Here is a summary of Cognitive Behavioural Therapy interventions recommended by National Institute for Health and Clinical Excellence (NICE)

Depression (mild severity)

The NICE clinical guideline CG23 on depression states that a number of brief psychological interventions are effective in mild depression. The choice of treatment should reflect the patient's preference based on informed discussion, past experience of treatment and the fact that the patient may not have benefited from other brief interventions. Psychological treatment specifically focused on depression such as brief cognitive behavioural therapy (CBT) of 6–8 sessions over 10–12 weeks (low intensity) should be considered.

Depression (moderate severity)

The NICE clinical guideline CG23 on depression recommends that all patients with moderate depression should be offered antidepressant medication before psychological interventions. Psychological treatment specifically focussed on depression such as brief cognitive behavioural therapy (CBT) of 6–8 sessions over 10–12 weeks (low intensity) should be considered.

Depression (moderate to severe)

A number of structured psychological interventions of longer duration, usually of 16–20 sessions over 6–9 months (high intensity) from an appropriately trained member of the mental health team are effective. In addition to the evidence for their effectiveness, the choice of treatment will reflect patient preference and past experience of treatment. When patients present initially with severe depression, a combination of antidepressants and individual CBT should be considered as the combination is more cost-effective than either treatment on its own.

Anxiety

The NICE clinical guideline CG22 on anxiety does not distinguish between mild, moderate and severe forms of generalised anxiety disorder or of panic disorder. A higher intensity of treatment is recommended for generalised anxiety disorder than for panic disorder.

Panic disorder

Low-intensity CBT in the optimal range of duration (7–14 hours in total) should be offered for people with panic disorder, and for most people CBT should take the form of weekly sessions of 1–2 hours and be completed within a maximum of 4 months of commencement.

Generalised anxiety disorder (GAD)

High-intensity CBT in the optimal range of duration (16–20 hours in total) should be offered to people with generalised anxiety disorder, and for most people CBT should take the form of weekly sessions of 1–2 hours and be complete within a maximum of 4 months from commencement.

Obsessive-compulsive disorder (mild functional impairment)

NICE clinical guideline CG31 on Obsessive-Compulsive Disorder recommends that in the initial treatment of adults with obsessive-compulsive disorder (OCD), low-intensity psychological treatments (including exposure and response prevention [ERP]) (up to 10 therapist hours per patient) should be offered if the patient’s degree of functional impairment is mild and/or the patient expresses a preference for a low-intensity approach. Low-intensity treatments include:

·   brief individual CBT (including ERP) using structured self-help materials

·   brief individual CBT (including ERP) by telephone

·   group CBT (including ERP) (note, the patient may be receiving more than 10 hours of therapy in this format).

OCD (moderate functional impairment)

Adults with OCD with moderate functional impairment or those with mild functional impairment who are unable to engage in low-intensity CBT (including ERP), or for whom low-intensity treatment has proved to be inadequate, should be offered the choice of either a course of a selective serotonin reuptake inhibitor (SSRI) or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.

OCD (severe functional impairment)

Adults with OCD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP).

Body Dysmorphic Disorder (mild functional impairment)

NICE clinical guideline CG31 on OCD recommends that adults with body dysmorphic disorder (BDD) with mild functional impairment be offered a course of CBT (including ERP) that addresses key features of BDD in individual or group formats. The most appropriate format should be jointly decided by the patient and the healthcare professional.

Body Dysmorphic Disorder (moderate functional impairment)

Adults with BDD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive individual CBT (including ERP) that addresses key features of BDD.

Body Dysmorphic Disorder (severe functional impairment)

Adults with BDD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP) that addresses key features of BDD.

Post-traumatic Stress Disorder

PTSD where symptoms are present within 3 months of a trauma

NICE clinical guideline CG26 on post-traumatic stress disorder (PTSD) recommends that trauma-focused CBT should be offered to those with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event. These treatments should normally be provided on an individual outpatient basis.

Trauma-focused CBT should be offered to people who present with PTSD within 3 months of a traumatic event.

The duration of trauma-focused CBT should normally be 8–12 sessions, but if the treatment starts in the first month after the event, fewer sessions (about 5) may be sufficient. When the trauma is discussed in the treatment session, longer sessions (for example, 90 minutes) are usually necessary. Treatment should be regular and continuous (usually at least once a week) and should be delivered by the same person.

PTSD where symptoms have been present for more than 3 months after a trauma

All PTSD sufferers should be offered a course of trauma-focused psychological treatment (trauma-focused CBT or eye movement desensitisation and reprocessing). These treatments should normally be provided on an individual outpatient basis.

The duration of trauma-focused psychological treatment should normally be 8–12 sessions when the PTSD results from a single event. When the trauma is discussed in the treatment session, longer sessions than usual are generally necessary (for example 90 minutes). Treatment should be regular and continuous (usually at least once a week) and should be delivered by the same person.

Healthcare professionals should consider extending the duration of treatment beyond 12 sessions if several problems need to be addressed in the treatment of PTSD sufferers, particularly after multiple traumatic events, traumatic bereavement, or where chronic disability resulting from the trauma, significant co morbid disorders or social problems are present. Trauma-focused treatment needs to be integrated into an overall plan of care.