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  #1  
Unread February 9th, 2005, 01:15 PM
JustBen JustBen is offline
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Default PET & CBT

The first item In the Clinical Digest section of this month's Psychotherapy Networker has a provocative title: Has Cognitive Therapy Peaked?

The article refers to a study published in the August '03 issue of the Journal of Consulting And Clinical Psychology that compares the effectiveness of Cognitive-Behavioral Therapy with Process-Experiental Therapy in the treatment of depression. As it turns out, both were very effective, but those receiving PET reported a greater improvement in regard to interpersonal difficulties than those in the CBT group. The authors of the study also point to the second Scheffield study (Shapiro, D. A., Barkham, M., Hardy, G. E. & Morrison, L. A. (1990). The second Sheffield Psychotherapy Project: Rationale, design, and preliminary outcome data. British Journal of Medical Psychology, 63, 97-108.) as an indication that CBT fared poorly in this interpersonal aspect when compared with exploratory therapy.

A couple of questions that may generate some discussion:
What was the general reaction to the PET/CBT article when it was first published back in 2003? (I'm so accustomed to seeing CBT at the top of the heap in these studies, I can't help but be curious as to what the reaction of the CBT community was to these findings.)

Do you think that CBT lacks "what it takes" to help people improve their interpersonal lives (at least as compared to other modalities)? If not, how do you explain these outcomes?

PET places a lot of emphais on "chairwork". I've read some articles about chairwork in CBT, but I wonder if any cognitive therapists out there are using it on a regular basis. If so, what do you use it for (i.e. is chairwork being adapted for CBT-specific uses like "disputation", or are CBT therapists adopting more traditional Gestalt-type usage)?
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Unread February 14th, 2005, 11:08 PM
James Pretzer James Pretzer is offline
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Default Has Cognitive Therapy Peaked?

"Has Cognitive Therapy Peaked?" is indeed a provocative title but a major leap is involved in going from the findings of these studies to questioning whether CT has "peaked." The study in question (Watson, Gordon, Stermac, Kalogerakos & Steckley, 2003) found that both CT (a la Beck, Rush, Shaw & Emery, 1979) and a humanistic approach called Process-Experiential therapy (PET) produced significant reductions in depression, general symptomatology, and dysfunctional attitudes while increasing self-esteem. So far, this is not big news. CT has never claimed to be the only effective treatment for depression.

However, there is an additional finding that the authors of this study (and apparently the Psychotherapy Networker as well) make quite a bit of. One additional outcome measure used in this study was the Inventory of Interpersonal Problems, a self-report measure of interpersonal problems. Scores on this measure showed that, following treatment, PET subjects reported that they were less domineering and controlling, less overly accomodating, less self-sacrificing, less intrusive and needy, and more assertive. CT subjects reported no change in their level of assertiveness or overly-accomodating behavior. The authors of the study go on to interpret this finding as showing that PET is superior to CT in addressing interpersonal issues.

Why are they wrong? Because Cognitive Therapy for Depression (Beck, Rush, Shaw & Emery, 1979) is a treatment for depression, not a treatment designed to increase assertion. It isn't supposed to increase assertion, it is supposed to treat depression. CT can be used wonderfully to increase assertion but when we do that, we use cognitively-informed assertion training to increase assertion, not CT for depression. If the client is both depressed and unassertive, we would combine CT for depression and cognitively-informed assertion training. However, when the treatment protocols are standardized for an outcome study, it prevents the therapists from tailoring the treatment protocol to address the client's other issues.

Apparently, the authors of the study did not grasp the idea that CT for depression is a protocol designed to treat depression and that we use somewhat different treatment protocols to treat other problems. I'm amazed that they were able to do a competent job with CT for depression given their limited understanding of it.
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