‘CBT: The Cognitive Behavioural Tsunami:…’ engulfing IAPT

this is the title of a just published book by Farhad Dalal, [ London, Routledge] it is a scathing critique of IAPT and its’ ‘managerialism’. Staff too afraid to speak out publicly, a concern primarily for operational matters: numbers and waiting lists. The author reviews randomised controlled trials to try and ascertain the proportion of people who actually get better. Dalal rightly sees IAPT’s claim to a 50% recovery rate as preposterous and its’ criterion for treatment attending at least 2 sessions as unbelievable.

Curiously, Dalal appears not to have heard of my study that showed a recovery rate of just 10%.:

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

It was possible for me to invalidate IAPT’s claims precisely because I used the DSM criteria that Dalal decries. Unfortunately Dalal, as a group analyst would create a psychological therapy service without any evidence base.

In 2014 Ehlers, Clark et al published a ‘gold standard’ randomised controlled trial of the treatment of PTSD

https://www.dropbox.com/s/yqq5v94iiaobyoe/PTSD%20EHlers%202014%203%20out%20of%204%20recover%20cbt%202%20out%20of%204%20emotin-focussed%20support.pdf?dl=0

what makes it ‘gold standard’ was that a) assessment was conducted using a standardised semi-structured interview of high reliability b) outcome was assessed independently of treating clinician using the standardised initial interview, making it possible to specify what proportion of people were no longer suffering from the disorder c) there was a follow up to determine if treatment gains were maintained d) there was a credible attention control condition, so that it was possible to determine whether there was something specific in the treatment that made a difference.

Set against this ‘gold standard’ there is to my knowledge no study of any low intensity therapy that has met the above criterion. Quite simply low intensity interventions do not have a reliable evidence base. Further routine practice can also be assessed using criteria a) b) and c) but this has never been done in relation to IAPT except by myself in a limited context.

This ‘Tsunami’ may destroy everything in its’ path, but we have to know what would constitute the building of an evidence based mental health system see Towards a Mental Health System That Works (2017) Scott London: Routledg: https://www.amazon.co.uk/Towards-Mental-Health-System-Works/dp/1138932965/ref=sr_1_2?ie=UTF8&qid=1550698217&sr=8-2&keywords=Towards+a+Mental

BBC News Video critique of IAPT here: https://vimeo.com/316124732

Dr Mike Scott

4 thoughts to “‘CBT: The Cognitive Behavioural Tsunami:…’ engulfing IAPT”

  1. Mike – many thanks for sharing this publication. I’ll try and get a hold of it. I must say I feel a little more hopeful that the tide may be turning a little. Newer interventions like CfD and some sense of an embryonic pluralism. The whole edifice may collapse before then of course, given the current haemorrhaging of staff. I’m not sure if you were aware that Sweden set its face against a monopolistic therapy model some while back, and the Swedish National Audit Office concluded that the programme has failed to meet its objectives? https://www.scottdmiller.com/swedish-national-audit-office-concludes-when-all-you-have-is-cbt-mental-health-suffers/

  2. ‘Failed’? What’s ‘failed’?

    Towards the end of that video David Clark makes the case for rolling out internet-delivered rather than face-to-face therapy. He also advises the audience to make friends with economists and politicians if they want to achieve their goals, and to deliver results to politicians in time to help them win the next election. That seems quite important to him. In another video he discusses using D-cycloserine as a cognitive enhancer for psychological therapy, (except, worryingly, he calls it D-cyclosterine, despite his chemistry/drug interventions background). On the plus side though, with internet-delivered therapy I guess you would avoid a face-to-face session……

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