Strategies for Measuring the Quality of Psychotherapy: A White Paper to Inform Measure Development and Implementation. A. Cognitive Behavioral Therapy

05/15/2014

CBT is a structured, focused, short (typically 6-16 weeks) therapy in which the provider and consumer work together to identify and address problematic thoughts and beliefs and their relationship with behaviors. The provider uses a range of techniques to alter these thoughts and behaviors, such as asking open-ended questions to help the individual recognize and challenge these thoughts and assigning homework that requires the individual to identify thoughts associated with particular events and the consequences of those thoughts (Beck 2011). CBT is goal oriented and tends to focus on the individual's current problems. CBT is one of the most widely used psychotherapies; in a survey of mental health professionals, 79 percent of respondents identified CBT as one of their theoretical orientations (Cook et al. 2012).

Studies suggest that CBT is effective in treating depression, anxiety, and PTSD in both children and adults (Cape et al. 2010; Chambless and Ollendick 2001; Clark et al. 2012; Foa 2009; Forman-Hoffman et al. 2013; Hofmann et al. 2012; Institute of Medicine 2012; Jonas et al. 2013; Otte 2011). In Table II-1, we provide a snapshot of clinical guidelines that recommend CBT. Most of these guidelines include a recommendation for an initial treatment length that varies from 8-12 sessions for adults with PTSD and 16-20 sessions for adults with major depression. These guidelines generally recommend CBT based upon the results of randomized and non-RCTs. There is some evidence supporting the effectiveness of CBT in treating attention deficit hyperactivity disorder in adults (Ramsay 2007). Although the majority of research on CBT has examined its use in specialty mental health treatment settings, a recent meta-analysis supports using CBT in treating depression and anxiety in primary care settings (Cape et al. 2010).

TABLE II-1. Snapshot of Clinical Guideline Recommendations for Using Psychotherapy for the Treatment of Depression, Anxiety Disorders, and PTSD

Guideline Developer

Type of
  Evidence 
Strength of Recommendation
CBT IPT Psychodynamic  
American Psychiatric Association RCTs, previous literature reviews, and possibly non-RCTs Substantial clinical confidence Substantial clinical confidence Guideline Workgroup: may be recommended on the basis of individual circumstances 

Guideline Steering Committee: moderate clinical confidence

National Institute for Health and Clinical Excellence RCTs Ranged from high to low depending on the type of comparison group and the outcome Ranged from moderate to low depending on the type of comparison group and the outcome Ranged from moderate to very low depending on the type of comparison group and the outcome
VA/U.S. Department of Defense RCTs, systematic reviews, practice guidelines Strong recommendation to provide the treatment Strong recommendation to provide the treatment No recommendation for or against the routine provision of the treatment
Anxiety
American Psychiatric Association (panic disorder) RCTs and possibly non-RCTs Substantial clinical confidence   Moderate clinical confidence
National Institute for Health and Clinical Excellence (generalized anxiety and panic disorders) RCTs Ranged from high to low depending on the type of comparison group and the outcome   Ranged from moderate to low depending on the type of comparison group and the outcome*
PTSD
National Institute for Health and Clinical Excellence RCTs Treatment shows clinically important benefits   Good Practice Point**
ACPMH RCTs Body of evidence can be trusted to guide practice    
VA/U.S. Department of Defense RCTs Strong recommendation to provide the treatment   No recommendation for or against the routine provision of the treatment
NOTE: Each guideline is included in reference list under the name of the guideline developer. Please refer to Appendix A for definitions of the strength of recommendation. 

* The studies did not show statistically significant differences between psychodynamic therapy and the comparison groups. 
** The recommendation is to advise consumers that "convincing evidence" does not currently exist that the therapy has clinically meaningful effect.
 

 

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