Some reservations concerning the current cognitive emphasis in therapy

The extent to which new treatment techniques that focus on cognition have come to dominate therapy over recent years is not consistent with the empirical outcome evidence, which suggests that it is usually the behavioural components of interventions (whether labelled ‘cognitive’ or ‘behavioural’) that are the most potent effectors of clinical improvement. In this article recent outcome studies (involving predominantly treatments derived from Beck's approach) are reviewed, and the effects of the cognitive trend on clinical practice (both positive and negative) explored. Apart from some notable exceptions, the outcome evidence suggests that cognitive techniques do not enhance the effectiveness of behavioural treatment. A number of problems and misconceptions associated with both the current cognitive emphasis and a more traditional behavioural approach in the clinical context are discussed.