A Scientific Examination

Literature Review:

The purpose of this chapter is to critically analyse the perceived efficacy of cognitive behavioural therapies based on scientific evidences. CBT is a counselling treatment which encourages the person to deal with their own issues by presenting change in their conduct or perspective (Kennard, et al, 2008). This treatment is applied to treat the patients of depression, anxiety and can likewise give gainful outcomes in the treatment procedure for other mental and physical medical issues. It depends on the joined strategies of behavioural and cognitive research and is unique in relation to the verifiable methodology of other psychotherapy (Scott, et al, 2006; Kennard, et al, 2008). The analysis is conducted based on the following themes stated below:

CBT is considered as gold therapy:

CBT is the highest quality level mental treatment as the best standard the physicians have in the field at present accessible for the accompanying reasons stated below:


(1) CBT is the most explored type of psychotherapy.

(2) No other type of psychotherapy has been demonstrated to be methodically better than CBT. As there are precise contrasts between psychotherapies, the patients had been observed to commonly prefer CBT.

Moreover, the CBT hypothetical models/systems of progress have been the most inquired about and are in accordance with the present standard ideal models of human brain and conduct (e.g., processing of any data). Simultaneously, there is plainly space for additional improvement, both as far as CBT's success and adequacy and also about its hidden assumptions or pathways of progress (Hofmann, 2012).

In present day to day life, CBT can be considered as an umbrella term of experimentally bolstered therapeutic interventions for unmistakably characterized psychopathologies that demands explicit treatment mediations. To add to this information, CBT has been incorporated as a more trans-demonstrative/process-based and customized approach, with a definitive objective that connects the remedial approach to the procedure undertaken based on the individual needs of the patient (Hofmann, 2012). clinical preliminaries carried on in a conventional approach examining the efficacy or success of CBT incorporate waitlist control, the control conditions set as placebo, the as usual treatment also known as TAU, and other elective medications such as psychodynamic treatments and pharmacotherapies.

Perceived efficacy of CBT:

However, various CBT investigations have comprised of less effective comparers (e.g., wait list control conditions), there are likewise numerous investigations also that contrasted CBT with solid correlation conditions (e.g., medicinal tablets or placebo mental treatment, TAU and different psychotherapies, pharmacotherapy), which met the tough rules of an observational treatment (Hofmann, 2013). Without a doubt, study conducted by Cuijpers et al. 2016 found that about 54% of all considered preliminaries for the disorder depression that included around 34 examinations and about 20% of absolute preliminaries for the condition of anxiety which consisted around 25 investigations met the measures for a solid correlation i.e., pill placebo mode of therapy or TAU. However, the study of Cuijpers et al. 2016 further stated that 17% of the all the investigations for anxiety and depression disorders were of standard quality and that the connection between the nature of CBT contemplates and the impact sizes was not solid within the studies. Several other psychotherapies apart from interpersonal treatment for depression (Cohen, 2013), which also had comparable numbers, cannot compete with these numbers with respect to the dynamic status of the comparator and the investigation quality. Cognitive conduct treatment was the main type of psychotherapy tried with the most rigid standards for example in randomized controlled trials and dynamic comparator along with evidence based system utilized in the field of clinical health. This was considered to be comparable for those utilized in the event of examining the efficacy of pharmacotherapy. In this manner, it was the main psychotherapy to be distinguished with evidence based investigations among most clinical rules. As a conclusive statement it can be said that numerous more up to date, less detailed or of late tried psychotherapies began to utilize CBT as the reference or standard treatment, regularly contending for their efficacy or adequacy when finding no distinction from CBT.

Efficacy of CBT for relapse prevention:

The danger of recurrence in significant Major Depressive Disorder (MDD) is related with overall high burden of mental illness. CBT and its changed way of therapy may be effective in prevention of recurrence. Major Depressive Disorder is one of the most widely recognized and persistent mental issue, which shows its symptomatic manifestations of low life, low state of mind, low self-assurance, and repugnance for any exercises without stating any particular explanation (Hayes, and Hofmann, 2017). It is one of the main sources of overall inability and is related with rough 16% lifetime predominance rate. Moreover, it is connected with constant high danger of repeat which eventually results in an expanded ailment burden (Hayes, and Hofmann, 2017). Several researchers have stated that danger of relapse subsequent to encountering one scene of significant depression was half, after two was 80% and after three may be up to 90% (NIMH, 2016).The most usually utilized treatment for alleviating the symptoms of relapse of depression rate after fruitful pharmacotherapy may be consecutive pharmacotherapy. But prolonged exposure to such medications is related with tremendous reactions, for example, contradictions with other drugs. However, in clinical practice, successive implementation of pharmacotherapy is related with high chance of rebelliousness among patients and psychotherapy is picked in response to inclination of acute patients (Holländare, 2011). Cognitive conduct treatment is one of the most every now and again utilized psychosocial treatments for wide variety of mental disorders, by focusing on changing the strategy of patients to adapt to issues with respect to changed motivations and perceptions for example, conviction, thought and behaviours.

