CBT and beyond

Treatments and therapies that were once considered the province of tree-huggers and crystal-gazers are increasingly a part of mainstream stress management strategies, reports Edmund Tirbutt 

Less mainstream therapies are increasingly being sought

Cognitive behavioural therapy (CBT) has been at the centre of stress management strategies for years. But a consensus is now emerging that a range of other therapies may be more suitable for certain individuals.
CBT, which challenges irrational thoughts and aims to move towards more rational thinking and behaviour, has seen its effectiveness borne out by a wealth of concrete research that has made it the preferred first line of treatment of the National Institute for Health and Clinical Excellence (Nice).
Beate O’Neil, health and wellbeing senior consultant at PSHPC, says: “Treatments need to be recognised by Nice for employers to start paying for them, and GPs, who are likely to be involved with helping employees return to work, are unlikely to recommend things not recognised by Nice. I don’t think CBT is going to go away because it’s a very useful treatment for depression and anxiety if used in the right way.”
But there is an increasing recognition that CBT is not necessarily the solution for everyone.
Ellipse case manager Kieran Stratton reports that its reception has been mixed and that employees in the more blue-collar industries are typically less responsive to it – probably due to the stigma that comes with counselling in certain social and occupational environments. He also observes that some employees simply aren’t able to show the necessary commitment to the therapy.
A good therapist will therefore normally have a number of tools up their sleeve and select the one most appropriate to any particular case. But group risk providers and consultants differ noticeably with regard to which of these alternatives they single out.
Friends Life director of group protection David Williams says: “There are lots of other forms of talking treatments similar to CBT, such as Human Givens Therapy, which is not overly concerned with the causes of the difficulty but seeks solutions in the present for the future. Also being talked about again is psychodynamic therapy, which works by exploring how your personality and early life experiences influence your current thoughts, feelings, relationships and behaviour. Once you have the extra understanding, you can practice more helpful ways of dealing with difficult situations.”
Canada Life senior rehabilitation consultant Ruth Taylor says: “Unfortunately CBT has been perceived by some as the panacea for all ills, and the trend has been to offer it wherever possible instead of where needed and where appropriate. This has left some individuals and service providers wondering why the intervention has not met expectations or delivered the level of recovery that was anticipated.
“So while CBT does have a place in the hierarchy of talking therapies, solution focused brief therapy (SFBT) is deemed to be quicker and more specific and targets the desired outcome of therapy as a solution rather than focusing on the symptoms or issues that brought someone to therapy in the first place. It requires only three to six sessions, as opposed to an average of six to 14 for CBT, which makes it a cheaper option. But, like CBT, there are issues with accessibility and the availability of skilled therapists and it’s not suitable for all.”
Mindfulness, which technically actually falls under the CBT umbrella, is also attracting increasing interest from employers. Based on meditation techniques used in the Far East, it teaches individuals to be present in the moment rather than be distracted about the past or project into the future.
Aviva UK Health medical director Doug Wright says: “Mindfulness doesn’t stop you feeling emotions
per se but it does allow you to deal
with them more dispassionately. This therapy has proved effective in preventing relapses in those who have previously experienced mood-based mental health problems as well as those currently experiencing mild to moderate symptoms.”
Another approach that is beginning to be talked about is Ecotherapy, which uses a structured programme linked to the natural environment to help those with milder forms of depression. Cost-effective and free from unpleasant side effects, this has attracted considerable interest from mental health charity Mind. Andrea Woodside, a trustee of Mind, reports that 71 per cent of people who engage in it experience a significant lessoning of symptoms of mild to moderate depression.
Many employers who claim not to have heard of Ecotherapy may in fact already be benefiting from it to an extent through informal groups meeting within their organisations or via relevant practices encouraged by the company itself under a different label.
Taylor, says: “Businesses where individuals are in sedentary office-based roles have found that away days and community assistance projects such as gardening for the elderly have also had a positive effect on their employees as well as serving the community and social responsibilities.”
New developments in coaching are also beginning to make their presences felt. A number of coaches are now also trained in neuro-linguistic programming, and some coaches are now even starting to qualify in neuroscience to take an interest in how the brain works.
Association for Coaching chief executive Katherine Tulpa says: “There is a definite trend for middle managers to receive coaching as opposed to just the most senior executives, and managers themselves are learning coaching skills to lead and engage more effectively. There is even a trend for HR professionals to become qualified to be a coach to formally coach employees and managers.
“Chief executives are also increasingly recognising coaching as a leadership style and so, while each member of the top team still gets coached individually, there is a collective approach that is helping to bring teams more closely together. Additionally, coaching is starting to be used as part of an integrated approach by being combined with programmes for talent, learning and development and performance management.”
But a principal drawback of coaching continues to be a lack of concrete data to prove that it actually stops stress problems from occurring, because it is hard to know what problems would have occurred without it. The field also still lacks any formal regulation. So, as with clinical approaches not endorsed by Nice, employers need to exercise caution.
Health management consultant Peter Marno: says “Anyone venturing outside Nice guidelines needs to be aware that there can be charlatans out there and, ultimately, if employers endorse them they could end up being sued if an employee goes to a tribunal as a result of being dismissed for not complying with a method or for failing to register any suitable improvement. A good employer would always seek recommendations or references.”