The Improving Access to Psychological Therapies (IAPT) latest annual report states that the recovery rate for PTSD sufferers (24,097) given CBT was 13.1% . Whilst the recovery rate for those receiving EMDR (4,908) was 11.4%. By its own metric only the tip of the iceberg recover.
In total IAPT treated (defined as attending 2 or more sessions) 34,328 PTSD cases and offered 15 different therapies, despite only 2 (CBT and EMDR) being NICE compliant. 15% of cases were given a non-NICE compliant treatment – whither the Services claim of NICE compliance?. With 70.2% given CBT and 14.3% EMDR. For those undergoing EMDR 4153 are on their first course but 2268 are on their second course i.e of those undergoing EMDR over a third 35.32% are on their 2ndcourse. This is not what a person expects to happen.
The metric of recovery used by IAPT for these PTSD cases is the PHQ9. This is clearly bizarre, as the PHQ9 is a measure of the severity of depression. A possible defence of IAPT’s dismal failure to help the traumatised, would be to admit that its method of auditing, of PTSD cases in particular, has been seriously flawed. But unfortunately IAPT behaves like politicians when confronted with manifest failure.
In IAPT if a person has PTSD there is a 97% (31,570/ 34,328) chance of them scoring above 10 on the PHQ9. But if a person does not have PTSD (591, 492) only 1077/592,623 or 0.18% would be correctly identified by a PHQ9 score of below 10. Thus using the PHQ9 for detecting PTSD has poor specificity. It is a totally useless metric for identifying PTSD, and would yield an enormous number of false positives. The same results apply if the GAD7 is used as the metric. Whichever metric is used these two measures are useless for detecting PTSD and create false positives resulting in unnecessary treatment.
IAPT details the trajectory of PTSD clients going through its’ service yet claims in its Manual that the Service does not make diagnoses. Only politicians can square such circles, alas for us mere mortals. The gold standard in a PTSD outcome study is to use a standardised reliable diagnostic interview, IAPT is yet to overcome its lifelong phobia about their use. One can only suppose that there is a fear of starkly revealing their inadequacy and it is easier to hide behind expressions of concern over cost.
In my own study, Scott (2018) of 90 cases going through IAPT assessed using the SCID diagnostic interview, for those with PTSD the recovery rate was 15%. Again we are looking at the tip of the iceberg of recovery.
IAPT’s training of its therapists with regards to trauma is clearly amiss, it may be that the positive (50% recovery) trauma focussed trials that they draw upon are not sufficiently user friendly to deliver in routine practice and I have detailed an alternative Scott (2022).
Dr Mike Scott