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A lift for those who are down

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Mark Easton | 16:25 UK time, Wednesday, 29 October 2008

Since almost everyone is affected directly or indirectly by the painful consequences of clinical depression and anxiety, I thought I would post some good news.

The new psychological therapies which are being rolled out in England appear to be having a remarkable impact.

Look at the 'before and after' table below.

The proportion of patients exhibiting severe depression is halved. The moderate categories have been reduced by three-quarters. The proportion of patients with no depression or anxiety has increased ten-fold.

And this impressive result has been achieved, for the most part, using the existing stock of therapists. Some of the eleven "pathfinder" sites which provided the data believe that recruiting and training new staff will bring even better results. You can see the full report here:

Before and after tableNo-one pretends that talking therapies such as cognitive behavioural therapy (CBT) are a panacea, but for millions of people who suffer with depression and stress, they do offer a potential route to recovery. If it was in pill form, people would have no hesitation in saying it was, for many, a cure.

What CBT and other talking therapies do is teach people how to eradicate irrational negative thoughts - patients effectively learn how to 're-plumb' their own brains so they can escape their spiral of anxiety or depression.

Yesterday, at an NHS conference on the therapy programme, I met Antony - a young man from Stoke who had been to hell and back. Work problems had led to a breakdown which his GP knew could not be fixed with pills.

Fortunately, one of the new psychological therapy programmes was operating in his area and he was able to get access to the kind of help which has been, and still is, missing in much of the country.

In an emotional address to the health workers gearing up for the expansion of such services, Antony revealed how CBT had transformed his life in a matter of weeks.

From being unable to work or even leave his house, he now has the confidence to make a speech to a few hundred mental health professionals in a London hotel. Describing his life before therapy he told them: "I was so bad I thought daytime television was good".

The government has agreed to spend increasing sums on this kind of help: by 2010 the budget will be more than £170 million. But even this will only provide services to about half the population in England and if we are not careful we could end up with a 'post-code lottery' in terms of provision.

I understand the Department of Health may be about to announce which areas will get the next wave of psychological support services. Ministers have been persuaded that every penny spent will save them money in Incapacity Benefit and health care costs.

Coincidentally, the NHS today published some new statistics on mental health services in England.

The data reveals how increasing numbers were accessing help even before the push to expand the use of psychological therapies.

As you may know, I like maps and today's release includes one which shows the use of mental health services in England.

Number of patients mapIt is hard to know quite what to make of it to be honest. Does increased levels of use imply worse mental health or better services? Certainly, it appears that it is in urban areas that one sees the highest proportions accessing such help. But then, for reasons that elude me, Leeds / Bradford appears to have a very low number of patients getting care.

I would, as ever, be grateful for your thoughts.

Comments

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  • 1. At 6:05pm on 29 Oct 2008, John Ellis wrote:

    CBT works very well I went through a course about 5 years ago private at the time. Depending on what is being dealt with it can be very stressfull though, even though for me it wasn't a fix for all issues it does teach a very succsesfull way of coping with stress and breaking it down into things that become irrelevent once your outside the nutshell you encase the problem in.

    Its also one of the oldest of therapys being created in its first forms by budda.

    I think its something everyone should have a go at, even if its just for your own well being, mindfullness is very healthy.

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  • 2. At 6:34pm on 29 Oct 2008, daisybeast wrote:

    As a depressive myself, I am always hopeful whenever I see that there are advances in treatment and attitude. It is, however, a drop in the ocean.

    Considering the number of people, particularly young people, who die every year by suicide, you would have thought more money would be targeted at depression, and more research. In reality, it is something that people still do not want to talk about. Thousands of people will walk through the night to raise money for breast cancer, for instance, but there still seems to be a sense of embarassment about the annual death toll of depression.

    For those of us who suffer, or who have suffered, there is still no treatment that is reliably efficient. Depression, so far, remains an illness that you have to dig yourself out of, and until we find an actual cure, there will still be a frightening number of people who lose that battle.

    Incidentally, where I live, there is still a waiting list for talking therapies such as CBT, which can stretch for up to two years.

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  • 3. At 6:59pm on 29 Oct 2008, delminister wrote:

    my depths of depression varies depending upon the situation in the home and of late i have been close to cracking.
    i try not to use pills i fight it in the open not letting it get the upper hand by pure will power.
    but of late with our earnings been cut by 45% per week every thing is tight food is low and its getting harder to beat these feelings of self distruction.

