Cognitive Behaviour therapy

CBT outcome

CBT add on negative

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A clinical trial is considered efficacious when tested under ideal conditions
and effective when beneficial under routine circumstances. The evidence for effective brief therapies is not as strong as has been claimed,
especially if you consider that many effects reported at the 5% level of significance will be false positives.
For example, a report has claimed cognitive behaviour therapy
to be effective in treating people with psychotic experiences.
Much of the cited evidence reported effects at the 5% significance level.

The randomised controlled trial, which presented the more robust data,
was not assessed "blind" and did not include a no treatment control group.

The evidence for the claimed pre-eminence of cognitive behaviour therapy
in treating less severe mental health problems is similarly defective.
One study gave from six to a maximum of 12 sessions of psychological therapy,
either cognitive behaviour therapy or non-directive counselling,
or usual general practitioner treatment.
Both psychological interventions gave better results (on the Beck depression inventory
but not on three other outcome measures)
than usual general practitioner care at four months, but this advantage was not maintained at 12 months.

The difficulties that cognitive behaviour therapy encountered in another study
(in which the cognitive behaviour therapy arm was abandoned after eight of 11 couples failed to attend therapy sessions)
point to the complexities of conditions such as depression and the difficulties in providing effective therapy.
The apparent brevity and simplicity of cognitive behaviour therapy seems not to acknowledge fully this complexity.

There are dangers in a therapy being presented in a more positive light than the data from clinical trials merit.
For example, acronyms for clinical trials that suggest therapeutic benefits
seem to have more influence than their actual results on prescribing habits.
In addition to the lack of evidence for brief cognitive behaviour therapy having a clinically significant effect,
the claim that such studies are randomised controlled trials does not stand up to scrutiny.
They are not, and it is extremely difficult, perhaps impossible,
to meet the criteria for randomised controlled trials in research into psychotherapy.
Declaring that these flawed studies meet the "gold standard" of clinical research
is a marketing rather than a research strategy.