There is something of an Emperor's New Clothes moment about the revelation at a conference last week that the claim that cognitive behavioural therapy (CBT) is more effective than other treatments is just a "myth" and we could be wasting millions of pounds (The Herald, July 7). Many researchers will wonder why CBT gained its undeserved status and took so long in being exposed for what it is.
In the first place, many people so-defined do not really have "depression". They may be, understandably, fed up with the unemployment, or disruption to education, decline in their standard of living, social isolation and fractured relationships that a long-term disabling illness - such as ME (myalgic encephalomyelitis), for example - may bring. But this is not the same as what depressed people experience for no such apparent reasons, and should not be treated the same.
Those who are claimed by researchers to be, or say they feel, better are put in the "depressed CBT success" file. In reality, they may not have been depressed people and those who truly are depressed, if they are included in those referred for CBT at all, may have shown some improvement due to other treatments, such as drugs, confounding the conclusions of CBT trials.
The patients claiming success for CBT may be misleading. No-one knows the true scale but there is probably good reason to think that the number of people who say that CBT did them good when the therapist is present but say, quite differently, that it did not, or did not last, in the relative anonymity of online forums may be an underestimate of the real magnitude. Many may give an over-optimistic assessment to the GP who referred them, for fear of upsetting them, being poorly treated in future or even dropped from their list.
By continuing their unwarranted assumption that CBT is successful, therapists remain employed and avoid having to admit they do not understand the physical cause of an illness. It is also a mistake to think that it is always better to do something - anything - than to take no action. It is not true to say that, if CBT does no good, it will do no harm. It may be the last straw for a patient who has been ill for decades, tried everything and for whom this is just another false hope.
CBT is not a good investment, even for the conditions such as depression and anxiety for which it was developed; it certainly isn't the panacea the government has been led to believe it is, and it is a sponge for precious research funds that could be better utilised to find the physical cause which should, in turn, suggest an effective treatment. Dr John H Greensmith, ME Free For All.org, 36a North Street, Downend, Bristol. Your article on cognitive behavioural therapy only goes to confirm what the real experts, those who live with mental health problems, have stated for some time: that CBT is appealing and works for some, but only as one choice from a menu of psychological therapies. The real challenge is to give us a minimum waiting time for these therapies, similar to that which many others with physical health problems will soon enjoy!
Shaun McNeil BSc, Glasgow.
