Can talking make you better?

CBT does not cure cancer, schizophrenia or arthritis, but it does improve mood, coping and quality o

Professor Ravetz is right. Cognitive behaviour therapy is Labour's new therapy of choice. But why is it suddenly popular in government circles not previously noted for their interest in psychological treatments?

Talking therapies are nothing new, but despite their long history many have struggled to prove themselves in a health service dominated by the economists. Psychoanalysis looks at deep-seated reasons for why we are the way we are - but even if it can answer questions about the human condition, it has not proved a success in treating specific disorders, and often takes years not doing so. In contrast, counselling is usually brief and cheap, but is sometimes not much more than sympathetic listening and empathy. Neither is much good when it comes to treating well-defined conditions such as panic disorder, phobias, obsessions and compulsions.

Cognitive behaviour therapy does represent a genuine advance in the treatment of many conditions. Unlike psychoanalysis it does not depend upon searching inquiries into childhood or early life, or speculative forays into the unconsciousness. CBT is about identifying conscious thoughts - thoughts about dying when having a panic attack, for instance, or about being useless when in the presence of other people. And then it is about how we react to these thoughts and how these behaviours in turn impact back on our thoughts and feelings. Perhaps I was in a road accident some years ago. Now I refuse to get into a car in case it happens again, and get tense and anxious even thinking about it. What I need is to identify my fearful thoughts, understand how they relate to my experiences, and then start a cautious programme of overcoming these fears by gradually spending more and more time in cars, as I learn that it is not inevitable that history will repeat itself. CBT is directive - it is not enough to be kind or supportive, although CBT therapists should be both - what is also needed is clarifying the thoughts which are determining our reactions and planning new behaviours as alternatives to these previously unsuccessful ways of coping or managing symptoms.

CBT has one further advantage over its predecessors. Because it is easier to describe, monitor and evaluate successes and failures, and because it deals in measurable outcomes, it lends itself to the empirical approach. And so there is now a wealth of evidence sufficient to satisfy even the most sceptical health economist that CBT can and does improve outcomes in various disorders.

Randomised controlled trials, which remain the gold standard of evidence, have shown that CBT is effective not just in the classic psychiatric disorders such as post-traumatic stress disorder, major depression, agoraphobia or schizophrenia, but also physical disorders such as cancer or rheumatoid arthritis, and even disorders such as irritable bowel syndrome or chronic fatigue syndrome that lie somewhere in between. Of course, CBT does not cure cancer, schizophrenia or arthritis, but it does improve mood, coping and quality of life.

CBT is not a panacea. And yes, it is trendy. Too trendy - since in the largely unregulated bear pit that are the psychotherapies virtually anyone can, and many do, claim to be carrying out CBT. To become a skilled CBT therapist takes about the same length of time as it does to become a doctor. That raises legitimate questions about the new "Improving Access to Psychological Therapies" initiative. Sometimes known as the Layard initiative, after the economist who has steered the scheme through government, this is intended to add 3,500 new CBT therapists to the NHS workforce.

A predecessor, the "Graduate Psychology Programme", which gave GPs access to psychology graduates who had not completed any clinical training and who became known colloquially as "barefoot psychologists", ran into difficulties since many GPs found that these willing but unskilled personnel lacked the experience and qualifications to make any meaningful impact. The Layard scheme has learned from the past, but will need to ensure that improving access is not at the expense of standards.

Finally, is this really a sly scheme simply to reduce the staggering costs of disability benefits? The answer is no, not directly. The aim is to give everyone who is suffering from clinical depression or an anxiety disorder the option of an effective psychological treatment, regardless of whether they are on benefits or not. However, if that also means that some are able to re-enter the world of work, then so much the better. If there is one thing that has been established by a generation of psychiatric research, it is the strong relationship that exists between mental health and unemployment.

Simon Wessely is head of the department of psychological medicine at the Institute of Psychiatry, King's College London

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery

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An English hero for the ages: Ian Botham at 60

Botham blends his sportsmanship and deep-seated passion for cricket with a lust for life.

Begging W H Auden’s pardon, it is possible both to honour and to value the vertical man, and in the case of Ian Botham, who turned 60 on 24 November, it is our bounden duty. No sportsman has given Britons so much to enjoy in the past half-century and no sportsman is loved more. Two decades after he retired from first-class cricket, his reputation as one of life’s champions remains unassailable.

