Cognitive Behavioural Therapy Essay

Cognitive Behavioural Therapy (CBT) is recommended by the NICE guidelines as an effective treatment for many mental health problems, specifically depression and all of the anxiety disorders. But is it a therapy open to all? When Professor Lord Layard wrote his paper: â€Å"Mental Health: Britain’s Biggest Social Problem? † in 2005, he noted that: â€Å"16% of adults of working age have a mental illness† Of these 16%, he stated that, only a quarter were utilising any type of treatment. It was this sort of finding that lead to his recommendation to increase accessibility to proven therapies such as CBT. This was achieved with the roll out of the Improved Access to Psychological Therapy (IAPT) programme. The diagram below shows how the IAPT programme has been divided up into 3 steps: It is this stepped approach that will contribute to overcoming some of the barriers that societies diversity may have with accessing CBT. What might these barriers be? One of the first barriers an individual faces may be around the concern of being stigmatised. It may be too hard for them to think about accessing CBT therapy for fear of what others may think. They may not want to take time off work to attend sessions for fear of it impacting negatively on their career prospects. The stepped care model means they are able to receive the lowest appropriate service tier support. This may mean that an individual is able to access therapy using guided self-help, allowing them to work through the programme in their own time and at their own pace. Online programmes such as â€Å"Fearfighter† and â€Å"Beating the Blues† allow the individual to access therapy where and when they like. Not only do these sort of programmes overcome the fear of stigma but they also overcome the issue of long waiting lists meaning that the individual can access treatment on their terms almost instantaneously. Only if this level of support proves unsuccessful will the individual then be â€Å"stepped up† to the high intensity support. These internet CBT programmes also overcome geographical difficulties, as long the individual has access to the internet and phone. In my opinion the internet is one of the main ways in which barriers may be removed. Morland et al (2011) conducted a study on the effectiveness of CBT delivered via video conferencing compared to the â€Å"traditional in-person†. The results indicated that the outcomes were just as effective. A promising move for those that are unable to access traditional CBT as a result of their location or possible mental health issue, for example those suffering agoraphobia. At the core of CBT is the individual’s motivation to learn and change. This in itself can lead to difficulties, especially in children and young people. Often this â€Å"group† is being taken to therapy rather than choosing to go. Hudson (2005) found that large numbers of youngsters were not responding to the CBT treatment that they were receiving. As far as children and young people are concerned there seems to have been limited research onto the success of CBT treatment. The first controlled trials did not take place until the early 1990s and the majority of research has focused on the impact of CBT on adults. Even so the NICE guidelines on Depression in Children and Young People recommended the use of CBT, firstly, rather than pharmacological interventions. So how has CBT been adapted to incorporate children and young people, whose very cognition and emotional stages differs from that of adults? There have been some creative adaptations to the CBT model such as â€Å"Think Good Feel good†. Here the concept of CBT is broken down into easy to manage bites. There is also a lot of use of cartoons and speech bubbles, allowing the young person to access their thoughts and feelings in a safe way. The need to use more non-verbal techniques to help the young person to engage in the process such as, storytelling, drawing and games is also highlighted in this book. O’Reilly et al (2009) have also developed an interesting approach to using CBT with children and young people. They have created a game called â€Å"gNAtenboroughs Island† which is played by the youngster alongside a therapist. Each session introduces another core CBT concept to the young person, such as the connection between thoughts, feelings and behaviours. These are presented in a non-threatening way and also a way that may be more engaging to this age group. Cerangolu (2010) found that video games could enhance the therapeutic experience. They could help facilitate the therapeutic relationship as young people may be more willing to relate to a therapist that is ready to engage and understand their normal way of playing. Also sitting side by side rather than at the conventional â€Å"ten to two† setting also may make the young person relax. How the game is played can also reveal the young person cognitive style. As technology develops so do the opportunities to engage young people in therapy. Apps for smartphones are constantly being developed that allow the young person to access their homework in a more user friendly way, to record their thoughts and emotions instantaneously. To allow them to engage in therapy in the same way that they engage in their life. Homework may be a part of CBT therapy that causes a young person to disengage, especially as the very word may cause them to have negative connotations. Gaynor et al (2006) found that compliance toward completing homework dropped the further into therapy a young person was. It is important that the therapist and client work together to agree the homework and that the young person is encouraged to set their own, as this may encourage a â€Å"buy in â€Å"to its importance. It may be that the therapist stays away from using the language of school and calls it â€Å"practise work† or â€Å"work for self†. Initially I saw CBT treatment as regimented and unmoving, but the more I have researched the barriers that different people may encompass when thinking of embarking on treatment the more I realise that CBT is indeed structured but there is an innate flexibility about how it is delivered. It is this flexibility that allows people from different backgrounds to engage in a CBT approach that sees them as an individual rather than specific disorder.