140 COGNITIVE THERAPY IN CLINICAL PRACTICE

We have concentrated on outcome studies as being the main strategy for clinical research, not because it is the only strategy, but because it is one of the most difficult strategies to implement well. The main alternative to outcome studies is to look at short-term, within-session changes in specific aspects of cognition and affect in response to specific manipulations. The most clear-cut example of using such within-session ‘minitreatments’ is a series of studies by Teasdale and his coworkers at Oxford on the use of distraction techniques to reduce the frequency of negative thoughts. Teasdale’s research in the 1970s was one of the first to demonstrate experimentally that negative thoughts could maintain negative mood by showing that negative mood was reduced when negative thoughts were reduced (Teasdale and Rezin 1978). Subsequent research has shown that this effect is more likely to occur in patients who are defined towards the neurotic end of the Newcastle Endogeneity Scale (Fennell and Teasdale 1987). For an equivalent degree of reduction in the frequency of negative thoughts, the more endogenous patients show a more attenuated mood response. This research has implications for use of this particular technique when treating depressed patients.

Similar procedures can be used within cognitive therapy for other client groups. A good example of this is the use of exposure to stimuli associated with drug use (Moorey, p. 171). The therapist was able to look at change in craving during exposure, and was therefore able to test out a hypothesis of the client that craving would not recover over time while she was exposed to these stimuli. Additionally, the therapist was able to note the changes in the nature of thoughts and images which came to mind during the exposure session. If a series of standard exposures were to be used with different patients it might be possible to derive very useful clinical guidelines indicating which patients would benefit most from this technique. Cognitive therapy provides a range of techniques which lend themselves very easily to the scientist-practitioner mode of therapy.

Both strategies of clinical research, larger-scale outcome studies, and smaller-scale investigation of the processes underlying treatment have been used for some time in research into depression. They are beginning to be used with research with other client groups. It is a very exciting time to be a cognitive therapist, able to make use of these techniques for new client groups for whom they have not been used in the past. The cases described in this book show that the techniques appear to be able to be used very effectively indeed. Longer series of patients and standardised outcome trials will follow. This volume marks the end of the beginning for the wider application of cognitive therapy.

Note

1.To achieve these numbers of responders, there will need to be more patients in the initial treatment trial, since not all patients will respond to the acute treatment.

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