the evidence base that CBT works with the psychological sequelae of physical conditions is of a wholly different order to that for depression and anxiety disorders (the original remit of IAPT). As a consequence therapists entering this area could become quickly demoralised, increasing the already high rates of burnout. To my knowledge, there are no studies in the LTC area that a) compare the CBT treatment with an active credible attention control group and b) involve independent assessment by a person blind to treatment. Rather outcome assessments are entirely by self report measures such as the PHQ9 and GAD7 of dubious relevance to the destabilisation that can arise from having an LTC.
Training appears to focus on what the therapist should do and the needed competences. But therapists should be aware that these are largely expert consensus statements, the least credible type of evidence and not something derived from an established evidence base.
There are all sorts of minefields in this area not least the diagnostic confusion between say cancer and depression both result in tiredness, insomnia and loss of appetite. Yet training appears not to address this.
One is reminded of the adage ‘fools rush in where angels fear to tread’, is it enticement by empire building and the availability of funds?.
Dr Mike Scott
3 replies on “IAPT’s Training Of Therapist’s On Working With Long Term Physical Conditions Muddies The Waters on Efficacy”
There is a study on CBT and ME, PACE, oh dear https://www.roydswithyking.com/pace-trial-scandal-me-cfs/
Definitely reason to be concerned.
Am I missing something? with NICE having to rethink the new Depression guidelines, does this not mean there is no evidence base at present? Shouldn’t IAPT suspend its “treatment”.
Interesting Michael, in the PACE trial there was no blind assessor, looking at an objective measure of outcome such as how far people can walk, the emphasis in publication was on subjective measures with no attempt to compensate for this by at least ensuring blindness. The trial lacks credibility
I think that there certainly need to be an independent investigation of IAPT.
On the matter of recovery for MUS patients (or lack of), watch just a minute of this video –
from 29.0 to 30.0 mins. NB This refers to the PCPCS Tavistock service rather than IAPT.
If MUS patients don’t recover in this service, then what hope is there for them with IAPT?