Information for Mental Health Professionals
Indications and Description of CBT:
- CBT is one of the most effective and cost-effective, evidence-based psychological interventions available in the treatment of mental disorders.
- As a stand-alone treatment, it is as good as or better than medication for the treatment of anxiety disorders and unipolar depression (mild to moderate).
- CBT is a problem focused therapy indicated for anxiety disorders such as simple phobias (e.g. needle or blood phobias, dog phobia), panic disorder, social anxiety, obsessive compulsive disorder, acute and post-traumatic stress disorders and generalized anxiety disorder.
- Other disorders for which CBT alone is an effective treatment include hypochondriasis (health anxiety), tic disorders, and impulse control disorders such as intermittent explosive disorder, trichotillomania and gambling.
- As part of a multimodal or team approach, CBT can improve outcomes in the treatment of major mental disorders such as schizophrenia, bipolar disorder, and eating disorders.
- The CBT offered in the MUHC CBT Unit is time-limited with most therapies being 12-20 sessions in length. All fees are covered by the Régie de l'assurance maladie du Québec in eligible clients.
Patient suitability:
Patients who do best in CBT are those who endorse the idea of resolving their problems by identifying their thoughts in difficult situations and considering alternate ways of thinking and behaving. Doing “homework” or practice exercises between sessions, a key feature of CBT, has been associated with greater therapeutic success.
Referring clients to the MUHC CBT Unit:
All patients seen in the MUHC CBT Unit must have a referral form filled out by a medical doctor, (their family doctor, psychiatrist or other medical specialist). This form can be obtained by email, fax or regular mail from the MUHC Administrative Coordinator, Marie Josée Lalonde, and can be returned by mail, fax or email to the MUHC CBT Unit. (see Contact section).
Eligible patients include those over 18 years or over, with anxiety, mood, psychotic or other disorders who are interested in psychological treatment for their problems. Since the MUHC CBT Unit offers only time-limited CBT, all patients should have a general practitioner or psychiatrist who will resume their general care after therapy is over. Those with disorders like schizophrenia or bipolar disorder should already have a treating psychiatrist, physician, team or case manager in place to offer any necessary concurrent care related to medications or other issues.
Within three weeks of receiving referrals, patients are triaged by telephone by our administrative coordinator to ascertain their specific problems and expectations, and explain the functioning of our Unit. The time between triage and subsequent assessment is usually between 3-6 months, but varies depending on demand and urgency of the case. We cannot safely accept individuals who are suicidal or in need of urgent psychiatric care. However, for some individuals with time-sensitive concerns, (such as pre-operative needle phobia, post-partum depression), exceptions are sometimes made. All requests for exceptional consideration should be discussed with the administrative coordinator personally.
The specialized cognitive behavioural assessment includes the administration of self-report questionnaires pertinent to the specific problem and some general symptom measures, as well as a 1.5-hour semi-structured interview, focused on confirming diagnoses and assessing suitability for short-term CBT. Clients receive a “taste of CBT” during this interview. At the end of this assessment, the treatment team and patient discuss if CBT is indicated and appealing for the patient. In the event that the patient’s problem or response to the interview indicates that CBT would not be the best treatment for their problems, other treatment recommendations will be made. Referring physicians will receive a copy of our recommendations.
Treatment in the MUHC CBT Unit:
The MUHC CBT Unit is a University teaching Unit of McGill University. Therapies are administered by staff psychiatrists and psychologists, or by postgraduate students in the mental health professions working under close clinical supervision. Therapists in training include psychiatry residents, or students in psychology, occupational therapy, nursing, etc. from accredited university programs (such as McGill University, Concordia University, Université du Québec à Montréal). All sessions with training therapists are videotaped for supervision and quality assurance purposes.
When therapy ends, post-treatment questionnaires are filled out to measure therapeutic change. These are shared with the patient. A brief summary of treatment will be sent to the referring physician.
MUHC CBT Unit psychiatrists involved in the care of clients may occasionally make suggestions about medication management to referring physicians if pertinent to a particular case. However, in general, individuals undergoing CBT in the MUHC CBT Unit are advised to keep their medication doses unchanged, in order to see more clearly the effect of CBT on their symptoms.