Renowned UK psychologist Oliver James argues that cognitive behavioral therapy (CBT) is a “scam” and a “waste of money.” His proof for the argument? Effects of CBT do not last.
It’s true. The effects of virtually all treatments for mental illness do not seem to last forever. Whether you’re taking a psychiatric medication or are involved in virtually any form of psychotherapy, the moment you stop the treatment, the effects of that treatment begin to fade.
But does that make treatment a “scam”?
Of course, when making a broad claim like this, it’s easy to cherry-pick the research to show support only for your argument. It’s a lot more difficult to look at all the literature and come to a more nuanced conclusion.
Yet, for the public good, this is exactly what we expect professionals and researchers to do. And if the researcher or professional won’t be objective, we turn to journalists to do so. How does Jenny Hope, “Medical Correspondent for the Daily Mail,” fare?
Miserably, unfortunately. Instead of challenging the claims — or even putting them into any kind of context — Ms. Hope simply repeats these outrageous remarks as “news.” One guy making outrageous claims about an entire field, and there’s no effort to balance the claims out with, you know, actual science?
Is CBT Effective Long-Term?
The short answer is that yes, it can be effective over the long-term — completely contrary to Oliver James’s claims. (James appears to be beating the drum for a different kind of psychotherapy — psychodynamic therapy — over CBT. His references are fine, but of course he doesn’t include any study that is contrary to his assertion, painting a biased picture of the research.)
I turn to Paykel et al.’s (2005) robust study of 158 patients who had depression and were randomized into one of two groups. The first group of patients received cognitive-behavioral therapy (CBT) for 20 weeks plus clinical management (minimal contact with healthcare workers), while the other group just received the clinical management. Both groups also received antidepressant medications.
The researchers followed up with the patients at the end of 6 years. Was the CBT useless and a scam?
This follow-up study, to a mean of 6 years post-randomization, and 4 – 6 years after the end of the treatment phase, has shown that effects of CBT on reduction of recurrence persist for some time, although with weakening, and are only lost fully between 3 and 4 years after cessation of the treatment. There was also reduction of time with residual symptoms.
The effects are important because of the high risk of relapse and recurrence in subjects with residual depressive symptoms, in spite of comparatively high doses of antidepressants.
In other words, the CBT helped but the effects of the CBT weakened over time. Exactly what a reasonable person would expect for a treatment.
But hey, don’t just believe this one study.
Another study by Fava et al. (2004) also looked at the long-term effects of CBT, following 40 patients with clinical depression for 6 years. Their findings were even stronger:
Cognitive behavior treatment resulted in a significantly lower relapse rate (40%) at a 6-year follow-up than did clinical management (90%). When multiple recurrences were considered, the group that received cognitive behavior treatment had a significantly lower number of relapses in comparison with the clinical management group [medication alone].
And there are yet other studies in the research literature that show similar positive long-term outcomes for those who undergo cognitive behavioral therapy (CBT).
CBT Is Effective, Even Long-Term
Is the evidence overwhelming? Perhaps not, because there are simply not a lot of studies that have examined the impact of CBT long-term. CBT shouldn’t be marketed as a “cure all” for depression, or be made to seem that it works for all people who try it (it doesn’t).
But it certainly points in a direction the exact opposite of that claimed by Oliver James, that CBT is a “scam” and a “waste of money.” The actual research data show that the effects of CBT help most people with major depression long-term. Not everyone, and the effects of this form of psychotherapy clearly wear off over time.
While James’ black-and-white claims make for a catchy headline, I expect a more nuanced picture from such an acclaimed psychologist. It’s clear CBT is indeed effective for many, many people who try it. It’s just not a magic bullet — but that’s not a problem with CBT itself, but how certain people market it.
For further information
The Daily Mail article: ‘CBT is a scam and a waste of money’, says leading psychologist
Fava, et al. (2004). Six-Year Outcome of Cognitive Behavior Therapy for Prevention of Recurrent Depression. American Journal of Psychiatry, 161.
Paykel, et al. (2005). Duration of relapse prevention after cognitive therapy
in residual depression: follow-up of controlled trial. Psychological Medicine, 35.