Mindfulness Based Cognitive Therapy

Different sorts of modifications of CBT were seen as successful too, for example, Mindfulness Based Cognitive Therapy (MBCT) (Raue, 2009; Kuyken, 2015; Kuyken, 2012). MBCT utilizes traditional strategies for CBT with added care of reflection. It is a class-based aptitudes preparing program and created for expanding the capacity of patients to forestall the repeat of depression in the long term (Renaud, J., 2013). MBCT could not just assist patients to be increasingly mindful towards negative contemplations in the time of potential backslide yet additionally permit them to dispose of rumination after the episode of depression (Haddock, 2014). Through MBCT, specialists could enable members to process their encounters by means of care and contemplation aptitudes, and consequently members could improve their negative emotions (Holländare, 2011).However, numerous investigations had found that MBCT probably would not diminish the danger of building up another backslide of depression among patients with two past recurrence episodes (Renaud, J., 2013).The preventive efficacy of MBCT was expected to upset the procedures of potential backslide frequently by diminishing the degree of depressive patterns of idea reactivated by negative sentiments though there may be various classifications of depression disorders.

CBT as intervention for schizophrenia disorder:

The National Institute for Clinical Excellence (NICE) rules suggest that individual CBT should be offered to all individuals who are diagnosed with the mental health condition schizophrenia. An investigation via randomised control trial with a sample population of 187 clients accepting the care treatment from one large emotional wellness care trust in North West England was led over a year period. The review recorded that solitary 13 (6.9%) of therapy using clients were offered and 10 (5.3%) got individual CBT inside the year review period. Execution of CBT was seen as poor among the focus gathering populaces. The CBT for psychosis and schizophrenia recommends a person to meet the healthcare professional and share about their feelings and thoughts which would help them to cope with their symptoms. The treatment was considered to improve the recurrence rate of psychosis and schizophrenia among the grown-ups according to NICE (Kuyken, 2015).


When contrasted with the surveys conducted by authors Beshai et al. 2011and furthermore, Bockting et al. 2015, the study findings obtained by Zhang, et al, 2018 revealed that based on the "best proof" by utilizing quantitative meta-investigation approach, which could outline the study quality and nature of preventive impact of the therapy intercession on diminishing rate of Major Depressive Disorder. This particular meta-examination could likewise validate whether noteworthy impact found in certain investigations are precise or just arbitrary. Our meta-examination concentrated on assessing the impact of CBT and its changed form for diminishing recurrence rate among subjects with MDD in the phase of remission (a particular time frame of MDD) (Clarke, 2015). This clinical inquiry was more explicit than the other two surveys when contrasted among each other. Accordingly, the findings stated were more focused on the target population which could be generalised (Clarke, 2015). Likewise, we utilized an alternate result proportion of HR to analyse the findings of the investigation. Moreover, this aptitude when applied has the advantage of taking into account of increasingly accessible data of the preliminary, including the quantity of patients who neglect to finish the investigation and time of patients when the event occurred in terms of follow-up.So far, two meta-examinations have been performed to assess the relapse avoidance impact of psychotherapy in patients with MDD in the phase of remission. Therefore, when contrasted between these two meta-examinations, we likewise saw CBT as successful in the counteraction of another recurrence scene. The article directed by Piet et al. found that MBCT essentially diminished the danger of recurrence contrasted with control and did not fundamentally decrease the danger of recurrence when contrasted with m-ADM (Piet, and Hougaard, 2011).

Therefore after studying so many evidences the care based psychological treatment such as MBCT can be considered as a powerful psychosocial approach that intends to help individuals in danger of recurrence of mental disorders such as anxiety and depression to learn aptitudes to remain well by changing the thought process (Kuyken, 2012). A investigation uncovered that members in the MM treatment focus group had an essentially more serious hazard for recurrence when compared with the MM+CBT treatment focus group during a half year of continuation treatment. Also, tolerant fulfilment was fundamentally higher in the MM+CBT gathering. Despite the fact that entrance to MBCT over the UK is improving, it is still in the phase of inconsistency (Raue, 2009). Therefore this investigation gave us a logical framework to comprehend what encourages and bolsters the successful implementation and sustenance of the MBCT (Raue, 2009). After a customary course of CBT for depression which is about twelve to about four months, the normal individual would not just feel significantly better yet will have the option to work considerably more successfully. CBT can successfully focus on the contemplations and practices that keep away the issues with liquor, and supplant drinking habit with more advantageous methods for adapting. Therefore, in this way CBT helps to promote the relationship between the patient and their immediate carers and family members (Edelman, 2012).

