IAPT purportedly offers NICE –indicated treatments for depression and anxiety at Steps 1-3. But the NICE guidelines do not offer guidance on the treatment of specific phobias or adjustment disorder. So that in practice Psychological Therapists fail to adequately distinguish between these excluded categories and the included ones such as PTSD, OCD etc. The result is that there is a serious mismatch between disorder and treatment, for example I’ve just seen a person treated with 10 sessions of trauma focussed CBT, I knew him to have simply a specific phobia about driving and travelling as a passenger in a car and he was still suffering from just this after IAPT treatment. The treatment records referred to ‘likely PTSD’, such statements are not only unreliable but dangerous. There is a need for a
In practice IAPT treatment is determined by therapists rules of thumb, such as ‘if the trauma was extreme and there are disturbing intrusions go for PTSD treatment’, ‘if there was prolonged abuse go for complex PTSD’, ‘ a high score on the Impact of Events Scale means PTSD is likely’, but there is no scientific basis for such rules. The NICE guidance makes no mention of treatment being determined by the therapists ‘formulation’, but many therapists are perfectly happy with this supposed magical insight into the way forward, which they see as a product of their clinical experience and acumen. In practice lip service is paid to the NICE guidelines, for the most part therapists do their own thing, with perhaps a psychometric test such as the IES thrown in to appease management and a concern to use keywords like habituation, trauma focussed CBT and exposure. Training courses do not it seems help students critique the validity of the IAPT treatment approach.
Wither true accountability?
Dr Mike Scott