Depression

See Lifestyle Interventions (exercise, diet)

CBT and severity of depression

• [B]aseline severity has little influence on efficacy of CBT
• CBT leads to greater symptom reduction than pill-placebo. 

CBT versus counselling for depression: it ain’t what you do, it’s the way that you do it

• This blog is going to focus on a recent study that compares the efficacy of two talking therapies: generic counselling and cognitive behavioural therapy (CBT) in treating depression (Pybis et al, 2017).
• This is clearly a robust evaluation of the efficacy of CBT (clearly defined by the authors in this study) and generic counselling (ill-defined in this study) in the treatment of depression in patients referred to IAPT services in England and Wales. Certainly the evidence suggests the two main models of talking therapy are on a par. This doesn’t come as a surprise to me as there has been for some time a growing belief that the quality of “therapeutic relationship” is the biggest determinant of the efficacy of talking therapies. This current study also, rightly in my view, raises the thorny subject of therapist competence. This is perhaps the greatest contribution that this study can make to further our insight into the predictors of efficacy. Is it possible that CBT has the potential to be more effective than counselling, but that this is negated by the nature of those employed by IAPT services? After all, CBT practitioners tend to be younger and have less “life experience” when compared to counsellors. It would have been fascinating to know if this was indeed the case for this current study, but I know this data is not gathered as part of the so-called IAPT minimum data set.
• Another key limitation of this and any other study reporting on generic counselling lies in the heterogeneity of this therapy type. As the authors rightly point out, generic counselling could range from completely non-directive person centred therapy through to very directive approaches and as in the case of certain counselling, can also encompass CBT! This can only be addressed if counsellors use a manualised approach (as being trialled currently with the BACP developed Counselling for Depression).

* * * * * 

Misc.

• Recalling Happy Memories in Adolescence Can Cut Depression Risk