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In conclusion it can be said that CBT therapy is applied to treat the patients of anxiety, depression and can also provide beneficial results in the treatment process for other mental and physical health problems. It is based on the combined principle of cognitive and behavioural psychology and is different from the historical approach of psychotherapy. RPT is also a type of CBT which aims to prevent the relapses of the mental health symptoms by guiding the participant to anticipate the circumstances that may provoke the relapse. It is a short term psychotherapy treatment approach that involves hands-on practical therapy for solving problems. The advantage of this technique is the short span of time which is applied to solve the majority of emotional problems. It employs the ever -evolving principle for the patient and their problems in the cognitive terms, emphasizes on the good therapist and patient relationship, promotes collaboration and active forms of participation, task oriented and focuses on the present condition. Therefore, CBT commands the global rules for psychosocial therapeutic interventions, making it a first-line treatment, as verified by the National Institute for Health and Care Excellence's guidelines and American Psychological Association.


Kennard, B.D., Emslie, G.J., Mayes, T.L., Nightingale-Teresi, J., Nakonezny, P.A., Hughes, J.L., Jones, J.M., Tao, R., Stewart, S.M. and Jarrett, R.B., 2008. Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 47(12), pp.1395-1404.

Scott, J.A.N., Paykel, E., Morriss, R., Bentall, R., Kinderman, P., Johnson, T., Abbott, R. and Hayhurst, H., 2006. Cognitive–behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. The British Journal of Psychiatry, 188(4), pp.313-320.

Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T. and Fang, A., 2012. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), pp.427-440.

Hofmann, S.G., Asmundson, G.J. and Beck, A.T., 2013. The science of cognitive therapy. Behavior therapy, 44(2), pp.199-212.

Hayes, S.C. and Hofmann, S.G., 2017. The third wave of cognitive behavioral therapy and the rise of process‐based care. World Psychiatry, 16(3), p.245.

Cohen, J., 2013. Statistical power analysis for the behavioral sciences. Academic press.

Cuijpers, P., Cristea, I.A., Karyotaki, E., Reijnders, M. and Huibers, M.J., 2016. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence. World Psychiatry, 15(3), pp.245-258.

Cuijpers, P., Donker, T., Weissman, M.M., Ravitz, P. and Cristea, I.A., 2016. Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis. American Journal of Psychiatry, 173(7), pp.680-687.

Depression. NIMH. May 2016

Holländare, F., Johnsson, S., Randestad, M., Tillfors, M., Carlbring, P., Andersson, G. and Engström, I., 2011. Randomized trial of Internet‐based relapse prevention for partially remitted depression. Acta Psychiatrica Scandinavica, 124(4), pp.285-294.

Raue, P.J., Schulberg, H.C., Heo, M., Klimstra, S. and Bruce, M.L., 2009. Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study. Psychiatric Services, 60(3), pp.337-343.

Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., Lewis, G., Watkins, E., Brejcha, C., Cardy, J. and Causley, A., 2015. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, 386(9988), pp.63-73.

Kuyken, W., Crane, R. and Dalgleish, T., 2012. Does mindfulness based cognitive therapy prevent relapse of depression?. Bmj, 345, p.e7194.

Renaud, J., 2013. Mindfulness-based cognitive therapy for depression. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(4), p.328.

Piet, J. and Hougaard, E., 2011. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical psychology review, 31(6), pp.1032-1040.

Haddock, G., Eisner, E., Boone, C., Davies, G., Coogan, C. and Barrowclough, C., 2014. An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. Journal of Mental Health, 23(4), pp.162-165.

Beshai, S., Dobson, K.S., Bockting, C.L. and Quigley, L., 2011. Relapse and recurrence prevention in depression: current research and future prospects. Clinical Psychology Review, 31(8), pp.1349-1360.

Bockting, C.L., Hollon, S.D., Jarrett, R.B., Kuyken, W. and Dobson, K., 2015. A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence. Clinical Psychology Review, 41, pp.16-26.

Clarke, K., Mayo-Wilson, E., Kenny, J. and Pilling, S., 2015. Can non-pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials. Clinical psychology review, 39, pp.58-70.

Edelman, S., 2012. Change Your Thinking with CBT: Overcome stress, combat anxiety and improve your life. Random House.

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