title: No pain, no gain: depressed clients' experiences of cognitive behavioural therapy.
abstract: OBJECTIVE
  Cognitive behavioural therapy (CBT) is an effective treatment for depression, but many clients do not complete therapy. What clients find difficult about CBT is poorly understood. This study explored clients' views and experiences of face-to-face CBT.
  
  
  METHODS
  A mixed methods design was used to collect data as part of the CoBalT trial.
  
  
  METHODS
  Participants randomized to CBT indicated their reasons for never starting or stopping therapy on the follow-up questionnaires. In-depth qualitative interviews took place with a purposive sample (n = 26) of those randomized to CBT. Framework analysis was used to analyse across the data.
  
  
  RESULTS
  Seventy-four participants withdrew from therapy or were discharged for non-adherence. A total of 54 (73%) gave reasons for not starting or stopping CBT; mostly the time/location was inconvenient or they had other commitments. Interviews identified that clients could struggle in, and between, CBT sessions. This was true for those who did and did not complete therapy. CBT homework was the biggest challenge and was often associated with negative school homework experiences. Although clients may have disliked aspects of CBT, those who attended more than one session felt that they had gained insight into managing their depression.
  
  
  CONCLUSIONS
  Highlighting the possible barriers to adherence in CBT can help clinicians to better prepare clients in making an informed choice about therapy. Exploring these issues during therapy may also help with engagement. Despite the challenges, clients can still benefit from CBT by learning strategies that enable them to effectively deal with their depression.
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Barnes
authors.forename: Sofie
authors.initials: S
authors.lastname: Sherlock
authors.forename: Laura
authors.initials: L
authors.lastname: Thomas
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.forename: Willem
authors.initials: W
authors.lastname: Kuyken
authors.forename: Amanda
authors.initials: A
authors.lastname: Owen-Smith
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Nicola
authors.initials: N
authors.lastname: Wiles
authors.forename: Katrina
authors.initials: K
authors.lastname: Turner
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000188:drug therapy / Q000628:therapy*; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents