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Cognitive-behavioural therapies: achievements and challenges
  1. Brandon A Gaudiano
  1. Dr B A Gaudiano, Butler Hospital, Psychosocial Research Program, 345 Blackstone Boulevard, Providence, Rhode Island 02860, USA; Brandon_Gaudiano{at}brown.edu

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In 1976, psychiatrist Aaron Beck posed this question about a new form of therapy that emphasised changing patients’ dysfunctional cognitions: “Can a fledgling psychotherapy challenge the giants in the field—psychoanalysis and behavior therapy?” (p 333).1 Since that time, cognitive-behavioural therapy (CBT) has emerged as one of the most dominant modes of psychological treatment. In this article, I briefly discuss the factors responsible for the current popularity of CBT, review some of the criticisms that have emerged about the treatment, and describe recent innovative work that may end up changing the nature of CBT in the years to come.

CBT AS AN INCREASINGLY POPULAR AND EVIDENCE-BASED PRACTICE

Cognitive-behavioural therapy has become increasingly popular with clinicians and the general public alike over recent years. Surveys of therapists indicate that CBT is fast becoming the majority orientation of practicing psychologists.2 Partly because of its commonsense and clear principles, self-help books based on CBT approaches have also come to dominate the market.3 Even media articles frequently extol the virtues of this form of psychotherapy. A recent Washington Post article proclaimed: “For better or worse, cognitive therapy is fast becoming what people mean when they say they are ‘getting therapy’” (p HE01).4

What accounts for CBT’s sustained and growing popularity? The short-term, structured nature of the treatment makes it particularly amenable to empirical investigation, and it has accumulated an impressive research base. Butler and colleagues5 report that there are now over 325 clinical trials of CBT for various clinical populations, including mood disorders, anxiety disorders, marital distress, anger, childhood disorders and chronic pain. In an examination of 16 separate meta-analyses of CBT studies, they reported that the treatment produced large effect size improvements compared to control conditions for emotional disorders in adults and adolescents. Furthermore, results indicated that CBT was somewhat superior to antidepressants, and equal in efficacy …

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