The recommendations in this guideline are relevant to the following presenting problems: depression, including suicidal behaviour, anxiety, panic disorder, social anxiety and phobias, post traumatic disorders, eating disorders, obsessive compulsive disorders, personality disorders, including repetitive self harm, and some somatic complaints (eg chronic pain, chronic fatgue).
The following condition for which psychological therapies may be helpful are excluded from this guideline: Disorders in childhood and adolescence, psychoses including schizophrenia, mania and bipolar disorder, alcohol and other drug addictions, sexual dysfunction and paraphilias, organic
Brain syndromes, and learning disabilities. The guideline does not consider pharmacological treatments, but in general, there is no reason Why medication and psychotherapy should not be used together.
Effectiveness of all types of therapy depends on the patient and the therapist forming a good working relationship. The patients age, sex, social class or ethnic group should not determines access to therapy. In considering psychological therapies, more severe or complex mental health problems should receive secondary, specialist assessment. Therapies of fewer than eight sessions are unlikely to be optimally effective for most moderate to severe mental health problems. Often 16 sessions are required for symptomatic relief, and more for lasting change. Counselling is not recommended as the main intervention for sever and complex mental health problems or personality disorders. A co-existing personality disorder may take treatment of most disorders more difficult and possibly less effective; indications of personality disorder include forensic history, severe relationship difficulties, and recurrent complex problems. Patient preference should inform treatment choice, particularly where the research evidence does not indicate a clear choice of therapy. Interest in self-exploration and capacity to tolerate frustration in relationships may be particularly important for success in psychoanalytic and psychodynamic therapies. The skill and experience of the therapist should also be taken into account. More complex problems, and those where patients are poorly motivated, require the more skilful therapist. Psychological Therapies and Counselling
8 sessions: for any effect
16 sessions: for symptomatic relief
more: for lasting effect
Psychological therapy should be routinely considered as an option when assessing mental health problems.
Patients who are adjusting to life events, illness, disabilities or counselling losses may benefits from brief therapies such as counselling.
post traumatic stress symptoms may be helped by psychological therapy, with most evidence for cognitive behavioural methods. Routine debriefing following traumatic events is not recommended.
Depression may be treated effectively with cognitive therapy or interpersonal therapy. A number of other brief structured therapies for depression may be of benefit, such as psychodynamic therapy.
Anxiety disorders with marked symptomatic anxiety (panic disorder, agoraphobia, social phobia, obsessive compulsive disorders, generalised anxiety disorders) are likely to benefit from cognitive behavior therapy
Psychological intervention should be considered for somatic complaints with a psychological component with most evidence for CBT in the treatment of chronic pain and chronic fatigue.
Eating disorders can be treated with psychological therapy. Best evidence in bulimia nervosa is for CBT, IPT and family therapy for teenagers. Treatment usually includes psycho-educational methods. There is little strong evidence on the best therapy type for anorexia.
Structured psychological therapies delivered by skilled paractitioners can contribute to the longer-term treatment of personality disorders.
PTSDCognitive behavioral therapy (Psychological therapy)
Depression-Cognitive therapy/Interpersonal/Psychodyn. therapy brief strd therapy)
Anxiety disorders (Includes OCD) Cognitive behaviour therapy.
Somatic complaints Psychological interven therapy with psychological components
(max in chronic pain)
Chronic fatigue disorder-Psychological therapy
Psychological therapy shows benefits over no treatment for a wide range of mental health difficulties. There is evidence of counselling effectiveness is mixed anxiety/depression, most effective when used with specified client groups, e.g. postnatal mothers, bereaved groups. CBT has been found helpful. Some evidence of efficacy has been shown for other forms of psychological therapy. Single session debriefing appears to be unhelpful in preventing later disorders. CBT and IPT effectively reduce symptoms of depression. Benefits has also been found for other forms of psychological therapy, including focal psychodynamic therapy, Psychodynamic interpersonal therapy and counselling. CBT effectively reduces symptoms of panic and anxiety. Behaviour therapy and cognitive therapy both appear effective in treatment of obsessional problems. Psychological therapies have benefit in a range of somatic complaints including gastrointestinal and gynaecological problems. CBT has been found more effective than control in improving functioning in chronic fatigue and chronic pain. Etiology of CBT and IPT in bulimia has been established. Individual therapies have shown some benefit in anorexia, with little to distinguish treatment types. Early onset of anorexia may indicate family therapy, and later onset, broadly based individual therapy. A number of therapy approaches have shown some success with personality disorders, including dialectical behaviour therapy, psychoanalytic day hospital programme and therapeutic communities.
Types of psychological therapy
Cognitive behaviour therapy (CBT)This refers to the pragmatic combination of concepts and techniques from cognitive and behaviour therapies, common in clinical practice. Cognitive techniques (such as challenging negative automatic thoughts) and behavioural techniques (such as graded exposure and activity scheduling) are used to relieve symptoms by changing maladaptive thoughts, beliefs and behaviour.
Psychoanalytic therapies A number of different therapies draw on psychoanalytic theories. Focal psychodynamic therapy identifies a central conflict arising from early experience that is being re-enacted in adult life producing mental health problems. It aims to resolve this through the vehicle of the relationship with the therapist giving new opportunities for emotional assimilation and insight. Psychoanalytic psychotherapy is a longer-term process (usually a year or more ) of allowing unconscious conflicts opportunity to be re-enacted and interpreted in the relationship with the therapist.
Systemic and family therapy (whether treating individuals, couples or families) focuses on the relational context addresses patterns of interaction and meaning aims to facilitate personal and interpersonal resources within a system as a whole. Therapeutic work may include consultation to wider networks such as other professionals working with the individual or the family.
Other: This list is not comprehensive. Many others types of therapy are practised including cognitive-analytic, existential, humanistic, feminist, personal construct, art therapy, drama therapy, Transactional analysis, group analysis and interpersonal therapy (IPT).
Counselling: A form of psychological therapy that gives individuals an opportunity to explore, discover, and clarify ways of living more resoucefully, with a greater sense of well being.
Note: This article is a summarised version from RxPG First AID for PLAB Part 1