Mental health: This is why cognitive behavioural therapy is being recommended instead of medication

COVID-19 has left many people grappling to manage their mental health, and that’s prompted some governments to rethink the treatment of depression and anxiety.

As daily commutes turned into shuffles between the bedroom and the kitchen for some and job uncertainty caused stress and anxiety for others, the pandemic pushed mental health into the spotlight, with data from the US and the UK showing a rise in cases of depression.

With more people suffering, the UK’s National Institute for Health and Care Excellence (NICE) updated its guidelines on how to treat and manage depression for the first time in 12 years. The new guide puts a focus on patient choice, and advises treating those with “less severe depression” with therapy, exercise, mindfulness or meditation before antidepressants. It also advocated the use of cognitive behavioural therapy, or CBT.

Around 17% of UK adults experienced some form of depression this summer, according to the Office for National Statistics (ONS), up from 10% pre-pandemic, with young people and women more likely to be affected.

The use of drugs as a treatment has increased, with 23% more patients in England receiving an antidepressant item in the third quarter of 2020-2021 compared with the same quarter in 2015-2016, according to NHS data. The picture is similar in the US, with a sustained increase in the use of antidepressant medication prescriptions, according to the 2020 Drug Trend Report.

“Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression,” the NICE guidelines say. “The risk-benefit ratio is poor.”

Cognitive behavioural therapy (CBT) – both within a group or as an individual – are listed among the top treatment options for less severe depression in the NICE guidelines. This form of therapy focuses on how thoughts, beliefs, attitudes, feelings and behaviour interact, and teaches coping skills to deal with things differently, the guidelines say.

“Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past,” the NHS says. “It looks for practical ways to improve your state of mind on a daily basis.”

A CBT programme usually means a session with a therapist once a week or once every 2 weeks, according to the NHS. The patient works with the therapist to break down problems into areas like thoughts, physical feelings and actions and work on changing negatives to positives.

“Cognitive behavioural therapy can be as effective as medicine in treating some mental health problems, but it may not be successful or suitable for everyone,” the NHS says.

CBT can be completed in a relatively short period of time compared with other therapies, can take place in a group and can teach practical strategies that can be applied in multiple situations, the NHS says.

Even so, the NHS points out it requires patient co-operation, a willingness to attend the sessions and carrying out any extra work and it may not be suitable for people with complex mental health needs.

“Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood,” the NHS says.

Changes to the way we treat mental health are needed since the pandemic compounded the stress many people are feeling. Employees around the world are reporting increased levels of anxiety and physical ill-health, according to a World Economic Forum survey.

In response, businesses are appointing Chief Health and Chief Medical Officers to their boardrooms to ensure workforce wellbeing is prioritized. Often former doctors, their work can range from work-from-home strategies to managing burnout. The World Economic Forum has launched a new Chief Health/Medical Officers community for sharing best practices and understanding where investments should be best utilized.

What’s clear is that an increased awareness of mental health is here to stay, as are varied ways of helping people. Building a trusting relationship and working in an open, engaging and non-judgemental manner are key, according to the NICE draft guidelines.

“Explore treatment choices in an atmosphere of hope and optimism,” NICE says. “Explaining the different courses of depression and that recovery is possible.”