Psyched About CBT

In their new book Thrive: The Power of Evidence-Based Psychological Therapies, Richard Layard, an economist at the London School of Economics, and David Clark, a psychologist, argue that public health policy should focus more pointedly on cognitive behavioral therapy (CBT). Bryan Appleyard unpacks the idea and nods along:

The success of CBT — and its offshoot, mindfulness — is at the heart of this book’s case for increased spending on mental health. The most succinct summary of the method is “thoughts are not facts”. People suffering, typically, from anxiety or depression are trapped in thought processes that they have come to believe are truths about themselves and the world. The therapist identifies these thoughts, then provides techniques for reducing or eliminating their impact. It doesn’t take long — typically 12 sessions — and it has much higher success rates than any other treatment — about 50%. Mindfulness, meanwhile, is a meditation technique inspired by Buddhism that helps people to see thoughts as passing phenomena rather than traps. …

If Layard and Clark are right, we seem at last to have found a gentle, non-disruptive and apparently risk-free way of dealing with the worst and most commonplace miseries of the mind. Let’s do it.

Daniel Freeman and Jason Freeman defend CBT from detractors:

CBT is sometimes criticised as an overly simplistic, once-size-fits-all strategy. Layard and Clark remind us that when done properly CBT is far more nuanced. For each problem, clinicians develop and test a specific theoretical model of symptoms and causes and on this basis generate a targeted treatment strategy. The aim is not to create a blithely complacent Stepford population, but to help people achieve meaningful and positive change in their lives. CBT isn’t merely effective, it is also relatively cheap – certainly when compared to the spiralling costs of medications such as antidepressants. …

CBT, as Layard and Clark acknowledge, doesn’t work for everyone. And it doesn’t mean that we don’t need to address the causes of mental illness, such as poverty, stress, and lack of social support. But it’s time we got serious about tackling psychological problems, ramping up research and providing people with the treatments that have been proven to work.

But Jenny Diski raises an eyebrow:

The authors are clearly compassionate people who want to abolish the misery of mental illness, and CBT, so appealing to economists with its manualised conversations, standardised questionnaires and worksheets, and in tune with contemporary culture’s desire for measurable fast outcomes, is the pragmatists’ holy grail. CBT aims to get the patient symptom-free, back to work and paying her taxes. In generations to come, if we can ward off the return of the repressed, people will be looking back at 20th-century literature and philosophy and wondering what on earth they were on about with their incomprehensible talk of the unconscious, their tales of guilt, sublimation, drives and dreamwork. Because, by then, the mysteries of the human heart will have been abolished and all the world will be transparent and symptom-free.