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Cognitive therapy should be targeted

The authors of the article on cognitive behaviour therapy (June 9) make claims not born out by current research. They claim it is effective but fail to say what they were comparing CBT with.

Recent research comparing CBT with counselling for a number of conditions in primary health care reveal there are no differences in outcome at six months and 12 months between patients who received expert CBT and those seen by a trained primary care counsellor.

What is important for any PCT wishing to contract for such a service is that the high rates of attrition and the great shortage of trained CBT therapists mean they would probably get a much better deal from strengthening services in primary care and only spending money to target those patients who have not responded to the service delivered in primary care to be seen by counsellors.

Services that now use CORE as their clinical outcome measure will be able to identify such patients easily and so could greatly reduce the number referred to a service providing CBT if one was available with short enough waiting lists to make it worthwhile

Dr Graham Curtis Jenkins


Counselling in Primary Care Trust

Staines, Middlesex

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