Future Directions

We predict that the period to 2030 will see a range of exciting developments in cognitive therapy research and practice. In the area of outcome research, the most obvious area for advancement is where promising initial research suggests that cognitive therapy may prove to be an evidence-based approach: personality disorders, anorexia nervosa and substance misuse. Here efficacy and effectiveness research is urgently needed to establish whether people with these complex mental health problems can be helped through cognitive therapy. Similarly, psychotherapy outcome research is needed to examine how cognitive therapy fares when it is adapted to different populations (for example, older adults) and to different service settings (such as primary care).

In a climate of managed health care, evidence-based practice and practice guidelines, researchers, practitioners and policy makers are increasingly asking the question 'What works best for whom?' Beyond the comparative outcome studies, this sets the stage for increasingly interesting psychotherapy process and psychotherapy process outcome research. The mechanisms by which cognitive therapy is effective are not well understood, and this research will inform practice and health-care policy. The stepped care approach to planning services and interventions is likely to be important here, as we become increasingly knowledgeable about what works for whom and through what mechanism. Cognitive therapy is amenable to contemporary stepped care approaches, whereby clients are assessed and offered increasingly specialised, intensive and complex interventions based on an algorithm of clinical need and optimal cost-effectiveness. Using the range of cognitive therapy approaches, steps might graduate from bibliotherapy to computer-based approaches, to brief psycho-educational approaches in primary care, to brief group approaches in secondary care to more in depth and extended individual or group cognitive therapy in either secondary or tertiary care.

The recent focus on primary and secondary prevention of emotional disorders is welcome and there is much mileage in building on initial successes (see, for example, Jaycox et al., 1994; Segal, Williams & Teasdale, 2002). The acceptability of cognitive therapy to many children and adolescents and to people with recurrent mental health problems combined with an increasing acknowledgement that primary and secondary prevention are high priority health-care areas suggests we are likely to see much innovative and important work in this area.

Cognitive therapy is established as a mainstream psychotherapy of choice and training; supervision and accreditation are areas that require further development that extends and builds on existing best practice. There is an increasing body of cognitive therapy practitioners and researchers who are well placed to continue this work.

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