ABSTRACT
Cognitive behavioural therapy (CBT) is a highly structured, evidence-based treatment that aims to address patients’ current problems. The treatment is goal oriented, in that goals are agreed between the patient and clinician usually in terms of improving the patient’s distressing emotional states and unhelpful patterns of thinking and behaviour. All of these may interfere with the patient’s day-to-day functioning. Each aspect of treatment is explicitly discussed and the patient and clinician work together to solve the patient’s
problems using a range of interventions informed by a coherent cognitive behavioural treatment rationale and working within an agreed, short-term (average 12-18 sessions) timeframe. Central to the cognitive behavioural model is the idea of a normalizing treatment rationale. Thus, the emotional responses that characterize anxious and depressive states are seen to exist on a continuum with normal emotional reactions that we experience every day. Thus, when looking at the evidence base for CBT treatments there is a wealth of research data that demonstrate many of the cognitive and behavioural features of common mental health problems are also present in individuals who do not meet the diagnostic criteria for such problems. Examples include the frequency of reported intrusions (a feature of obsessive compulsive disorder and generalized anxiety disorder) in the general population; experiments in mood induction demonstrating a link between low mood and negative thoughts in both depressed and non-depressed subjects; the tendency for all humans when anxious to pay more attention to the object or event that is the focus of our fear, as demonstrated in threat cue detection experiments. For a comprehensive review of this literature the interested reader is directed to Williams et al. (1997). So what is the difference between a normal human response to distress and the nature of the response that is seen in mental health problems? The difference is that in mental health problems these emotional responses are seen as more intense, persistent and out of proportion with our usual responses.
