Mental Health Today tweeted a question, “What do we know about whether Cognitive Behavioural Therapy (CBT) is the best method of treatment for mental health problems?” (Tweeted 18/07/2018).
Our team at the University of Oxford are attempting to answer this question. We think it will take us 2 years to answer and it is unlikely we will be able fit our answer into 280 characters!
In 2014, The Economist published an article which reported 43% of all therapy courses in Britain are CBT and how over 6000, new therapists were trained between 2007 and 2014. Combined with several recommendations to use CBT for various mental health problems from the Government Health Watchdog, NICE, it seems the answer to the MHT’s tweet is, “yes” (only 3/280 characters).
There is a vast amount of research conducted to answer this question and, to try and answer one part of the question, our team is wading through it.
A randomised control trial (RCT) is currently our best method to test if a treatment is effective. A group of people with a mental health condition, for example, generalised anxiety disorder, are recruited into a study. They are randomly allocated to either receive CBT or a control. The control group could be receiving nothing or it could be receiving something (e.g. a different treatment, a drug, or a placebo treatment). Measures of the participants’ anxiety will be taken before and after having the treatment/control and sometimes again at a follow-up (e.g. 12 months after completing the trial). We test the difference in anxiety scores between the two groups (CBT versus control).
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If you search for randomised control trials of CBT, you will find tens of thousands of trials. Researchers have combined trials conducted in one particular population e.g. all RCTs of adults with generalised anxiety disorder, into systematic reviews. These reviews can combine the results of all the trials together, which is like doing one very large trial to explore if CBT improves the patient’s symptoms. However, if you search for CBT systematic reviews you will find thousands (and thousands).
The effectiveness of CBT
We have been funded by the National Institute of Health Research Health Technology Assessment board to search all available systematic reviews which examine the effectiveness of CBT for mental (and physical) health problems. We aim to produce an overview of the numerical data reported in RCTs and synthesised in systematic reviews which will offer one perspective to answer the MHT tweet.
"Why are we doing this?", I ask myself, whilst trawling through 7000 abstracts. We would like to create a map which reveals where we have high quality evidence to demonstrate that CBT is effective or not effective for which mental/physical health problem, for which type of people, and in which context.
We also want to map where there are evidence gaps, where there is either no research or no high quality research available. For health problems where we have several reviews which are similar, we will explore the possibility of using another type of analysis called panoramic meta-analysis to produce summary statistics of the overall effectiveness of CBT for that particular population.
We strongly believe that this piece of work must be useful for people living with mental (and physical) health problems, for clinicians deciding which treatment to use, and for research to progress in a meaningful way. Our team includes people who have used CBT to help them cope with mental health problems, several clinicians from different fields who use CBT, and researchers who dedicate their career to exploring CBT.
Why am I writing this blog? ...Anything other than those 7000 abstracts. In order to reach our goal of producing a relevant and useful piece of work, we would love to receive feedback from all perspectives on our project. Ideas? Thoughts? Criticisms?
For more details our full research plan is published in the British Medical Journal Open and can be accessed for free by following this link TBC or feel free to contact me at email@example.com .
The Cognitive Behavioural Therapy – Overview project is funded by the NIHR Health Technology Assessment group (Project 16/174/24). The Primary Investigator is Dr Beth Fordham who is based in the University of Oxford at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (https://www.ndorms.ox.ac.uk).