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  • 4. At 7:33pm on 29 Oct 2008, jayfurneaux wrote:

    It would be useful for you to have a map showing the areas where this treatment is available. One benefit is that it could slash the cost of prescribing anti depressants.

    CBT is based on the idea that it is our thoughts (based on underlying beliefs about ourselves and the world) that produce our feelings, resulting actions or inactions. This often results in a vicious circle. Of all the talking therapies it appears to be the most effective.

    Some drug rehabilitation therapies are adopting CBT, but other approaches still rely on (older) approaches that rely on a belief in a higher being. It would be useful for study to compare the long term outcomes of the two in regard to addiction treatment.

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  • 5. At 9:17pm on 29 Oct 2008, Bloofs wrote:

    CBT does seem to be having an impressive effect, but sadly it doesn't work for everyone. I myself did not find it particularly helpful when I was thinking irrationally - because you can't 're-plumb' your mind when you don't know where the pipes are. In other words, an irrational person finds it difficult to see the rational aspect to their lives. And CBT requires a lot of hard work, form filling, diaries, sheets of paper that a lot of depressed people simply can't be bothered with when they are low. I know I was too lazy to do CBT properly, and I wasted my psychologists's time.

    One NHS psychotherapist told me that for some people, CBT offers a seemingly straightforward 'When you have thought A change it to thought B' but this is not possible for some people who may do better with a more informal talking therapy. For those thinking very irrationally, it's hard to see where they can begin when it comes to CBT.

    Therefore in our rush to praise CBT we shouldn't ignore the range of talking therapies, or totally discount drugs, which (while recent studies show they may be nothing more than placebos) do seem to help a lot of people.

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  • 6. At 02:06am on 30 Oct 2008, AnyPenny wrote:

    I can vouch for CBT: It pulled me out of the hole and didn't make a lifelong therapist-goer out of me.

    I combined it with a psychiatrist-prescribed low dose of antidepressant medication, but I sincerely believe it's the talk therapy that makes a recovery long term (hopefully as close to permanent as possible). I'm a believer.

    In the United States, I know patients of psychological therapy are most common in urban areas. It's probably a combination of the fact that it's more socially acceptable there, there are more therapists to choose from, and maybe income has something to do with it since it's either partially or not at all covered by health insurance.

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  • 7. At 11:32am on 30 Oct 2008, Spytrx wrote:

    Written of course by a non-professional with no prior knowledge in psychology or the subject matter.

    It makes me sick to the bone that journalists are let loose on subjects they know nothing about and inform the public of the so-called progress of any kind of ailment. Feeling a little down these days is classed as being depressed because it is a money spinner - a strong headache is a migraine, etc, etc. No wonder the health care system is in the state it is in if we prescribe a treatment for anything end everything - and at the same time missing to treat those with the real illness with the care and attention they need and deserve.

    The public is so misinformed about the seriousness of how disabling some psychological depressions can be because of hacks like you.

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  • 8. At 1:52pm on 30 Oct 2008, arny wrote:

    If you want to look at this scientifically, you really do need to think more critically.

    I think if you look into it you'll find CBT is about as effective as other kinds of voodoo, whether it be walks in the park, medication, religion, neuro linguistic programming or other forms of talking therapy.

    Firstly ask yourself, how do they measure depression to get the classifications of severely depressed, moderately depressed etc?. What they do is give the patient a questionaire. The problem is if you've spent 20 weeks training a patient to 'think less negatively' this will have an effect on how they answer the questions, whether they are actually less depressed or not. This could easily push a whole chunk of people across the borderlines between the categories.

    Another issue is if 10 sessions of CBT is enough to cure a patient of depression, just really how depressed were they in the first place, when compared say to a chronic depressive that's suffered serious problems for years? Might such temporary depressives get over their 'breakdown' one way or another anyway? It's very easy for any group of therapists to concentrate on the section of people that will respond best. I seriously doubt the figures would be quite so impressive if CBT therapists were given the most difficult cases.

    Another issue is how the results change with time. For example valium may be very effective 3 months from the start of treatment, but after 3 years the patient may be worse than if they hadn't taken anything. And the same could apply to talking therapy or any other treatment too.

    I use the word 'voodoo', but I don't mean to imply voodoo doesn't have it's place; everyone needs to believe in something, and evidence does seem to indicate that patients do better with some attention in some form or another. But it really isn't a matter of science and figures similar to what you've quoted can be grossly misleading.

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  • 9. At 2:13pm on 30 Oct 2008, David5412 wrote:

    Mark Easton's amateur confident advocacy of this therapy is unwise. Just because it is being promoted by the Labour government does mean it works.

