The Entire IAPT Process Is Based on Deception

Is it possible to stop fake psychological therapy by telling the truth? The client is at a railway station to board a train to where he/she knows not, but seeking a better life. They may have arrived at the station under their own steam and/or at the promptings of family/friends/GP. But the ‘trip advisors’  have rarely visited/evaluated the destinations. In social psychology terms the advisors have not engaged in effortful central processing of outcome data. Bypassing the latter with a heuristic (peripheral processing) that the IAPT service’ must be good because it is NHS/Government funded and in any case the mental health burden will be shared out’.

 

The client believes that they will encounter mental health professionals who can reliably diagnose and treat whatever disorder they have. But nobody told them the service does not make diagnoses [IAPT Manual (2019). At the 30 minute telephone assessment the Psychological Wellbeing Practitioner does not tell them that: a) they are not trained to diagnose b) nor trained to provide psychological therapy and c) in the first instance they will likely undergo low intensity CBT of undetermined potency in treating depression and the anxiety disorders. The deception makes for easy boarding of the IAPT train. The PWPs cram the clients onto the train by using low intensity interventions but unsurprisingly 69% of PWPs suffer burnout, whilst the rate of burnout amongst high intensity therapists is 50% [ Westwood et al (2018)] . To help mitigate their stressors the PWPs have regular supervision, but this to is a deception, as they often have less than 3 minutes to discuss a case. Over a third (38%) [Psychological Therapies Annual Report (2020-2021)] of clients get off the train before their 2nd treatment session, but that is not at places where they want to be. Nobody told them at the start of this level of dissatisfaction. Likewise nobody told them only the tip of the iceberg reach a destination where they have lost their diagnostic status Scott (2018), 9 out of 10 remain at square one. But IAPT keeps up the pretence advising the ‘trip advisors’ and Clinical Commissioning Groups of a 50% recovery rate. A million a year now enter the IAPT gates. It is difficult to escape the parallel as to how people were conned into Auschwitz.

 

Dr Mike Scott

Antidepressants and CBT in The Real World

A 24%  response rate combining the two, and manual driven psychotherapy conferred no added benefit Bartova et al (2021). In the podcast from Mad In America these findings are set against a 31% placebo response rate. Further no evidence that the interventions altered the course of a disorder, which is the prime objective of treatments for physical disorders. Rather the focus was on symptomatic relief. Articles covered in podcast include:

 

Pies and Dawson (2022) have today taken up the cudgel to attack the findings of Moncrieff et al (2002) that were the springboard for the podcast. But they are disingenuous in claiming that no one of academic credibility has ever suggested that low serotonin causes depression. For decades, at least in the UK this has been the dominant message given to patients, with the implication that they need antidepressants to restore the chemical imbalance. Pies and Dawson (2022) have recourse to a biopsychosocial model which posits interactions of thoughts, feelings, social factors and biology, in which will be found some biological factor that is of key importance in the development of depression and through which antidepressants will be found to work. But given the track record to date this seems unlikely and provides little basis for current pharmacological practice with the exception of the use of lithium. 

In the Bartova et al (2021) study the therapists claimed that they were adhering to a manual driven psychotherapy protocol, but no fidelity checks were made. A  similar scenario to the claim made by IAPT in the UK that it delivers CBT, but without any independent corroboration. It is I believe the case that CBT can make a real world difference for depression and the anxiety disorders if appropriately delivered.

 

Dr Mike Scott

What Is The Simplest Explanation of How Clients Fare In The Improving Access to Psychological Therapies Service?

 

The philosophical principle of Occam’s Razor suggests that the simplest explanations are usually the correct one. Most will present to IAPT at their worst and there will be some improvement with the passage of time and attention. But clients could just as easily have benefitted from attending the Citizens Advice Bureaux,  i.e there is no added benefit from IAPT. Last year over a third (38%) of those who accessed the IAPT service attended one or less treatment session, and it is unlikely that they would benefit from such a sub-therapeutic dose of therapy.  The suspicion is therefore that IAPT doesn’t work. If one tries to explain the therapeutic gains of defaulters (defined by IAPT as attending less than 2 treatment sessions) from the Service, complexity enters. The confusion is not lessened when one tries to explain how it is that completer’s attending on average of 7.5 sessions, apparently make gains comparable to those in randomised controlled trials, with just half the number of sessions! IAPT’s claims beggar belief.

CBT is allegedly ubiquitous in the Improving Access to Psychological Therapies (IAPT) service. Overall a 50% recovery rate is claimed. How then is it effective with one out of two completers of treatment but also ineffective with one out of two? We enter the black hole again.

It is axiomatic amongst CBT adherents that negative cognitions and avoidance behaviours perpetuate negative emotional states. It is further assumed that targeting these maintaining agents will resolve the negative emotional state. But this latter scenario will only unfold if the negative cognitions and avoidance behaviours are pivotal in the onset of the negative emotional state. If a person is suffering from, say chronic fatigue syndrome the salience of negative cognitions and avoidance behaviours may be questionable. The biopsychosocial model of CFS advanced by Deary et al 2007 is of such complexity, that no aetiological agent e.g child neglect, could be ruled out. Applying Occam’s Razor the likelihood is that a primary physical basis for CFS will be found or that it actually covers a range of disorders each with a different biological base. 

In the case of depression negative life events and neuroticism are strong predictors. But neuroticism could be the driver for negative cognitions and avoidance behaviours. However neuroticism itself maybe a product of a particular style of engaging in mental time travel, in which negative events are given a particular salience and homage is paid to them with avoidance behaviour. It is scarcely credible that 7-8 sessions of CBT therapy will nullify the effects of neuroticism/mental time travel for a period that the client would see as clinically meaningful e.g 8 weeks.

Dr Mike Scott