IAPT No Better Than Treatment As Usual

that is the conclusion of a just published study in the British Journal of Psychiatry by Serfaty et al, (2019).  In the study manualised IAPT-delivered CBT was compared to treatment as usual in treating depressive symptoms in people with advanced cancer. These authors concluded: 

‘our results suggest that resources for a relatively costly therapy such as IAPT-delivered CBT should not be considered as a first-line treatment for depression in advanced cancer. Indeed, these  findings raise important questions about the need to further evaluate the use of IAPT for people with comorbid severe illness’

Interestingly the IAPT therapists were all High Intensity Therapists  with mean Cognitive Therapy Rating Scale Score of 47.6  “at the upper end of the ‘proficient range’.” The primary outcome measure was the Beck Depression Inventory II and both the treatment as usual and the CBT group showed a mean reduction of 5 points. Curiously the MINI diagnostic interview was used to assess whether people were in fact depressed and would thereby qualify for the study but it was not re-administered at the end to determine how many were no longer depressed. Nevertheless even using a diagnostic interview trying to determine whether symptoms such as sleep disturbance and fatigue should count as part of a depression or as a feature of the illness   is realistically probably an impossible task.  The appropriate model with severe illnesses is probably support ( both tangible e.g heating allowance and emotional) rather than psychological therapy.

Serfaty et al Effectiveness of cognitive-behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial British Journal of Psychiatry (2019) Page 1 of 9. doi: 10.1192/bjp.2019.207

Dr Mike Scott

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