Promoting Good Practice in Cognitive-Behavioural Psychotherapies

Extract

The National Institute of Clinical Excellence (NICE) guidelines for anxiety (Panic and Generalized Anxiety Disorder) and depression were finally launched in December 2004, after much delay (see www.nice.org.uk). Given that these were such important documents, it might seem surprising that the launch went almost entirely unnoticed. Why was it surprising? Because the recommendations were ground breaking. CBT was identified as the first line treatment pretty much across the board, with huge resource implications. It is not the business of NICE to comment on resources (or the lack of these). However, it was noted in the anxiety guidelines that CBT should be available promptly from appropriately trained and supervised therapists. In many (if not most) areas, this strongly implies a huge change in emphasis in the delivery of psychological therapies. The (implicit) implications are staggering. With the honourable exception of Interpersonal Therapy in depression, other psychological therapies were not advocated – at all. In anxiety, combination treatment (medication and CBT) was not recommended as a first or second line treatment. Some medication (antipsychotic) was ruled out. Guided self-help (based on CBT principles) was “third choice”. So the explicit recommendation is that good quality, empirically grounded psychotherapies (CBT, CBT and IPT in depression) should be widely and promptly available, whereas therapies without an empirical basis were not recommended.