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A cognitive science approach to developing effective new treatments

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Professor David Clark, Professor of Psychology, Institute of Psychiatry, Kings College, London and Director, Centre for AnxietyDisorders and Trauma, Maudsley Hospital

  • Using experimental psychology to identify maintaining factors to target in new treatment programmes
  • Testing and re-testing of new treatments for efficacy and effectiveness: recent studies
  • How we can disseminate those treatments which are most effective


David M Clark is Professor of Psychology at the Institute of Psychiatry, Kings College London; Director of the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital, London; and Honorary Research & Clinical Advisor to the Northern Ireland Centre for Trauma & Transformation in Omagh. He is also a Fellow of the British Academy (London), a Fellow of the Academy of Medical Sciences (London), and Distinguished Founding Fellow of the Academy of Cognitive Therapy (USA). His research focuses on cognitive processes in the maintenance and treatment of anxiety disorders. With colleagues, he has developed effective cognitive therapy programmes for panic disorder, hypochondriasis, social phobia and post-traumatic stress disorder. Recently, he has worked with Lord Layard and colleagues on the Government’s Increasing Access to Psychological Treatments Initiative.


In recent years, psychological therapists of all persuasions have shown an increasing interest in using standardized measures to assess outcomes in clinical practice and in making this information available to the public. This welcome trend bodes well for the future of psychotherapy and will no doubt help to generate a richer set of evidence-based treatments for clinicians to draw on in coming years.

Current NICE Guidelines indicate that for most common mental health problems psychological treatments are at least as effective as medication in the short-term and tend to have more enduring effects. However, none of the treatments advocated in the guidelines work for everyone and there is clearly room for further improvement. There are several strategies that could be used to develop more effective therapies. This talk illustrates one strategy: the cognitive science approach that our group has adopted in anxiety disorders.

The starting point is the observation that individuals with anxiety disorders over-estimate the danger inherent in the world and/or their own bodies. Clinical observation and theoretical considerations are used to identify factors that may prevent clients’ excessively negative appraisals of danger from self-correcting. These “candidate” maintaining factors are rigorously tested in experimental and longditudinal prospective studies. Factors that are shown to contribute to the persistence of the disorders are then specifically focused on in therapy. Illustrations of the key maintaining factors and the way they can be reversed in therapy will be presented. Surprise findings and the way these have influenced practice will be highlighted. A review of controlled trials and the effect sizes that can currently be expected for the cognitive therapy programmes that have been developed with this approach in anxiety disorders will lead on to a discussion of four types of future challenge. First, how can the treatments be made more effective? Second, how can the treatments be disseminated in a way that will make them accessible to most patients who would like to try them? Third, how can we best train therapists in the new treatments? Fourth, how can we monitor the outcomes that therapists obtain in their routine practice with the treatments?