The Cognitive Behavioural Approach: CBT’s Big Brother

Cognitive Behavioural Therapy (CBT) is increasingly promoted as the treatment of choice in the UK. The Layard Report (2006) recommended a massive expansion in the provision of CBT. We discuss what we believe to be a fundamental contradiction in the thinking behind the Layard Report. After briefly reviewing the evidence for CBT, we suggest it suffers from a similar philosophical contradiction in the way it is practised. In particular, we argue that CBT is often associated with a pathological, disempowering model of psychological distress. Whilst recognising the current pressure to be seen to be practising CBT, we argue that a broader Cognitive Behavioural Approach (CBA), based on fundamental cognitive principles avoids the contradictions inherent in the provision of rigid, manualised CBT. CBA is proposed as a basis for understanding psychological experience and distress, and identifies the cognitions that are fundamental as causes of ‘mental health problems’ regardless of traditional diagnostic categories. The implications of CBA for prevention and therapy are discussed.