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1. What is Cognitive-Behavioural Therapy and why is it the only form of psychotherapy funded through the National Health Service in the United Kingdom? Updated: 05/06/14
Cognitive-Behavioural Therapy (CBT) is an umbrella term for a wide range of therapies which all share the same roots and principles. Essentially all CBT combines efforts to adjust ‘faulty thinking’ (maladaptive schemas) whilst using behaviour modification techniques to stop behaviour that would reinforce the faulty thinking. The focus then is on developing positive, enabling thinking processes with behavioural strategies that reinforce the new thinking. A large number of significant studies have shown CBT to be consistently effective in treating conditions such as Bulimia Nervosia, Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder. In conjunction with medication such as serotonin-specific reuptake inhibitors like fluoxetine (‘Prozac’), CBT is now recommended by the National Institute for Clinical Excellence (NICE) for the treatment of mild-moderate Clinical Depression. There have even been a number of reports of it being used successfully to treat symptoms of Schizophrenia.
In part the evidence base for the efficacy of CBT comes from the fact that, like the Cognitive and Behaviourist approaches in which it is rooted, it lends itself to testing via the ‘scientific method’. This doesn’t necessarily mean CBT is better than Neuro-Liguistic Programming, Psychoanalysis or Analytical (Jungian) Therapy, etc, etc. It means the research to date shows it to be more consistently effective across the board. For NICE and the NHS, CBT must seem a safer bet for investment – though the rather mixed take-up of CBT by health authorities indicates there is still a great deal of scepticism about it in some quarters. Additionally, several reports – eg, Richard Harrington et al (1998) – have queried the selection of CBT studies on which NICE support is based, with studies not supporting the efficacy of the approach omitted.
As smaller-scale studies and much anecdotal evidence provide support for other forms of psychotherapy, there is much concern amongst some psychotherapists that other techniques, which could, for some people, be a better option than CBT are being marginalised. For example, Christer Sandahl et al (1998) reported that, at 15-month follow-up into treatment of alcohol abusers, significantly more patients were abstaining from alcohol after Psychodynamic therapy than were patients treated with CBT. Yet Psychodynamic is not generally funded through the NHS.
2. Which therapy is more effective: NLP or CBT?
Neuro-Linguistic Programming (NLP) and Cognitive-Behavioural Therapy (CBT) are both umbrella terms covering a range of therapeutic models and techniques which share common principles and understandings. A significant number of scientific studies have validated the consistent effectiveness of CBT. The effectiveness of NLP techniques has not been validated in the same way; however, a very large number of personal anecdotes testify NLP has worked very effectively for them.
My own view as to why NLP works really well for many but perhaps not for all is that the difference is the ‘suggestibility’ of the client. Back in 1959 André Muller Weitzenhoffer & Ernest R Hilgard established that some people are more susceptible to hypnosis than others – pioneering the Stanford Hypnotic Susceptibility Scale. Since NLP therapies often involve the client entering a light trance state (or, at the very least, suspending disbelief), their suggestibility – or level of hypnotic susceptibility – will affect how well they can engage with the process. By comparison CBT depends more on rational challenges to faulty thinking (maladaptive schemas) – as well as behavioural conditioning.
However, there are a number of crossover points between NLP and CBT. For example, the very powerful NLP technique of meta-modelling is effectively a Cognitive rational exploration of another’s belief structures. Since NLP therapies, when they do work, tend to be very effective in a very short space of time, they can create an overwhelming sense of relief and almost ‘magically’ put the client into a changed state. Cognitive therapies, in contrast, can take some considerable time to really take hold. My own inclination in carrying out what I call ‘Personal Therapy’ is to use NLP therapies where the client has a workable degree of suggestibility. However, I find CBT follow-ons good for helping the change ‘bed in’; these can be very effective in mopping up the residue of lesser maladaptive schemas linked to it once the core maladaptive schema has been destroyed/changed.
Please note that since this FAQ was written, I no longer offer counselling & therapy as one of my services.