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Talking therapies

Frasier Crane, after discovering how few of his practice methods NICE are willing to fund.

However, in UK Psychiatry, you will generally come across just three types of talking therapies:

Cognitive Behavioural Therapy

CBT is a talking therapy that concentrates on the thoughts of patients, and then how they can adapt their behaviour to combat this[1].

Example of unhelpful cognition
Situation You fail your medical finals (like Admin did).
Thoughts "Oh my gosh, I'm such a failure, I'm never going to succeed".
Feelings Depression.
Actions Fail to focus on re-revising, just mope around in pyjamas, watching episodes of Frasier and eating cheese.
Example of helpful cognition
Situation You fail your medical finals.
Thoughts "Ah well, these things happen. I'd better try to do better in retakes".
Feelings Determined.
Actions Work towards exams in a structured but relaxed manner, become a consultant by the age of 26.


The explanation is that neither reaction is wrong or right, just helpful and unhelpful, and that living a life full of unhelpful reactions can lead to a vicious cycle.

CBT is recommended by NICE[2] for a range of psychiatric disorders: especially mood disorders and anxiety conditions. There are some arguments that CBT is not as effective as thought, subject to a catch 22: the more its used, the more research there is into it, at the expense of research into different talking therapies. Some studies have shown it to be less effective than commonly thought[3].

Dialectical Behavioural Therapy

DBT is used for one condition only: borderline personality disorder. They are notoriously difficult patients to treat[4], and treatment with other methods is generally thought to be ineffective, whereas DBT has some (but not much) evidence supporting it[5].

  1. Dialectical basically means balancing between change and acceptance.
  2. DBT combines techniques from CBT with techniques of "mindful awareness" inspired by Buddhist teachings.
  3. Borderline patients are prone to extreme distress when negative events happen. With CBT, they often can't get past the distress to focus on change. In essence, DBT helps patients them to deal with and move beyond the distress.

Other counselling

There are hundreds of other types (just watch an episode of Frasier to hear them waffling about them), but are generally less well used.

Within the NHS, GPs can currently refer to a Psychologist, for up to 6 sessions, or a Psychiatrist who may refer for longer therapy. Most NHS psychologists will do a variety of therapies although some just do one type. Many patients also choose to attend counselling privately.


References

  1. Cognitive-Behavioural Model (CBM) - http://www.10minutecbt.co.uk/?More_about_CBT:Cognitive-Behavioural_Model_%28CBM%29 : Last accessed 22/3/11
  2. Cognitive behavioural therapy for the management of common mental health problems by C Ashford et al. - NICE 2008; April:21-23. http://www.nice.org.uk/media/878/F7/CBTCommissioningGuide.pdf
  3. "Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials" by D Lynch et al. - Psychological Medicine 2010;40:9-24
  4. Skills Training Manual for Treating Borderline Personality Disorder by M Linehan 1st Edition - 1993.
  5. BorderlinePhD: Does DBT Work? - http://borderlinephd.blogspot.com/2010/11/does-dbt-work.html : Last accessed 24/3/11.