ABSTRACT
Introduction The use and efficacy of cognitive behaviour therapy (CBT) in the treatment of primary major depressive disorders is now well established on both sides of the Atlantic (e.g. Rush et al. 1977; Blackburn et al. 1981). More recently, its use in anxiety disorders has been similarly well described (Beck et al. 1985). The use of CBT in the treatment of depression or anxiety that arises as a secondary consequence of physical illness has been less extensively researched. A small number of studies have been published in the literature pointing to the possible use of CBT in patients with multiple sclerosis (Larcombe and Wilson 1984), epilepsy (Tan and Bruni 1986), and irritable bowel syndrome (Schwarz and Blanchard 1986), as well as with those suffering from painful conditions such as rheumatoid arthritis (Bradley 1985), or coping with the consequences of coronary surgery (Valliant and Leith 1986) or myocardial infarction (Stern et al. 1984). The sample sizes were small; the applications of CBT varied between group, individual, and telephone sessions; the outcomes were variable, with evidence of both success and failure. These modest results may dampen some therapists’ enthusiasm for trying CBT with physically ill patients, but the studies quoted so far can only be regarded as a preliminary attempt to ‘test the water’. Few of the reports gave details of the problems of applying CBT to these patients and relatively little information is available on if, or how, the CBT approach was modified to tackle the specific needs of this group.