    The data shown in the bar chart is of itself of little value - what proportion of people with depression improve over a similar time period without any intervention? A good study would include a control group.

    Considerable doubts have been expressed recently about the effectiveness of anti-depressant drugs, despite strong claims for them in the past (often by people with a vested interest). The claims for cognitive behavioural therapy should be approached with caution.

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  • 10. At 11:20am on 31 Oct 2008, shkodra wrote:

    I have suffered intermittent depression and anxiety for many years. I know a great deal about the subjects through both personal experience and my job. Recently I was referred to a psychiatrist in the private sector who after a quite superficial assessment diagnosed with bipolar disorder. I was treated with a mood stabiliser which had no beneficial effect but induced side-effects which made the overall situation much worse. I was also given a course of CBT. This I completed in about 8 weeks and the psychologist was very pleased with my "progress". Therapy consisted of reading passages from an American manual, some discussion and then doing some homework. Because I was doing "so well" I was allowed to leave the course early. Although I scored highly, it conferred no lasting benefit. The technique is beloved by the Insurance Companies because it allegedly gives good quantifiable results in a relatively short time. In reality it is a crude attempt to re-orientate thinking by exposure to repetitive statements. It was also much admired in China during the Cultural Revolution! One year later I am back in square one. My diagnosis of bipolar disorder has been overturned by another psychiatrist who disagreed completely with the original diagnosis (and incidentally shared my views on CBT). I am now taking an antidepressant which may be having a slight effect. I feel as if I have been let down badly by the mental health services in my area - it appears to be a lottery. You may find someone who is knowledgeable and empathetic who will recognise your problems and direct you to appropriate treatment. It may be that this is provided in your area and will be administered competently. Perhaps then you will recover, but if all this happens then you will have been a very lucky person.

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  • 11. At 1:55pm on 31 Oct 2008, KateS2008 wrote:

    As a therapist working within one of the Pathfinder agencies collecting data for this research, I would add that it seems that CBT is always the kind of therapy that is mentioned, whilst other theoretical perspectives are rarely mentioned, if at all. The agency in which I work has therapists working from Person Centred, Transactional Analysis, Gestalt, Existential, Trans-Personal, Integrative, and CBT perspectives.
    Having been part of the form filling and measuring exercises that have contributed to these statistics, what I can say is that they appear to be sound statistics based on what I experience of the change in my clients at the end of therapy, compared to their presentation at the start.
    Many people have quite rightly pointed out that re-wiring the brain doesn't seem enough, and as much as CBT has its place, I am of the opinion that it should be part of a therapeutic relationship in which the deeper feelings and triggers are explored also, for a more lasting and positive change to be brought about.
    My experience is that the organisation I work for is committed to bringing in new people, via a rigorous selection procedure, and so ensuring that the future of talking therapies is secured, for the masses, not just the "Clinical population".
    Doesn't everyone need a "leg-up" occasionally? And access to talking therapies for *everyone* is a cause close to my heart, but as has been already pointed out, money is the issue...

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  • 12. At 10:30am on 02 Nov 2008, notoappeasement wrote:


    I am awfully depressed in the present state of affairs with BBC and its fat cats. I can longer pay for BBC's upkeep but I have a solution of my own. Although BBC has been urged by ministers to end the culture of “fat cat” pay for top presenters or risk cuts to its £3.4 billion a year of public funding, I do not believe they will do anything to jeopardize their life style bestowed upon them by successive governments.

    BBC's nepotistic and parasitic culture must be brought to end. While disadvantaged group are suffering BBC management is enjoying royalist insular status at their cost. This must end!

    First step ought to be to exempt all over 65s from licence payment, next reduce the BBC tax over the next 3 years gradually to nil payment (just to give BBC chance to adjust to the realities of the world) and then SELL it off to highest bidder and disperse the proceed to improve our infrastructure and open couple of hospitals.


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  • 13. At 2:44pm on 02 Nov 2008, stalisman wrote:

    I think the only reality is that for most people one on one help is just a day dream.

    Think is an important word.

    It encapsulates ones view of the world and is very affected by ones intake in any form.

    My only thought is that those who have not meandered through that dark valley have no reason or right to pontificate.



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  • 14. At 5:36pm on 02 Nov 2008, cambersand wrote:

    I'm sorry to see that the media are still trying to define depression in terms of happiness and unhappiness. It is obviously possible for a non-depressed person to feel temporarily unhappy, just as it is possible for a person going through a period of depression to feel temporarily happy.

