Changes Bristol are an organisation, running support groups for those suffering from mental distress. This article was written for an edition of the internal newsletter on the 28th February
Article Author: Sarah Rudston
The IAPT (Improving Access To Psychological Therapies)’s plans to get everyone fair access to talking therapies seemed to be the start of something genuinely promising when introduced by the Labour government, and the fact that the plans weren’t immediately scrapped by the coalition seemed to be further good news.
However, the emphasis on CBT (one of the more short-term and cost-effective therapies) above all else, the fact that waiting lists can still reach up to 18 months before treatment and the unavoidable fact that the cutbacks are placing an even bigger strain on the already dwindling mental health services have made me sceptical to say the least. Once again, this scheme may just be a glorified pre-election campaign now facing a tough time in the real world.
In doing some research, the overall emphasis seemed to be on treatments which can show immediate results, hence why CBT seems to be a favourite. Reports were quick to roll out studies where CBT had been effective, but results were patchy at best, the best ones being with people receiving treatment for specific anxiety disorders rather than general depression. The relapse rate doesn’t seem to be mentioned, and the research articles I found tended to be mainly psychologists, psychotherapists and GPs bickering amongst themselves about whether CBT is more or less effective than other treatments with disregard for the patients.
My experience with CBT was inconclusive. When I was eighteen, I went for an extremely expensive course of CBT at a hospital which looked more like a hotel. My therapist was lovely, very warm and compassionate but I really don’t remember much about the actual treatment itself, other than it included a lot of flow charts, mood records and information about “fight or flight” responses. It was only after I finished treatment that I realised how ineffective it had been in actually treating the underlying causes of my depression. It was when I began long-term psychoanalytic therapy that I began to find some answers (and it probably also helped that it wasn’t paid for by my grandparents, and that my mother wasn’t waiting for me in the next room, on a luxury sofa, drinking coffee and doing Sudoku puzzles).
The idea behind CBT is that the patient needs to realise that their preconceptions are not necessarily accurate – that the reason that they are depressed may in fact be to do with their own thought processes rather than external factors. Not necessarily a problem – people who are depressed do tend to have a skewed view of reality, however , there’s something a bit eerie about the government wheeling out CBT as a “cure” in this way in light of the destructive mental effect of the economic downturn and the subsequent public sector spending cuts.
As Zoe Williams said in the Guardian in 2009, “[CBT] cannot talk you out of being unemployed”. (I’ve had nightmares where the government forces us all to have their version of CBT, where we’re all herded into a room to be told that the recession was entirely our fault…)
That’s not to say that CBT doesn’t work. I don’t find the concept of breaking down long-held destructive beliefs to be a waste of time – it’s just I’m not sure how successful it can be in such a short space of time (common recommendation is for six to twelve weekly sessions). The positive reports I found seemed to indicate that CBT had been a “stepping stone” on to other methods of recovery – but is this what the IAPT scheme is intending? I’m assuming not, as other therapies are rarely mentioned in their reports.
I supposed I am biased in that I’m now in Year Five of my treatment, and I have found long-term therapy to be the best treatment for me, but I do get a little bit fed up with the constant reminders on government health websites about how “costly” and “time consuming” long-term psychotherapy is, as if this is enough to discount it from treatment entirely in favour of CBT.
If the government is going to wheel out a treatment plan, they need to consider that there isn’t one answer for everyone.