The Emotional Health CBT Clinic: who are we?
We are a private clinic affiliated with the MUHC.
Dr. Michael Spevack founded the clinic in 1972 at the Montreal General Hospital. In 2002, the clinic moved to the Queen Elizabeth Health Complex. The mission of the clinic is to provide quality CBT services that are accessible. We are a team of over 15 therapists specialized in CBT.
What is the procedure?
The client calls and is given an appointment within the next two to four weeks at the most (we work hard to not have wait lists).
The goal of the evaluation with the psychologist is to ensure that CBT is likely to have a successful outcome given the presenting problem. The client also completes a life history questionnaire that covers detailed information about his/her health, family, work, and the problem for which he/she is seeking help, as well as the Depression Anxiety Stress Scale (DASS).
The case is then assigned to a therapist from our specialized team who is best suited to work with a particular client.
For depression and anxiety, group treatment is also available. These are 12-week programs (1.5 hour/week sessions) that are psychoeducational in nature. The client learns to challenge their negative or anxious thoughts to replace them with more adaptive thoughts, and are encouraged to engage in useful behaviors to overcome inactivity, isolation and avoidance. The Mind over Mood manual (Greenberger & Padesky) is used for the groups.
Useful info in making a referral to the clinic:
- The fee is based on the level of expertise of the therapist, from $125 for a supervised therapist to $155 for a licensed therapist. The fee for group therapy is at $55 per session, but can be reduced to $35 if the patient who you refer is not working.
- We offer day appointments, and for an additional fee evening and weekend appointments. Services are offered in English and in French.
- We are truly specialized in CBT (it is all we do!).
- CBT usually lasts about 10-20 sessions, although some individuals stay on for supportive counselling after the core CBT treatment is complete, and in cases where there are multiple problems or Axis-II pathology, treatment may take longer.
Do I need to write a referral note?
The majority of our clients are referred by their GPs or by their psychiatrists. We prefer to have a referral note when possible.
During the evaluation process, we ask new clients if they were referred, and if they do have a GP or psychiatrist.
If this is the case, we ask for permission to write a brief note to the GP and/or psychiatrist to let him/her know that their patient is receiving CBT at our Clinic, and in the case of a referral, to also thank the physician for the referral.
If appropriate, we may also write an update note as treatment progresses.
If you have any question about CBT and/or the Emotional Health CBT Clinic, please contact
Dr. Luisa Cameli at (514) 485-7772.
Does CBT work?
CBT is an empirically-supported form of therapy. The efficacy of CBT has been established in the treatment of these disorders:
Anxiety: including GAD, Social anxiety, OCD, PTSD
Meta-analyses of well controlled trials have confirmed the efficacy of CBT for anxiety disorders. In a recent meta-analysis, Norton & Price (2007) showed that treatments with CBT have significantly larger treatment outcome effect sizes than no treatment or placebo, as did Deacon & Abramowitz (2004) earlier.
Norton, P.J., & Price, E.C. (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. The Journal of Nervous and Mental Diseases, 195, 521-531.
Deacon, B., & Abramowitz (2004). Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60, 429-441.
Depression: major depression
Meta-analyses have also confirmed the efficacy of CBT for the treatment of MDD, with examples below:
Butler, A.C., Chapman, J.E., Forman, E. M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69 (6), 875-899.
CBT works in well-controlled studies, but does it work in clinical practice?
Stewart, R. E., & Chambless, D. L. (2009) ran a meta-analysis of effectiveness studies (i.e., studies that are clinically representative: studies in a clinically representative setting, with clinically representative monitoring, no pre-training of therapists, etc) and the results demonstrate that CBT is effective in clinical settings.
Stewart, R. E., & Chambless, D. L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of consulting and Clinical Psychology, 77 (4), 595-606.
IN GENERAL, CBT is Recognized as Effective by:
The World Health Organization (WHO)
The National Institute for Health and Clinical Excellence (NICE) in the UK
The National Institute of Mental Health (NIMH)
The Psychiatric and Psychological Associations in Canada, the US, Australia and the UK, amongst others
It is a Gold Standard for Depression and Anxiety:
In Frontiers in Psychiatry (2018), David, D., Cristea, I., and Hofmann, S.G., offer the opinion that CBT is the Gold Standard Psychological Treatment for these 3 reasons:
1) “CBT is the most researched form of psychotherapy.”
2) “No other form of psychotherapy has been shown to be systematically superior to CBT.”
3) “The CBT theoretical models/mechanisms of change have been most researched and are in line with the current mainstream paradigms of human mind and behavior.”
Why research is important:
When you seek a medical treatment, you trust that your doctor will recommend a treatment that is effective, in that it has been shown to work as it claims through research. Even in purchasing a product, you want to know that it has been tested. Why would this be different for therapy?
A key advantage of CBT being concrete and goal-oriented is that it can be studied relatively easily. For instance, you can take a group of individuals who suffer from depression, assign half to CBT and half to a waitlist, and compare the symptoms of depression in the 2 groups before and after 12 sessions. You can compare the efficacy of CBT to that of no-treatment; or of CBT versus medication, or CBT versus another form of therapy. This allows researchers to measure the effect of CBT, the size of the effect (small, medium, large) and to say that CBT has an overwhelming body of empirical support!
In fact, CBT is the most researched form of psychotherapy with about 90,000 studies published in PubMed (a database of articles in medicine and other health-related fields), the vast majority documenting its efficacy. No other form of therapy comes close to that.
What research does not mean:
First, because a treatment is shown to be effective, it does not mean that it will be effective for everyone. Remember that effectiveness means that if you give the treatment to one group (treatment group) and not to another (control group), the group that receives the treatment does significantly better on your measure of interest (e.g., better mood), and this result is obtained consistently. It does not mean that every single individual in the treatment group develops better mood, but simply that overall enough people improve, and they improve sufficiently, that the average in the treatment group is higher than that in the control group (note: you would expect that the mean of 2 groups would differ a bit just by chance, but to be effective, the difference has to be large enough that it is highly unlikely to reflect random variation – it is all about statistics. The trustworthiness of the result comes from replication). This is no different than for, let’s say, an anti-depressant that we know is effective: It may work for one patient and not for another.
Secondly, the fact that the effectiveness of CBT has been amply demonstrated does not mean in any way that other psychotherapy approaches don’t work! We wholeheartedly believe in the value of alternative and complementary approaches. All we are saying is that we are proud to be using an approach solidly backed by science and to know that CBT works!