No mere cricketer is he, either. Botham is a philanthropist, having raised more than £12m for various charities, notably Leukaemia and Lymphoma Research. In December, 30 years after his first walk from John o’Groats to Land’s End, he will set off again, in South Africa, where England are on tour. And he really does walk, too, not amble. As somebody who accompanied him on one of his dozen walks said: “You can’t keep up with him. The man is a phenomenon.”

Of all postwar sportsmen, only Bobby Charlton and, at a pinch, Henry Cooper come close to matching Botham’s enduring popularity. But Charlton, a shy man who was scarred by the Munich plane crash of 1958 (and may never have recovered from its emotional effects), has never comfortably occupied a public stage; and Cooper, being a boxer, had a solitary role. Botham, by contrast, spoke for England. Whenever he picked up his bat, or had a ball in his hand, he left spectators in no doubt.

Others have also spoken for England. Bobby Moore and Martin Johnson, captains respectively of England’s World Cup-winning football and rugby teams, were great players but did not reach out to people as naturally as Botham. Nick Faldo, Lester Piggott, Sebastian Coe and, to bring us up to date, Lewis Hamilton have beaten the best in the world, but they lacked those qualities that Botham displayed so freely. That is not to mark them down. They were, and are, champions. But Botham was born under a different star.

It was John Arlott, the great cricket commentator, who first spotted his uniqueness. Covering a match at Taunton in 1974, he asked the young colt to carry his bags up the rickety staircase to the press box, where Arlott, wearing his oenophile’s hat, pulled out a bottle of red wine and invited Botham to drink. Forty years later Botham is a discriminating wine drinker – and maker. Along with his friend and fellow England great Bob Willis, and their Australian wine­making pal Geoff Merrill, he has put his name to a notable Shiraz, “BMW”.

Arlott, with his nose for talent and good company, saw something in the young Botham that Brian Close, his captain at Somerset, was beginning to bring out. Later, Mike Brearley, as England captain, drew out something even more remarkable. As Rodgers and Hammerstein wrote, you’ve got to be carefully taught. And Botham, a fine team man as well as a supreme individual performer, has never withheld praise from those who enabled him to find his voice.

If sport reveals character, then cricket is the game that reveals it most clearly. In no other sport is the individual performance rooted so firmly in a team context. Every over brings a contest of skill and intelligence between batsman and bowler but only a team can win the match. “A cricketer,” as Arlott said, “is showing you something of himself all the time.”

Cricket also reveals national character more than any other sport. Football may be the most popular game in the world but cricket, and cricketers, tell us far more about England and Englishness. It is instructive, in this regard, to hear what Philippe Auclair, a French journalist and author long resident in London, has to say about Botham: “He is essentially an 18th-century Englishman.” In one! It’s not difficult to sense a kinship with Tom Jones, Fielding’s embodiment of 18th-century life, who began his journey, as readers may recall, in Somerset.

A country boy who played for Worcestershire after leaving Somerset, and who lives by choice in North Yorkshire, Botham is an old-fashioned Englishman. Although nobody has yet found him listening to the parson’s sermon, he is conservative with a small and upper-case C, a robust monarchist, handy with rod and gun, and happiest with a beaker in front of him. He represents (though he would never claim to be a representative) all those people who understand instinctively what England means, not in a narrow way, but through something that is in the blood.

Above all, he will be remembered for ever as the hero of 1981. Even now it takes some believing that Botham bowled and batted with such striking success that the Australians, who were one up after two Tests, were crushed. Some of us who were actually at Headingley for the famous third Test – thousands who claim to have been there were not – recall the odds of 500-1 on an England victory going up on the electronic scoreboard that Saturday evening.

Botham made 149 not out as England, following on, beat the Aussies by 18 runs. For three hours the country seemed to stop. In the next Test, at Edgbaston, Botham took five wickets for one run as Australia fell under his spell. Then, at Old Trafford, on a dank Saturday afternoon, he played the most memorable innings of his life and one of the greatest innings ever played by an Englishman: 118 magnificent, joyful runs. Joy: that’s the word. Botham brought joy into people’s lives.

Yet it was the final Test at the Oval, which ended in a draw, that brought from him a performance no less remarkable than those from before. He bowled 89 overs in that match, flat out, continuing to run in when others withdrew with injury. That was the team man coming to the fore. Little wonder his comrades thought the world of him.

Modest, loyal, respectful to opponents, grateful to all who have lent him a hand, and supported throughout a turbulent life by Kath, his rock of a wife, and their three children, this is a cricketing hero to rank with W G Grace, Jack Hobbs, Wally Hammond and Fred Trueman. A feature in the lives of all who saw him, and a very English hero. 

This article first appeared in the 26 November 2015 issue of the New Statesman, Terror vs the State