Cognitive behavioural therapy for major psychiatric disorder: does it really work?

Research co-led by an academic at the University of Hertfordshire, concludes that Cognitive Behavioural Therapy (CBT) is of no value in schizophrenia and has limited effect on depression.

Professor Keith Laws, at the University's School of Psychology, is one of the lead authors on a paper entitled: Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials, which has just been published online in the journal Psychological Medicine. The paper reviews the use of CBT in schizophrenia, bipolar disorder and major depression.

The results of the review suggest that not only is CBT ineffective in treating schizophrenia and in preventing relapse, it is also ineffective in preventing relapses in bipolar disorder.

The review also suggests that CBT has only a weak effect in treating depression, but it has a greater effect in preventing relapses in this disorder.

The authors focused particularly on methodologically rigorous trials that compared CBT to a 'psychological placebo' and also investigated the impact of 'blinding', i.e. whether or not the people who assessed the patients knew if they were receiving active treatment or not. Both factors are considered essential before a drug treatment is approved for use in psychiatric disorders.

The authors noted that not a single trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia and surprisingly few well-controlled studies of CBT in depression.

"The results of this review are important because in March NICE re-approved CBT for use in all people with schizophrenia. The Government is also investing millions of pounds to provide CBT for depression and anxiety in 250 dedicated therapy centres across England," said Professor Laws. "Yet the evidence here is that the effectiveness of this form of therapy may be less than previously thought, to the point of being non-existent in schizophrenia."

The other authors of the paper are Professor Peter McKenna, Benito Menni Complex Assistencial en Salut Mental, Barcelona and Dr Damian Lynch, University of Glasgow.

Full bibliographic information: Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials
D. Lynch, K. R. Laws and P. J. McKenna