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CBT may give the best results for GPs in counselling

In response to Dr Graham Curtis Jenkins's letter 'Cognitive therapy should be targeted' (June 23), recent research suggests in fact non-directive counselling is no more effective than usual GP care.

The research on cognitive behavioural therapy (CBT) in primary care is extremely limited. The single study he is referring to found no difference between CBT and non-directive counselling, but the study itself was limited to only two conditions, depression and mixed depression and anxiety.

There were many other problems with this study. The improvements noted were self-reported with no verification. Treatment adherence ­ a key factor in CBT ­ was not measured. Moreover, the results were unreliable because of sampling bias.

The authors admit 'we cannot show that the trial participants are representative of eligible patients generally'.

Dr Curtis Jenkins then suggests any PCT would probably get 'a much better deal' from strengthening the existing services in primary care and using non-directive counselling as an alternative to CBT.

But the truth is that CBT is supported by more clinical evidence than all other forms of psychological therapy (including non-directive counselling) combined.

It has been shown to be the most effective form of psychotherapy not only for depression, but for a whole range of emotional and behavioural disorders. These include anxiety, panic disorder, phobias and PTSD to name a few.

CBT is simple and directive in encouraging clients to help themselves in between therapy sessions. It has all the hallmarks of an effective approach to brief therapy.

This makes it ideal for GPs with a special interest in mental health. I would like to suggest more research is needed in this area and that CBT is likely to prove the much better deal.

Dr Steve Harris

GP registrar

London N8

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