    The defining factors of depression have more to do with not being able to feel 'normal', or function 'normally' for long periods of time, rather than short term changes in mood. This is why is is defined as a mental illness and treated as such. The media could go a long way to help changing the misconception, and as a result, help more people understand, recognise and be sympathetic to the illness.

    I am currently undergoing CBT, not because of a recent bout of depression, but because I want all the tools I can get to help me deal with it the next time it happens. I do not expect to finish the course feeling 'happier', just better equipped to deal with an illness that I am prone to, and better able to manage my symptoms as and when it happens again.

    I am pleased the NHS are providing a service which at least tries to address the causes as well as the symptoms, at least in one area of our nation's health!





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  • 15. At 12:52pm on 04 Nov 2008, portliho wrote:

    practised CBT 12 years ago, the main reason it was a successful treatment was that "candidates" were screened for level of motivation- - Interestingly many "clients" also had concurrent psychotherapy- because our responses don;t usually just appear. "Maladaptive" behaviour manifests slowly, layer upon layer to fit with our beliefs. Treatment was as much about enabling a person to gain fuller insight, to connect to how they got to where they were, so that they could challenge and alter debilitating behaviour/thoughts usually rooted in childhood, in effect, nurture themselves using adult mind. As for depression, I am unsure. This is more to do with how we "cope" with an experience . Yes CBT can help a person understand immediate thought processes and how effects feelings behaviour, but where is the space for the person to get their head around how they got to where they are? where is the affirmation that it is a perfectly natural response to feel shit about an experience.... CBT is akin to a plaster although it is much easier to understand, is quicker and cheaper than psychotherapy for example and gets great results *provided the client is motivated*-

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  • 16. At 1:12pm on 04 Nov 2008, purplefreak10 wrote:

    It's all very well saying that the treatment works, that's great news for the people that can actually get it, but what about the thousands of people languishing on waiting lists that can't get the help in the first place?

    Also, as arny5000 has pointed out, the grade of depression is determined by a questionnaire which is totally inaccurate.
    I am a previous sufferer of severe depression who happened to score mildly depressed after my questionnaire as I'd had a rare good week and was told not to look at the previous weeks or months but the last 7 days only!
    Even after my 7th suicide attempt, I was told that I looked okay and they didn't think I would benefit from any kind of support.
    Be interesting to see the figures if we were all recorded and not just those that make the stats look good...

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  • 17. At 11:17am on 07 Nov 2008, martduke wrote:

    i was attacked in 2004.luckily the person that did it ended up behind bars for quite a while.it shook me up big style.after 6 months of treatment i was able to rebuild my life and go out again and its been fab.i now have two wonderfully rewarding p/t jobs and without the help i definately wouldn,t be as i am now.if ya there at moment go for it as it,ll change your life.

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  • 18. At 6:13pm on 07 Nov 2008, John Ellis wrote:

    CBT will work well with trauma such as your martduke, its all still fresh in your mind and hasn't had the chance for the trauma to become a foundation of how you felt about yourself and those outside of your direct sphere of influance. That heavy stone that was left inside is soon broken up and digested by reason.

    It took private meens via work for me to get mine but i have suffered and waited for treatment like this since i was 11 im now 39.

    So between the ages of 11 my first suicide attempt and 34 my last major breakdown when i got private treatment. little help was offered other than the kind words pull your self together. The CBT for me is a tool that I use to cope with life I know there are no cures just different treatments that will prevent a premature death. This is why CBT is hard to get as is not offered to people with long term problems or when it is offered to these people they have to do a lot of waiting, as its only a tool for them and not a cure.

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  • 19. At 2:30pm on 10 Nov 2008, dee andrew wrote:

    I find that after I have used the mobile I get anxious and depressed so I keep it to a minimum.
    It does appear that microwaves affect the brain and some people can get psychological problems.
    Specialists would agree that depression is increasing and environmental factors could be the cause and some are putting forward one: the unlimited use of mobile phone, WiFi, wireless phones, microwave ovesn etc.
    The research of the effect microwaves have on the brain is there and it is about time the media publish it, and the BBC, not depending on advertising revenue, could do so.
    Sadly telecomunication companies are influential enough to stop any publication.

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  • 20. At 00:07am on 12 Nov 2008, John Ellis wrote:

    test. i cant post stuff .. new thread dont like me :( theraphy plz ;)

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  • 21. At 08:59am on 12 Nov 2008, John Ellis wrote:

    Mark fix your alcohol and price blog please Ive posted 6 times to it now and it's not accepting new posts. No other place to post the fault sorry please remove this post.

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