Oliver James Rubbishes CBT and Happiness

Submitted by tonyplant on October 24, 2006 - 16:37.

I like the work of Oliver James: he is an interesting speaker and an engaging writer. I've been aware for some time that he is not in favour of Layard's enthusiasm for cognitive-behavioural therapy (CBT) and he usually makes his viewpoint in a cogent manner.

Not today. Today, Oliver James has contributed a piece to the Daily Mail: Therapy on the NHS? What a crazy waste of £600 million! He starts off with the headline figure that depression and anxiety cost the £17 billion per year and then moves on to deride Layard's proposed £600 million investment in expanding the provision of CBT on the NHS.

It's an infuriating piece. James makes several sideswipes about the efficacy of CBT.

CBT is a form of mental hygiene. However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of positive polish. But shiny surfaces tend not to last.

According to James

The CBT patient is taught a story to tell themselves, a relentlessly positive one. If the therapist is skilled, the patient becomes able to ignore many of their true feelings.

When tested at the end of the treatment, like a well-coached pupil taking an exam, they often regurgitate the positive story.

I thought that one aspect of CBT might be the examination of whether negative thoughts and feelings are grounded in unrealistic beliefs. Is it possible that these negative thoughts and feelings are false rather than true?

James claims that CBT has a high relapse rate and is only dubiously effective. Well, it seems as if a lot of the literature indicates that CBT is effective*, and that its 'time until relapse' rate for depression is better than conventional management.

As for the remainder of the discussion, James makes the usual, tiresome equivalence of happiness and hedonism; he decries happiness as:

a brief, chimerical state. Rather than being determined to Think Positive, we should pursue insight, maturity and authenticity.

I agree that hedonism is "a brief, chimerical state" but (as I've argued repeatedly), happiness is considerably more. Discussions of happiness and recent scientific research indicate that happiness consists of three elements: the meaningful life; the engaged life; and the pleasant life. I don't think that the message of happiness research is "think positive" it seems to be that people might benefit from identifying their character strengths - which may well reflect "insight, maturity and authenticity".

If happiness centres were to exist solely "to promote rose-tinted bubbles of positive illusions", then that would be as sinister as James suggests. But Layard has proposed centres for mental health, not happiness. If these happiness centres work with people to improve their resilience and that would help the estimated 1 in 10 young people that are said to have a mental health problem that is severe enough to merit treatment - then, that is a fine use for the money, and might well prevent a lot of unhappiness and illness later in life.

It is repeatedly said that the UK has an epidemic of depression. There is a lot of debate about whether people are depressed, anxious or unhappy. Despite the slang term, we don't have happy pills. GPs can only offer anti-anxiety or anti-depressant medication to patients who may be unhappy enough that it is harming their health, work, social and family life. If they are some of the people who might be helped by CBT or methods that cultivate resilience, then again, it might be a worthwhile investment.

Apart from a relationship with a therapist on whom patients can depend, and the implication that we might need access to such a therapist for 2 years or more - I'm not particularly clear on whether or not Oliver James does have an affordable proposal that would alleviate the profound unhappiness or mental health problems that GPs are confronted with in their surgeries.

There have been some fascinating discussions: e.g., the one between Layard and Persaud. If James and others can have a serious discussion in public about what can be done to help people in distress, that would be very helpful. If there are serious concerns about the effectiveness of CBT than we need references, and we need people to interpret the conflicting data for us. Otherwise, we can all cite the papers and meta-analyses that illustrate our own point of view. As James is one of our leading commentators, I expect more of him.

References*

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

Chambless, D.L., & Ollendick, T. H. (2001). Empirically Supported Psychological Interventions: Controversies and Evidence. Annu. Rev. Psychol, 52, 685-716.

Copyright 2006, Tony Plant Happystance Project

Layard | happiness | depression | CBT | anxiety