The Maudsley Debate: CBT for Psychosis Oversold?

The video above is from the 50th Maudsley Debate in London, the index for which you can find here. I’ve never heard of the Maudsley Debates until I got an email about this one, “CBT for Psychosis Is Oversold: This House Believes that CBT for Psychosis is Oversold.” CBT stands for “Cognitive Behavioral Therapy. ” If you want a little more very basic background on CBT, you can view my post on it. One of my colleagues, Dr. Scott Temple, PhD, sent out this link in an email message to the faculty and residents in our Psychiatry Department.

Dr. Temple is a leading teacher of psychotherapy theory and practice to our trainees. He also practices CBT with many patients, including those with psychosis.

Because the link for this particular debate is part of an index page, I’m taking the liberty of copying pertinent information from the current web page below:

ABSTRACT:

Cognitive behavioural therapy for psychosis (CBTp) is a recognised treatment for people with psychosis, aimed at helping people make sense of their experiences, and dealing with the distress caused. Psychosocial treatments, such as CBTp, are at the core of existing services for people with psychosis, and since the first CBTp trial over fifteen years ago, it has developed a significant evidence base. As a result  it is now recommended by the National Institute for Clinical and Health Excellence (NICE) as a treatment choice for every adult with psychosis and schizophrenia. Recently, the evidence base pertaining to CBTp has been called into question, with a meta-analysis in the British Journal of Psychiatry showing a small level of efficacy in studies with more methodological rigour. On the back of this, a randomised controlled trial (RCT) in the Lancet suggested it had beneficial effects in people with psychosis who were not taking antipsychotic medication (which has been the mainstay of treatment for psychosis for over 50 years). Amidst all of this, the question remains as to whether its benefits have been overstated, and the question arises, “has CBT for psychosis been oversold?”

SPEAKERS:

For the motion:

Peter McKenna, Research Psychiatrist, Barcelona

Keith Laws, Professor of Cognitive Neuropsychology, University of Hertfordshire

Against the motion:

David Kingdon, Professor of Mental Health Care Delivery, University of Southampton

Peter Kinderman, Professor of Clinical Psychology, University of Liverpool

Chair: Professor Sir Robin Murray, Institute of Psychiatry

Scott Temple, PhD

Scott Temple, PhD

Dr. Temple’s observations on the video included a reminder that he delivered a Grand Rounds presentation on CBT for schizophrenia in the fall of 2012 in which he indicated that the effect sizes for CBT were modest but clinically significant, indicating the importance of CBT as an augmenting therapy to medication. I learned from him that there is a spirited scientific and policy debate going on about this issue in the United Kingdom. He also made the point that the debate is not about whether CBT works, but whether it’s been “oversold.” Prior to the debate, the audience was polled, and they were evenly split on the proposition. The vote changed dramatically after the debate. I recommend watching the video. He thought it was great fun and highly recommended it for the residents.

I think it was fun, too. Because the audience included patients as well as mental health professionals, I thought it might appeal to an even broader audience. I had trouble making the video work on Internet Explorer, but it’s probably just me. However, you might consider trying another web browser if you have the same problem.

I was struck by how good-humored the event was, despite the obvious tendency for polarizing side debates on biomedical vs humanistic models of therapy and the disease vs life story perspectives in psychiatry (see Mchugh, P. R., MD, and P. R. Slavney, MD (1998). The Perspectives of Psychiatry, The Johns Hopkins University Press).

Tell me what you think.

 

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