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Psychological therapies as part of integrated services

Expansion of the provision of psychological therapies such as CBT has the potential to liberate many thousands of people from misery. But we should not think of emotional distress as a symptom of 'illness' and 'prescribe' CBT as if it were some form of drug. Since the ways in which people make sense of the world and respond to challenging circumstances are primary determinants of their mental health and well-being, these are reasonable targets for a therapeutic response. It can clearly prove useful to help people identify the lens through which they see the world - how they think about themselves, other people, the world and the future - how and why they have developed that particular perspective, and what impact that has. It is equally useful to explore the practical applications of this approach, helping people to learn new ways of looking at the world. But there's much more to a psychological approach than 'talking treatments' for 'mental disorder'.

We need significant investment in psychological approaches, including CBT. But this is not enough. Services should be designed such that all aspects of a person's mental health needs can be assessed and addressed. This would include comprehensive assessment of physical health and consideration of the possible role of medication. This should be integrated with an equally comprehensive assessment of the person's social circumstances and a practical, integrated, plan to address these real-world issues. Of course, as a psychologist, I am bound to argue that we also need to understand how the person is making sense of their world and consider what could be done to help them change either their understanding of the world or to develop more appropriate responses. But I am also saying that we need to start thinking a little differently about CBT itself. CBT is effective because it is a systematic way of helping us reflect on our own thought processes and, if necessary, changing them. This is not merely a form of 'talking treatment'. It is the practical application of the fact that our mental health is largely dependent on our understanding of the world, our thoughts about ourselves, other people, the future, and the world.

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