IAPT 10 NICE Guidance 0

a study by Barkham and Stone https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1899-0 of over 33,000 IAPT cases has revealed high intensity counselling as being the most cost effective, requiring on average just 6 sessions compared to the 9 sessions for high intensity CBT, to achieve the same result. But the NICE Guidance  recommends CBT as the first line treatment not only for depression http://www.nice.org.uk/guidance/cg90 but also the common anxiety disorders. In the 2 years since the published study, IAPT appears not to have considered that there is likely something wrong with its’ data set when it provokes a conclusion at variance with the NICE Guidance. However it is IAPT that has muscle at the coal face, not NICE. The juggernaut of IAPT carries on, paying lip service to NICE Guidelines to placate NHS England and local Clinical Commissioning Groups.

The Barkham and Stone study also suggests that whatever of the 4 trajectories clients take in IAPT: 1. high intensity counselling (9%) 2. high intensity cbt (18%) 3. low intensity cbt followed by high intensity counselling (20%) 4. low intensity cut followed by high intensity cut (53%) there is no difference in outcome, all improve by 6 points on the PHQ9 each starting off at a score of 15. This would suggest that there are no meaningful distinctions between the categories and that the stepped care approach bears no fruit. Yet IAPT continues with stepped care. IAPT fails on quality control, it can provide no meaningful data with regard to treatment integrity i.e a guarantee that an evidence based protocol has been followed for a reliably identified disorder. Nor can it provide any evidence that the observed changes of score would not have happened with the passage of time and attention (an active placebo).

Regrettably IAPT, markets itself superbly with Ontario in Canada being the latest to be conned by the IAPT model, when will people wake up and smell the coffee.


Dr Mike Scott

In IAPT, CBT No Better Than Counselling

a study of IAPT data, by Barkham and Stone (2018), published in BMC Psychiatry, (see link below), shows high intensity CBT is no better than high intensity counselling. The authors note that this finding runs counter to NICE Guidance and they might have added to the specific superiority of CBT found for particular disorders, see Tolin et al (2015) [ link below]. This makes the whole IAPT database and its customary analysis suspect. Whatever the intervention Barkham and Stone (2018) found a 6 point reduction on the mean PHQ9 score of 15. Such a reduction one would expect with time and any ‘credible’ attention treatment.

Interestingly the Barkham and Stone (2018) study found low intensity CBT did not enhance performance of any high intensity intervention. The case for low intensity interventions appears to be built on sand. There was no evidence in this study that there were meaningful distinctions between CBT and counselling (i.e no fidelity checks) and no evidence of fidelity to an evidence based treatment protocol. Fidelity checks are impossible without the reliable diagnosis IAPT eskews.

The Barkham and Stone (2018) study lays bare the many fault lines in IAPT, the tremors can be felt when will the earthquake occur?



Dr Mike Scott