Cognitive and behavioural therapies: the state of the art

The cognitive behavioural group of therapies (CBT) has flourished over the last four decades, not only in terms of the extensive number of clinical and non-clinical problems to which it is being applied – from emotional problems to psychoses, substance misuse, personality disorders, and marital problems – but also in terms of its supporting evidence base. In this paper, the basic cognitive behavioural model and its application are revisited. The important findings of a recent review of meta-analyses of the effectiveness of CBT in a range of conditions are described. CBT is effective in different age groups, in head-to-head comparison with other interventions, and in the retention of benefits following treatment cessation. New techniques are being introduced as CBT evolves for specific disorders such as depression, various anxiety disorders, substance use disorders, personality disorders, and schizophrenia. These include ‘third wave’ interventions such as mindfulness, dialectical behaviour therapy, and acceptance and commitment therapy. Resources in terms of availability of therapists in everyday practice have been grossly inadequate, but this is now being addressed by the implementation of clinical guidelines and application of government funding. Research continues.