The Time is Now

Let's improve access to CBT services in BC

Mark Lau, PhD, RPsych

Reprinted from "CBT" issue of Visions Journal, 2009, 6 (1), p. 4

Mental health problems such as depression, anxiety disorders and substance use issues take a huge personal, economic and social toll on British Columbians. For the one in five people who will suffer from a mental illness in their lifetime,1 this means they may have problems in their family and/or work lives, along with the distress of their mental illness.

Fortunately, there are treatments that can help people who suffer from mental illness. For example, many people find medication to be helpful. But there are those who find that the medications don’t work. Others cannot put up with the side effects of medication. And many people simply prefer talk therapy to deal with their problems.

Research shows that several talk therapies can help people who suffer from mental illness. Cognitive-behavioural therapy (CBT) is the talk therapy with the greatest amount of evidence that it works. Over the past 25 years, hundreds of research studies have shown CBT to be helpful in treating many different mental disorders.2-3 It can help in treating depression, anxiety and problem substance use, to name just a few. These studies have also shown that, in many cases, CBT is as good as medication.4-5 In a few cases, it’s even better than medication.6 CBT has also been shown to cost less over the long term than medications, in some cases.7-8

What is CBT?

CBT is a form of talk therapy that focuses on how a person’s thoughts about themselves, the world and others relate to how they feel and how they act. In CBT, people learn to become aware of how their thoughts can affect how they feel and behave in the here and now. They also learn skills and techniques to experiment with new ways of looking at things and/or new ways of behaving. These changes can help us to feel better in the present and can be used to help prevent future problems.

...but not everyone in BC can get CBT

One of the biggest challenges with CBT is that not everyone in BC who would like to get CBT can do so. Unfortunately, at the present time, there are very few areas in BC that offer specialized CBT services. What does this mean for someone who could be helped by CBT but can’t access it?

Let me give you an example by telling you quickly about a client I treated for panic disorder early on in my career. The good news was that after about 10 sessions of CBT, she was no longer having panic attacks. At the same time, she asked me why she’d had to suffer for eight years before she could get a treatment that worked.

Let’s pause for a moment to think about this. Could you ever imagine a situation where researchers had discovered a new effective cancer treatment but it wasn’t made available to all the cancer sufferers who needed it? Of course not. New effective treatments are made available to those who need them fairly quickly. Yet this is not the case when it comes to CBT in BC and the rest of Canada.

Making CBT equally available to everyone in BC

A big part of the reason why patients can’t get CBT is that there are too few mental health providers who’ve been properly trained in CBT to meet the demand. But it doesn’t have to be this way. Over the last few years, other countries around the world have started projects to improve access to CBT. For example, in the United Kingdom, the government has provided roughly $600 million to train 3,600 CBT therapists over the next three years.9

Here in BC, there is hope for improving access to CBT. BC Mental Health & Addiction Services (BCMHAS), an agency of the Provincial Health Services Authority, along with the BC provincial government and the five regional health authorities are working together to close the treatment gap. All recognize the need for improved quality and availability of CBT for mental health and addictions across our province.  

Just last year, BCMHAS established the BC Cognitive Behaviour Therapy Network* to support system-wide efforts to increase the number of people who are trained to deliver CBT in BC. The goal of the CBT Network is that every person in BC will have equal access to high-quality CBT no matter where they live. This will lead to better care and treatment for people with mental health problems.

If you want to know more about CBT...

In this issue devoted to CBT, you can learn more about what CBT is, who it works for and why. You will get the perspectives of individuals who’ve had experience with CBT. You will learn about some of the exciting new developments in this field. And finally, you will learn about some of the CBT resources that are available in BC.

It’s my hope that, after reading this issue, you will share in my excitement about the potential benefits of CBT to help improve the lives of BC residents suffering from mental illness. The desire to see that all British Columbians are able to access this treatment is what keeps me going in my work. Perhaps it will also motivate you to talk to service providers and friends about the benefits of CBT.

 
About the author
Mark is a clinical psychologist, a research scientist and Director of the BC Cognitive Behaviour Therapy Network at BC Mental Health and Addiction Services. He’s also an Associate Professor of Psychiatry at UBC and a Founding Fellow of the Academy of Cognitive Therapy.

 

Footnotes:
  1. Canadian Mental Health Association. (n.d.) Fast facts: Mental health/mental illness. www.cmha.ca/bins/content_page.asp?cid=6-20-23-43.

  2. Butler, A.C., Chapman, J.E., Forman, E.M et al. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.

  3. Academy of Cognitive Therapy: www.academyofct.org/Library/InfoManage/Guide.asp?FolderID=1061.

  4. DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D. et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409-16.

  5. National Institute for Health and Clinical Excellence. (2004). Depression: Management of depression in primary and secondary care—NICE guidance. (Clinical Guidelines CG23). www.nice.org.uk/CG023.

  6. Antony, M.M. & Swinson, R.P. (1996). Anxiety disorders and their treatment: A critical review of the evidence-based literature. Ottawa: Health Canada.

  7. Antonuccio, D., Thomas, M. & Danton, W. (1997). A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (Prozac) in the treatment of depression. Behavior Therapy, 28(2), 187-210.

  8. Otto, M.W., Pollack, M.H. & Maki, K.M. (2000). Empirically supported treatments for panic disorder: Costs, benefits, and stepped care. Journal of Consulting and Clinical Psychology, 68(4), 556-563.

  9. Improving Access to Psychological Therapies: www.iapt.nhs.uk.

 

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