as effective to read a self-help manual about CBT as it is to endure CCBT.

But they are recommending both “Beating the Blues” and “Fear Fighter” be used by the NHS.

This of course is not anything to do with cost (yeah right).

From Ehealth- in 2007.

“Health secretary, Patricia Hewitt, said: “Mental health services have clearly improved substantially, but we want to offer patients even greater choice over how, when and where they are treated. Being able to access the right kind of therapy, instead of just being prescribed medication, is central to this vision for patients.

The DH have proposed that in 2007/08, the delivery of cCBT in every PCT in England will be an important building block in the implementation of the kind of comprehensive psychological therapy service envisaged by the improving access to psychological therapy programme.

Hewitt added: “Clinical evidence confirms that counselling and therapy are just as effective as medication in helping to treat most cases of depression. The guidance being published today will give the NHS the information they need to provide these services.

“In addition to continuing to improve services for people with severe mental health problems, we are working to improve the mental wellbeing of society as a whole, and providing a real, twenty-first century service for people with common mental health needs such as anxiety and depression.”

Yes and when I looked in the toilet this morning I found several bars of gold.
The DH says that at any one time, one in six adults is experiencing a mental health problem. Many are common, such as mild depression and anxiety.

Dr Peter Crouch, a GP and forensic medical examiner at the Taw Hill Medical Practice, Swindon said:

“We have been using computerised cognitive behavioural therapy for over three years and the feedback by our patients is extremely positive. Our patients have found that using it has significantly helped them to better cope with anxiety, insomnia and stress.

“Using the system has amplified the ability of our award winning local psychology service in Wiltshire to provide tangible and practical help and psychological support to those who need it. Very few services are able to be delivered within a few minutes of a consultation and in the patient's own home or at work, and anywhere else they can access the internet. As we have many patients who travel, some have logged in from halfway around the world to continue the programme of support.”

According to NICE the stats for adults are:

Prevelence of depression----------------------------954,332 people (2.6%)

Total cost of CCBT (first year)---------------------£24,253,985
Total cost of CCBT (second year)------------------£21,276,844

Costs for therapist led CBT for the same number of patients.

First year----------------------------------------------£90,429,563
Recurrent costs (each year)-------------------------£97,018,740

I haven’t included “fear fighter” costs. But the figures are very similar.

So, what we have is, the “experts” think that “book” based therapy is just as good as CCBT when it comes to treating us dysfunctional idiots who cannot “pull ourselves out of it” and need to waste public money when we should all sit down and read a “self help manual”.

And if the “powers that be” can persuade libraries to stock these manuals, it won’t cost the NHS a penny, because all of us sad gits who can’t cope can go to the library and take one out.

Because the waiting time for CBT is an average of 18 months just to get an initial assessment.

Thus saving the NHS about £20 Million for CCBT or £90 Million for CBT per year.

If the NHS want to save money I suggest that they log everyone with depression and anxiety onto My Ray this is a free CBT therapy website, donations can be made but it won’t cost £23 million.

Having been through the CCBT route I can definitely say that it is about as useful as NICE and I really don’t need to be told things that I already know, such as I have to change my attitude to life, and that things aren’t as bad as I think they are. Because I wasn’t assessed before “treatment” and there is no back up after the “therapy” ends.

The so-called weekly reports to GPs obviously don’t work because I entered that I was suicidal every week and my GP did nothing either because he didn’t care (which I don’t believe)” or that he didn’t get the report (which I do believe).

I would like to reiterate my comments from “this guy sings the blues”, CBBC doesn’t work because when you are depressed, be it mild, medium or catastrophic, you don’t give a shit because you are depressed you morons.

CBBC is just a cheap alternative to therapist based treatment, it is a way of fooling us that the NHS cares, and is doing something for us useless, depressed objects that are a drain on the country.

And because the waiting time of 18 months for CBT is so unacceptable, “they” don’t want the suicide rate to spiral out of control and spoil “their” stats, so the stopgap “therapy” CCBT was introduced. Giving the suppliers of the software an excellent income for years to come.
Community Care said this- “With an estimated six million people in the UK suffering from depression or anxiety disorders, there is a clear demand for therapies such as cCBT. The government last year launched two demonstration sites in Doncaster and Newham dedicated to developing models on how ­evidence-based psychological services should be adopted. Now may be the ideal moment for the government to ensure that these models, once developed, are actually implemented”

Absolute bollocks.

Depression is caused by: every day life, a catastrophic happening, chemical imbalance, being on the verge of bankruptcy, losing your job, losing someone you love, illness, constant pain, being old. I could go on but basically there are as many reasons to be depressed as there are types of people. It cannot be defined, it cannot be compartmentalised. It is personal, it is not a “disease” that can be treated en-masse, treatment must be adjusted to personality and circumstance. It must be administered by professional practitioners, and cannot be “cured” by a bloody computer in a library.

What depressed people need is support, proper counselling and financial backup, not some “lets pretend that computer software can cure us” attitude.

The dropout rate for CCBT is about the same as that for CBT, estimates are 20%, with a success rate of 50%. These figures are difficult to provide, as there are no official numbers available.
Would I recommend CCBT? Personally no, it did nothing for me apart from providing a way of entering ridiculous statements and listening to the pre-programmed response, which was of no use whatsoever.

Would I recommend CBT? I don’t know because I never got to “try” it mainly because the waiting time was so long.

In conclusion, CBT may be helpful for some people, because the patient can actually talk to someone who hopefully knows what they are doing, but it is expensive and the waiting time is unacceptable.

CCBT is about as useful as this firkin government, and you may as well read a book about it, that is of course if you can concentrate long enough because when you are depressed that is one of the first things to disappear.

Now, what was I saying?

Angus Dei



Dr. Liz Miller said...

Do you think that CBT and CCBT are taking the place of a good education?

CBT encourages people to rationalise their thoughts. If a person is well educated, then their thinking has already been rationalised. If the school system has failed, and their life is based on irrational impulses and fears, then learning to think effectively is likely to help.

Thus giving everyone CBT may backfire. People could start to use their brains for thinking. Once people start thinking properly, might the population stop swallowing political rubbish?

angus said...

Dr Liz

I think you have a very valid premise.

And maybe the Gov has shot themselves in the foot, because of the "blanket" therapy. People may well realise that they have been lost in a fog of blissful ignorance, and that the gov does not actually give a toss about them, the resulting backlash could even lead to politicians realising that most of them need far more serious therapy than CBT or CCBT.

Personally after "enduring" CCBT I would rather watch CBBC, the content is far more adult and at least you can have a laugh.