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Advances in Psychiatric Treatment (2003) 9: 21-30
© 2003 The Royal College of Psychiatrists

The evidence base for cognitive–behavioural therapy in depression: delivery in busy clinical settings

Graeme Whitfield and Chris Williams

Graeme Whitfield is a specialist registrar in cognitive–behavioural therapy and general adult psychiatry based at the Department of Psychological Medicine, University of Glasgow. He is a member of the National Committee of the British Association for Behavioural and Cognitive Psychotherapies (BABCP). Chris Williams, a senior lecturer in psychiatry (Department of Psychological Medicine, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. E-mail: chris.williams{at}clinmed.gla.ac.uk), is immediate past-President of BABCP and a member of the Royal College of Psychiatrists’ Psychotherapy Faculty Executive.

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review document Treatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.




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