Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.

KEYWORDS:

• Cognitive behavioural therapy
• individual CBT
• depression
• treatment components
• attitudes
• clinical practice

Acknowledgements

We are grateful to the therapists who participated in our survey. We thank June Johnstone and Vivien Jones for providing administrative support, and Eloisa Colman for facilitating the set-up of the study. We are also grateful to those colleagues who are involved with the INTERACT study as co-applicants but who have not participated in drafting this manuscript: Rachel Churchill, David Coyle, Simon Gilbody, Paul Lanham, Una Macleod, Irwin Nazareth, Steve Parrott, Katrina Turner, Nicky Welton, and Catherine Wevill.

This study was conducted in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a UKCRC Registered Clinical Trials Unit (CTU), in receipt of National Institute for Health Research CTU support funding. Study data were collected and managed using REDCap (P. Harris et al., 2009) hosted at the University of Bristol.

Disclaimer

The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosure statement

Chris Williams is the author of written and online CBT self-help resources, and is Director of a company which commercialises these resources. The other authors have no conflict of interests with respect to this publication.

Ethical statements

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, and its most recent revision. Authors have abided by the Ethical Principles of Psychologists and Code of Conduct as set out by the American Psychological Association. Ethical approval was provided by the University of Bristol, Faculty of Health Sciences Research Ethics Committee (29/2/2016; REC reference 31642). HRA approval was also granted (8/3/2016; IRAS reference 198271).

Additional information

Funding

This article presents independent research funded by the National Institute for Health Research (NIHR) (Programme Grants for Applied Research, Integrated therapist and online CBT for depression in primary care, [RP-PG-0514-20012]). The study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.