The idea that cognitive behaviour therapy (CBT) is more effective than other types of therapy is a myth, according to experts who attended a conference organised on behalf of the World Association for Person-Centered and Experiential Psychotherapy and Counselling at the University of East Anglia earlier this month.

The researchers presented data and critical analyses they claim debunks the widespread belief in the superior effectiveness of CBT and casts doubt on the thinking behind the government’s Improving Access to Psychological Therapies (IAPT) programme, which has allocated £173m to train CBT therapists throughout England by 2010.

Professors Mick Cooper and Robert Elliott of the University of Strathclyde, William B Stiles of Miami University, and Art Bohart of Saybrook Graduate School claim the government, the public and health officials have been sold a version of the scientific evidence that is not based in fact, but on a logical error. In a collective statement, they said: ‘This is how it works: 1) More academic researchers subscribe to a CBT approach than any other. 2) These researchers get more research grants and publish more studies on the effectiveness of CBT. 3) This greater number of studies is used to imply that CBT is more effective.’

Although CBT advocates rarely make this claim so boldly, their continual emphasis on the amount of evidence is misunderstood. This has direct negative consequences for other well-developed psychotherapies, such as person-centred and psychodynamic, which have smaller evidence bases than CBT. These approaches are themselves supported by substantial, although smaller, bodies of research.’

The researchers claim the accumulated evidence points to the fact that when established therapies are compared to one another in scientifically valid studies, the most common result is that all therapies are equally effective. A meta-analysis of more than 80 studies presented by Robert Elliott and Beth Freire at the Norwich conference, shows that person-centred and related therapies (PCTs) are shown to be as effective as other forms of psychotherapy, including CBT.

In view of these and other data, the researchers claim it is scientifically irresponsible to continue to imply that CBT is more effective: ‘We urge our CBT colleagues and government officials to refrain from acting on this harmful myth and to broaden the scope of the IAPT project to include other effective forms of psychotherapy and counselling.’

Professor Cooper went on to say: ‘The research consistently suggests that the kind of therapy that a practitioner delivers makes little difference to outcomes. The government’s decision to spend £173m on CBT can only be applauded, but not all clients will benefit from that approach. There is clear evidence that some clients will do better with other forms of therapy. It all depends on who the client is, and what kind of treatment they can most make use of.’

World-leading psychotherapy theorist and researcher, Art Bohart said: ‘There is evidence that some clients prefer an approach to counselling where the focus is on helping you explore and understand yourself. Client-centred and psychodynamic counselling are examples. In contrast, other clients prefer an approach where the therapist takes the lead in teaching you particular cognitive and behavioural skills, such as how to think. Since both work about equally well it is important that both be available to the public.’

The finding that different therapies are about equal in their effectiveness continues to be hotly contested by some CBT advocates, but the four researchers who presented at the Norwich conference are unanimous in calling for a more balanced, scientifically accurate reading of the available evidence.

University of East Anglia