When it failed to do so, he began to look for other ways of conceptualising depression. Through working with patients he found that some were reporting a stream of spontaneous beliefs, which he called automatic thoughts, which had to do with negative ideas about themselves, the world and the future. He began working with these automatic thoughts and found that by teaching patients to identify them and evaluate them realistically they started to see reality more clearly and had improved behavioural reactions.If you believe you would benefit from CBT, ask your GP. Many family doctors can refer you for treatment on the NHS, though there may be a waiting list. Alternatively, you can contact British Association for Behavioural and Cognitive Psychotherapies and they can put you in touch with a therapist in your area.BABCP, The Globe Centre, PO Box 9, Accrington, BB5 OXB (01254 875277; ; e-mail: babcp babcp ). Meanwhile, large parts of the private sector have gone over exclusively to CBT.”COGNITIVE THERAPY: A BRIEF HISTORYCognitive therapy was developed in the 1960s by Dr Aaron Beck, a psychiatrist at the University of Pennsylvania who had studied as a psychoanalyst. We now have extremely strong evidence of the effectiveness of CBT and that patients particularly like it and see it as empowering But it is not being delivered as much as it should be.

CBT is the upstart newcomer, and there is massive conservatism within the field of psychotherapy.”Most health authorities offer some CBT, but it is a small proportion of the psychological therapy available, Salkovskis says “I would say less than 30 per cent, if you’re lucky In some places it’s less than 5 per cent. The other psychological treatments, with a few rare exceptions, are not empirically grounded – they don’t have an evidence base for their effectiveness – but we continue to offer them. The obvious example of this is psychoanalysis.”I believe what is happening within the field of psychotherapy is getting dangerously close to being scandalous. “We are in a strange situation with CBT in that it is the treatment of choice for most emotional disorders, but it is not the commonest form of psychological therapy delivered. There are more people trained in other forms of psychotherapy and we are not increasing the number of people training in CBT.

She says the therapy has also been shown to be effective in a range of medical disorders, including irritable bowel syndrome, chronic pain, chronic fatigue syndrome, hypertension, migraine headaches, colitis and sexual dysfunction.It is little wonder that Salkovskis believes that CBT should be offered more widely on the NHS. CBT works by helping people to understand their addictive behaviour by exploring their belief about their drug use and their abilities to change that behaviour.”Dr Judith Beck, clinical associate professor of psychology in psychiatry at the University of Pennsylvania, is the daughter of Aaron Beck, the psychiatrist who developed CBT in the 1960s. Dr Luke Mitcheson, clinical psychologist at the centre, says: “We have clinical evidence that people reduce the amount they use and make significant changes in their social circumstances consistent with long-term recovery. Clients range from City workers to people living in crack houses. The centre, which treats about 100 clients a year, offers one-to-one counselling to users of cocaine and crack in particular. For the past three years, CBT has been the basis of treatment at the Marina House Stimulant Clinic in Camberwell, which is part of the South London and Maudsley NHS Trust. Much of the distress and unhappiness patients experience is concerned with what they think about the voices or delusions, and the therapy looks at their distorted thinking Drug users are also experiencing its benefits.